甲状腺癌颈淋巴结转移的螺旋CT表现

目的探讨甲状腺癌颈淋巴结转移的螺旋CT表现.方法1998-11～1999-12资料齐全44例甲状腺癌术前螺旋CT扫描图像进行回顾性分析,并与术后病理对照.观察淋巴结密度、分区和钙化,评价甲状腺癌颈淋巴结转移螺旋CT表现特点.结果据颈淋巴结转移一般特征中心坏死和环状强化.还具有(1)甲状腺癌颈转移淋巴结内细沙样钙化或斑块样钙化,(2)增强有明显强化22例(53.66%).平扫CT值28.00～50.54HU,增强后CT值62.85～145.78HU,并大多接近100HU或大于100HU.结论甲状腺癌颈淋巴结转移除中心低密度囊变、坏死和环状强化,淋巴结内见细沙样和斑块样钙化提示甲状腺内占位为恶性,淋巴结增强多较明显,CT值多接近或大于100HU.     

甲状腺乳头状癌淋巴结转移的CT特征及临床意义

目的：探讨甲状腺乳头状癌淋巴结转移的CT特征性表现,提高甲状腺乳头状癌淋巴结转移的诊断正确率,为外科手术方案和手术范围选择提供可靠依据。方法回顾分析经手术病理证实的共334例甲状腺乳头状癌患者的CT影像资料,对其中141例发生颈部淋巴结转移的病例进行统计学分析。结果141例患者中包括仅有中央区（Ⅵ区）淋巴结转移79例,CT诊断符合为60例;中央区及侧颈区（Ⅱ～Ⅴ区）均转移者62例, CT诊断符合51例。结果采用χ2检验。102例淋巴结密度、强化程度与甲状腺癌相似,其中23例伴有囊变坏死,14例伴有颗粒状钙化灶,7例并发喉返神经侵犯或气管、血管侵犯。结论甲状腺癌转移淋巴结好发部位为中央区;但侧颈区亦同样常常有转移,应高度重视。转移淋巴结的CT扫描特征：淋巴结明显强化,强化程度与甲状腺乳头状癌保持一致,可发生囊性变或坏死,以及出现颗粒状钙化灶,CT检查对临床手术方案制定具有重要指导意义。     

节细胞神经瘤与节细胞神经母细胞瘤的CT诊断

【摘要】目的：探讨节细胞神经瘤与节细胞神经母细胞瘤的CT表现特点及其鉴别诊断。方法：回顾性分析本院经手术病理证实的28例节细胞神经瘤及2例节细胞神经母细胞瘤患者的病例资料,所有患者均行CT平扫及增强检查。结果：28例节细胞神经瘤中,位于肾上腺区15例、胸段脊柱旁6例、腰段脊柱旁2例、颈鞘区4例、骶前区1例;肿瘤表现为圆形、类圆形、水滴状软组织肿块,边界清晰、边缘光滑;14例可见点状钙化;16例有伪足征;24例密度均匀,4例密度不均匀,1例含有脂肪成分。增强扫描轻度强化,11例呈片絮状延迟强化。2例节细胞神经母细胞瘤均位于肾上腺区,CT表现为不规则软组织肿块,密度不均匀,其内见明显坏死、囊变、粗大钙化,增强扫描明显不均匀强化,1例伴淋巴结转移。结论：节细胞神经瘤与节细胞神经母细胞瘤CT表现具有一定特征,CT对其定性诊断具有重要价值,出现肿块内粗大钙化、边界模糊、周围组织侵犯及淋巴结转移时,应考虑节细胞神经母细胞瘤的可能。     

甲状腺肿瘤的CT诊断

目的：笔者收集1989年来经我院手术诊治的甲状腺肿瘤137例，其中甲状腺癌120例，甲状腺瘤16例和甲状腺淋巴瘤1例，就其CT表现与鉴别作回顾性分析。材料和方法：本组甲状腺扫描层厚层距各5—8cm．其中平扫6例，平扫加增强扫描5例．余125例均为直接增强扫描。结果：甲状腺肿瘤CT表现无特征性，伴有囊性变时甲状腺癌可见瘤壁和瘤结节不均匀增强．壁厚薄不均；而腺瘤则瘤壁呈环状均匀增强，壁厚薄较均匀．57．5%甲状腺癌颈深下淋巴结转移，多为等高密度，尤以高密度为其特征．颈总动脉部位对鉴别肿瘤与伴结外浸润的淋巴结有意义．60．74％甲状腺肿瘤出现钙化。结论：CT为甲状腺肿瘤的诊断、分期和手术提供信息．     

