甲状腺结节样病变良恶性的MDCT鉴别诊断价值

目的探讨甲状腺结节样病变良恶性的MDCT鉴别诊断价值。方法对36例经手术病理及穿刺活检证实的甲状腺结节样病变患者的临床及MDCT资料进行回顾性分析。结果恶性病变16例,良性病变20例。二者性别、年龄无统计学差异（P〉0.05）;恶性者多表现为单发结节,形态不规则,边界不清楚,甲状腺包膜不完整,邻近结构的侵犯和颈部淋巴结的增大,与良性者比较具有统计学差异（P〈0.05）;病灶钙化率无显著性差异（P〉0.05）,但钙化的形态及部位差异具有统计学意义（P〈0.05）。病灶形态不规则、边界不清晰、甲状腺包膜不完整、病灶内细颗粒状钙化、邻近结构侵犯和颈部淋巴结增大对恶性诊断的阳性预测值分别为68.8%、70.6%、75.0%、77.8%、100.0%、76.9%,敏感性分别为68.8%、75.0%、75.0%、43.8%、56.3%、62.5%,特异性分别为75.0%、75.0%、80.0%、90.0%、100.0%、85.0%。结论 MDCT能全面观察甲状腺结节样病变的大小、形态、数量、边缘、强化、钙化、有无囊变、与邻近结构的关系及颈部淋巴结情等况,对这些征象进行综合分析,对良恶性的鉴别具有重要价值。

The Value of MDCT Differential Diagnosis in Benign and Malignant Thyroid Nodular Lesions

Objective To discuss the value of multi-detector row spiral CT（ MDCT） differential diagnosis in benign and malignant thyroid nodular lesions. Methods The MDCT and clinical data were reviewed and analyzed in 36 cases confirmed by surgical pathology and biopsy of patients with malignant thyroid nodular lesions. Results Malignant lesions in 16 cases, 20 patients with benign lesions. No statistical difference in the gender and age of the benign and malignant lesion （P〉0.05）. Malignant lesions showde single nodules mostly, irregular shape, unclear boundary, incomplete thyroid capsule, the invasion of adjacent structure and the enlargement of cervical lymph nodes. It had statistically difference compared with benign （P〈0.05）. There was no significant difference in focal calcified rate （P〉0.05）. But calcified form and part had statistically significant difference （P〈0.05）. Positive predictive value on irregular shape,unclear boundary, incomplete thyroid capsule,the invasion of adjacent structure and the enlargement of cervical lymph nodes for malignant diagnosis were 68.8 % 、70.6 %、75.0%、77.8 %、100.0 %、76.9 % respectively. Sensitivity were 68.8 %、75.0 %、75.0 %、43.8 %、56.3 %、62.5 % respectively. Specificity were 75.0 %、75.0 %、80.0 %、90.0%、100.0 %、85.0 % respectively. Conclusion MDCT can observe the thyroid nodular lesions roundly on the size, shape, number, edge, reinforcement, calcification, with cystic change or not, the relationship with the adjacent structures and cervical lymph nodes. Comprehensive analysis of these signs has important value to identify benign lesion and malignancy lesion.