甲状腺癌的CT诊断

目的:总结甲状腺癌的CT表现,提高其诊断准确性。方法:回顾性分析63例经手术或穿刺活检后病理证实的甲状腺癌的CT表现。结果:63例甲状腺癌,肿瘤最大径0.5 cm～8.5 cm,其中2 cm～5 cm者40例(63.5%)。全部肿瘤内均有不同程度的低密度区。肿瘤边缘模糊不规则56例(88.9%)。肿瘤内有颗粒样钙化29例(46.0%),其中直径≤2 mm的细颗粒钙化17例,8例兼有粗细混合性钙化,直径>2 mm的粗钙化4例。腺体边缘出现包膜/假包膜连续性中断的"残圈"征20例(31.8%),肿瘤周边出现"半岛状"瘤结节17例(27.0%),肿瘤囊变伴囊壁明显强化的乳头状结节8例(12.7%)。颈部出现淋巴结转移40例(63.5%),其中增强后明显强化22例,密度接近于正常甲状腺组织,10例转移淋巴结有囊性变伴囊壁明显强化的乳头状结节,7例淋巴结最大短径<0.8 cm,7例乳头状癌的颈部转移淋巴结内有颗粒样钙化(5例为细颗粒状钙化,2例为混合性钙化)。结论:甲状腺癌具有特异性的CT表现:细颗粒样钙化、囊变伴囊壁乳头状强化结节、半岛状瘤结节及残圈征,同时颈部淋巴结转移也具有原发病灶的特征性表现。CT薄层扫描可提高甲状腺细颗粒钙化的检出率。平扫加增强对甲状腺癌的定性和术前分期、制定手术方案十分重要。

CT Diagnosis of Thyroid Carcinoma

Objective To analyze the CT features of thyroid carcimona and elevate the diagnostic accuracy.Methods CT findings of 63 patients with thyroid carcinoma proved by surgery,biopsy and pathology were reviewed retrospectively.Results The maximum diameter of tumours ranged from 0.5 cm to 8.5 cm,in which diameter of 40 cases(63.5%)ranged from 2 cm to 5 cm.All of the tumours were heterogeneous hypodensity.56 cases(88.9%)were ill defined and irregular.29 cases(46. 0%)were found granular calcifications,including 17 cases with fine granular microcalcifications less than 2 mm,8 cases with mixed calcifications,4 cases with macrocalcifications exceeded 2 mm."No complete ring around the tumour"were revealed in 20 cases(31.8%),and"peninsular tubercles around the tumour"were revealed in 17 cases(27.0%).Cystic formation with intracystic obvious enhanced papillary-like nodules were found in 8 cases(12.7%).40 cases(63.5%)were revealed metastatic lymph nodes in the neck,including 22 cases with marked enhancement similar to normal thyroid gland,10 cases with cystic formation with intracystic obvious enhanced papillary-like nodules,7 cases with maximum short diameter less than 0.8 cm,7 cases with granular calcifications(5 cases with fine granular microcalcifications less than 2 mm,2 cases with mixed calcifications).Conclusion Thyroid carcinomas have the characteristic CT findings:fine granular microcalcifications,cystic formation with intracystic obvious enhanced papillary-like nodules,peninsular tubercles around the tumour and no complete ring around the tumour.CT manifestations of the metastatic lymph nodes also have the character of the primary carcinoma.La- mellar scan can increase the detection rate of fine granular calcifications.Conventional scan and enhancement scan are useful in the diagnosis of thyroid carcinoma,which is very important in evaluating the stage of thyroid carcinoma preoperation and se- lecting the surgical planning.