甲状腺癌淋巴结转移的CT表现

目的：评价甲状腺癌淋巴结转移的CT特点。方法：回顾性分析经手术及病理诊断的108例甲状腺癌淋巴结转移的CT表现。结果：108例中，颈上中深组淋巴结转移76例，颈下深组及锁骨上窝86例，气管食管沟52例，纵隔17例。84例乳头状癌中，16例淋巴结密度与正常甲状腺相似，24例有囊性变，其中18例淋巴结囊内有明显强化的乳头状结节，11例有细颗粒状钙化，24例滤泡癌，髓样癌，透明细胞癌中，17例淋巴结明显强化，17例与甲状腺原发或复发肿瘤密度一致，密度均匀或不均匀。结论：甲状腺癌转移淋巴结好发部位为颈静脉链周围，气管食管沟及纵隔；淋巴结明显强化，与正常甲状腺密度一致，囊性变，囊壁内明显强化的乳头状结节及细颗粒状钙化为甲状腺乳头状癌的特征性改变，淋巴结明显强化，与甲状腺肿瘤密度一致为滤泡癌，髓样癌，透明细胞癌转移淋巴结的特点。     

CT对结节性甲状腺肿的诊断价值

目的探讨CT对结节性甲状腺肿（NG）的诊断价值。方法41例由手术病理证实的NG患者均经CT平扫与增强扫描,随后,对所有患者的CT表现进行了回顾性分析。结果研究证实,绝大多数NG病灶的CT影像表现为具有低密度的圆形或类圆形结节影,增强后呈不均匀强化。在41例中,39例病灶边缘清晰,36例有病灶内坏死区,19例有病灶内小点状或沙粒样钙化,6例有颈淋巴结肿大,增强后呈均匀强化,4例误诊为甲状腺癌,1例误诊为桥本氏甲状腺炎。CT正确诊断34例NG,诊断准确率为87．8％。结论CT扫描,尤其是增强及薄层扫描,对NG具有较高的诊断准确性,并能显示其与周围结构的关系,因而它在鉴别甲状腺良恶性病变中起重要作用。     

儿童甲状腺肿瘤的CT诊断

目的 探讨儿童甲状腺肿瘤的CT表现。资料与方法 对12例经手术及病理证实的儿童甲状腺肿瘤进行回顾性分析。其中甲状腺腺瘤9例，甲状腺癌2例，淋巴瘤1例。结果 甲状腺腺瘤中囊实性4例，实性5例。其中l例实性甲状腺腺瘤伴桥本甲状腺炎，表现为弥漫性甲状腺组织内-稍高密度肿块影，增强后明显强化；其余8例平扫为低于甲状腺组织的低密度肿块，均无钙化，增强扫描后呈均匀或不均匀明显强化。甲状腺癌2例均为弥漫性的肿块，增强前后密度极不均匀，与周围组织分界不清，并伴有颈部淋巴结增大。淋巴瘤1例，为局限性均匀低密度影，占位较明显，增强后强化明显。结论 CT有助于诊断儿童甲状腺肿瘤，为临床提供早期诊断。     

牙龈癌的MSCT诊断及外科治疗

目的分析牙龈癌的MSCT表现特征及诊断价值,评价CT检查在牙龈癌诊断中的应用价值。方法回顾性分析经手术及病理证实的牙龈癌18例,其中男12例,女6例,年龄55~87岁,平均年龄68岁。18例均行CT平扫及增强CT扫描。对病变的部位、形状、密度及向周围浸润转移情况等几个方面进行回顾性分析。结果 18例病理类型均为鳞状细胞癌,下颌骨前牙区8例,下颌骨磨牙区4例,上颌骨前牙区5例,上颌骨磨牙区1例,18例均伴有颌骨溶骨性骨质破坏,15例伴有溃疡,侵犯颊部软组织1例,侵犯上颌窦1例,侵犯口底2例,同时侵犯腭部及上颌窦1例,7例伴有颌下及颈部淋巴结多发转移。牙龈癌CT平扫表现为上下颌骨牙龈区等或稍低密度不规则肿块,边界均模糊不清,内密度不均匀,浸润性生长。CT增强扫描后肿块明显不均匀强化,坏死囊变区不强化,增强后肿块边界及轮廓显示清楚,呈分叶状,7例颌下区及颈部间隙内可见多发大小不等的肿大淋巴结,增强后明显不均匀强化。结论 CT检查对原发性牙龈癌的形态、大小、密度及周围结构侵犯以及颈部淋巴结转移等方面有重要的诊断价值,增强扫描对病灶显示尤为重要。     

小甲状腺癌的CT表现分析

目的 分析小甲状腺癌的CT表现,探讨其CT征象.方法 对40例CT平扫及增强扫描后经手术病理证实的直径在1.0～2.0 cm的小甲状腺癌的CT表现进行回顾性分析.结果 (1)38例为单发癌灶,2例为双侧双发癌灶;2例合并对侧结节性甲状腺肿,1例合并对侧甲状腺腺瘤;(2)边缘光整,包膜完整者8个病灶;边缘不光整,包膜不完整者34个病灶,但未见明显周围软组织及重要器官侵犯;(3)病灶平扫密度均匀或较均匀,未见明显出血或坏死囊变区;病灶内伴钙化者30个病灶,钙化形态各异,以砂粒状多见(20个病灶),也可见不规则结节状、蛋壳状或桑椹状钙化;(4)增强后41个病灶明显强化(强化幅度＞40 HU,CT值在90～140 HU之间),其中38个病灶均匀强化,3个病灶中央强化明显,边缘可见一环形低密度影,呈镶嵌征;(5)伴颈部淋巴结肿大者24例(60.0%),可呈实性、囊实性或囊性,增强后可呈均匀明显强化、不规则环形强化或壁结节样强化;8例淋巴结内可见砂粒状、结节状或蛋壳状钙化.结论 砂粒状钙化、甲状腺包膜不完整、强化明显的甲状腺实性结节及伴钙化、囊变、实性部分明显强化的颈部肿大淋巴结为小甲状腺癌较为特征性的CT表现.     

鼻咽癌颈部淋巴结转移的CT表现

目的 分析鼻咽癌颈部淋巴结转移的CT表现及特点.资料与方法 分析1991年至2006年有完整临床及CT资料且经病理证实的鼻咽癌1100例.分析颈部淋巴结的表现,并对相关资料进行统计学处理.结果 1100例中1008例(91.64%)有颈部淋巴结转移,其中双侧转移656例(59.64%).咽后组淋巴结转移737例(67%),颈上深组转移973例(88.45%),颈后三角区转移367例(33.36%).CT扫描至相应部位发现有淋巴结转移者,颈中深组为630例(71.75%),颈下深组为200例(46.73%),锁骨上区为100例(30.96%).鼻咽癌可转移至颌下、颏下及腮腺内淋巴结,本组分别为93例(8.45%)、17例(1.55%)及38例(3.45%).转移淋巴结边缘规则614例(60.91%),边缘不规则394例(39.09%),其中明显侵犯周围结构者仅占70例(6.94%).增强CT扫描病例中98.50%的淋巴结为轻、中度强化,无强化及明显强化的淋巴结分别为0.69%和0.81%.转移淋巴结中50.60%密度均匀,49.40%内部密度不均匀,有低密度区,其中95例(9.42%)的淋巴结内有大片低密度坏死区,92例(9.13%)淋巴结内呈密度均匀一致的环状低密度区,且内壁规则.结论 鼻咽癌多发生颈部淋巴结转移,以咽后组与颈静脉链淋巴结多见.淋巴结边缘规则、增强后呈轻至中度强化、密度大致均匀为鼻咽癌淋巴结转移的典型表现.     

Cervical lymph node metastases of medullary thyroid carcinoma: CT findings

Medullary thyroid carcinoma (MTC) is a rare malignancy which spreads frequently to cervical lymph nodes. We report the CT findings of MTC metastatic cervical adenopathies in two patients with previously resected MTC. The CT scans showed calcifications (one patient) and massive homogeneous postcontrast nodal enhancement. Medullary thyroid carcinoma should be included in the differential diagnosis of entities showing calcifications and intense homogeneous adenopathic enhancement on CT studies. Received 25 September 1995; Revision received 27 February 1996; Accepted 29 February 1996     

Value of FDG PET in papillary thyroid carcinoma with negative 131I whole-body scan.

The management of metastatic thyroid carcinoma patients with a negative 131I scan presents considerable problems. Fifty-four athyrotic papillary thyroid carcinoma patients whose 1311 whole-body scans were negative underwent 18F-fluorodeoxyglucose (FDG) PET; the purpose was to determine whether this procedure could localize metastatic sites. We also assessed its usefulness in the management of these patients. METHODS: Whole-body emission scan was performed 60 min after the injection of 370-555 MBq 18F-FDG, and additional regional attenuation-corrected scans were obtained. Metastasis was pathologically confirmed in 12 patients and was confirmed in other patients by overall clinical evaluation of the findings of other imaging studies and of the subsequent clinical course. RESULTS: In 33 patients, tumor had metastasized, whereas 21 patients were in remission. FDG PET revealed metastases in 31 patients (sensitivity 93.9%), whereas thyroglobulin levels were elevated in 18 patients (sensitivity 54.5%). FDG PET was positive in 14 of 15 metastatic cancer patients with normal thyroglobulin levels. In 20 of 21 patients in remission, FDG PET was negative (specificity 95.2%), whereas thyroglobulin levels were normal in 16 patients (specificity 76.1%). The sensitivity and specificity of FDG PET were significantly higher than those of serum thyroglobulin. In patients with negative 1311 scans, FDG PET detected cervical lymph node metastasis in 87.9%, lung metastasis in 27.3%, mediastinal metastasis in 33.3% and bone metastasis in 9.1%. In contrast, among 117 patients with 131I scan-positive functional metastases, 131I scan detected cervical lymph node metastasis in 61.5%, lung metastasis in 56.4%, mediastinal metastasis in 22.2% and bone metastasis in 16.2%. In all 5 patients in whom thyroglobulin was false-negative with negative antithyroglobulin antibody, PET showed increased 18F-FDG uptake in cervical lymph nodes, mediastinal lymph nodes, or both. Among patients with increased 18F-FDG uptake only in the cervical lymph nodes, the nodes were dissected in 11. Metastasis was confirmed in all, even in normal-sized lymph nodes. CONCLUSION: FDG PET scan localized metastatic sites in 131I scan-negative thyroid carcinoma patients with high accuracy. In particular, it was superior to 131I whole-body scan and serum thyroglobulin measurement for detecting metastases to cervical lymph nodes. FDG PET was helpful for determining the surgical management of these patients.     

甲状腺髓样癌的CT表现及病理基础

目的：探讨甲状腺髓样癌（MTC）的CT表现特点和病理基础。方法：回顾性分析了28例经手术病理证实的MTC的CT表现，并与病理所见作对照研究。结果：肿瘤侵及一叶甲状腺22例，双叶6例。5例密度不均匀，23例表现为均匀低密度实质性占位（弥漫型19例）；25例增强扫描，17例原发灶轻度强化。淋巴结转移20例，其中行增强扫描的18例转移淋巴结多强化明显。对照病理，5例密度不均匀者镜下见囊变坏死（3例）或肿块内夹有未被侵犯的甲状腺组织（2例），而23密度均匀者未见上述改变，肿瘤组织中细胞分布大致均匀紧密，转移淋巴结内血管丰富。结论：MTC的CT表现以弥漫性均匀低密度肿块、轻度增强、多累及一叶甲状腺为特点，转移淋巴结以强化为特征。     

CT平扫与增强扫描对评价下咽癌及其侵犯范围的应用

目的分析CT平扫与对比增强扫描对下咽癌的诊断价值及下咽癌侵犯周围结构的表现。方法回顾性分析30例经手术或活检证实的下咽癌的CT表现,根据CT征象判断肿瘤的侵犯范围,并与喉镜相比较。结果奉组30例中,梨状窝癌16例（53％）,咽后壁癌4例（13％）,环后区癌5例（17％）,混合性癌5例（17％）。CT还可观察到深部结构侵犯及淋巴结转移,而喉镜只能直接观察到病灶表面情况。结论CT较喉镜能更全面地显示下咽癌的部位、大小、侵犯范围及有无淋巴结转移,对下咽癌的诊断有很大的帮助。     

256层CT全颈灌注成像在鼻咽癌颈部淋巴结转移中的应用研究

目的探讨256层CT全颈部灌注成像对鼻咽癌颈部淋巴结转移的临床应用价值。资料与方法采用256层CT对经临床及病理证实的25例患者行全颈部CT灌注成像,其中鼻咽癌15例,颈部转移淋巴结65枚,同时取颈部正常肌肉组(65枚淋巴结);结节性甲状腺肿10例,颈部有未转移淋巴结55枚。记录转移淋巴结、未转移淋巴结及颈部正常肌肉的灌注参数值[灌注(P)、血流量(BF)、血容量(BV)、达峰时间(TTP)],并比较各灌注参数值在转移淋巴结与未转移淋巴结及正常肌肉间的差异。结果转移淋巴结组、正常肌肉组及未转移淋巴结组P值中位数分别为32.54HU、8.04HU和20.92HU,PEI均数分别为36.14HU、14.74HU和35.95HU,TTP值均数分别为36.35s、53.05s、48.65s,BV值中位数分别为31.17ml/100g、8.28ml/100g和18.98ml/100g。转移淋巴结P值、PEI值与BV值均高于正常肌肉组织(P<0.01),TTP值小于正常肌肉组织(P<0.01)。转移淋巴结与未转移淋巴结间P值、PEI值、BV值差异无统计学意义(P>0.05),转移淋巴结TTP值小于未转移淋巴结(P<0.0...     

Imaging of anaplastic carcinoma of the thyroid gland]

Sixteen cases of anaplasic thyroid carcinoma have been reviewed. In 13 cases out of 16, a diffuse invasion of one or both thyroid lobes and of the isthm associated with calcifications (50%) and necrosis (62%) was present. In 6 cases out of 8, CT Scan with contrast media injection has detected an extension into surrounding tissues. Twelve of the 16 patients presented cervical lymph nodes on the ultrasound examination and 4 of 8 patients presented mediastinal lymph nodes on the CT Scan. In 3 cases out of 16, the anaplasic carcinoma of the thyroid presented as a localized, hypoechoic nodule associated with a cervical lymph node in 1 case.