中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2010年
2期
147-151
,共5页
甲状腺肿瘤%甲状腺结节%钙质沉着症%体层摄影术,X线计算机
甲狀腺腫瘤%甲狀腺結節%鈣質沉著癥%體層攝影術,X線計算機
갑상선종류%갑상선결절%개질침착증%체층섭영술,X선계산궤
Thyroid neoplasm%Thyroid nodule%Calcinosis%Tomography,X-ray computed
目的 探讨CT检出甲状腺内钙化灶对良、恶性病变的鉴别诊断价值.方法 搜集手术切除并经病理证实的甲状腺占位性病变318例,均有完整的CT及临床资料.CT平扫后行双期增强扫描,延迟时间为35、50 s.甲状腺钙化灶直径≤2 mm者定义为细颗粒钙化;钙化灶直径>2 mm者或呈壳状、大片不规则者定义为粗颗粒钙化;两种钙化兼有者归于混合性钙化.钙化数目为1个的定义为单发;钙化数目>1个的定义为多发.根据钙化在病灶内的分布分为内部钙化和边缘钙化.采用χ~2检验对良、恶性病变中钙化的多少、大小及分布进行统计学分析.结果 318例甲状腺占位性病变中甲状腺癌48例(乳头状癌26例,滤泡状癌7例,髓样癌3例,隐灶癌12例).甲状腺良性病变270例(包括结节性甲状腺肿36例,甲状腺腺瘤170例,结节性甲状腺肿伴腺瘤38例,腺瘤合并桥本甲状腺炎26例).共60例(18.9%)病灶发现钙化,包括甲状腺癌21例(43.8%),其中乳头状癌12例,隐灶癌6例,滤泡细胞癌2例,髓样癌1例;甲状腺良性病变39例(14.4%),其中甲状腺肿6例,腺瘤13例,甲状腺肿伴腺瘤19例,桥本甲状腺炎伴腺瘤1例,良性病变与恶性病变的钙化率差异有统计学意义(P<0.01);以甲状腺病灶钙化为标准诊断甲状腺癌的敏感度为43.8%(21/48),特异度为85.6%(231/270).细颗粒钙化37例,其中甲状腺癌8例,甲状腺良性病变29例;粗颗粒钙化23例,其中甲状腺癌13例,甲状腺良性病变10例,两者差异有统计学意义(P<0.01);以粗颗粒钙化为标准诊断甲状腺癌的敏感度为61.9%(13/21),特异度为74.4%(29/39).单发钙化的病灶31例,其中甲状腺癌13例,甲状腺良性病变18例;多发钙化的病灶29例,其中甲状腺癌8例,甲状腺良性病变21例,两者差异无统计学意义(P>0.05).恶性病变中钙化位于病灶内部的15例(71.4%),位于病灶边缘的6例;良性病变中钙化位于病灶内部的有12例(30.8%),位于病灶边缘的27例,两者差异有统计学意义(P<0.01);以钙化位于病灶内部作为标准诊断甲状腺癌的敏感度为71.4%(15/21),特异度为69.2%(27/39).结论 CT检查在甲状腺病灶中发现钙化且钙化位于病灶内部,和(或)为粗颗粒钙化时,考虑甲状腺癌的可能性大,应进一步行穿刺活检或手术切除.
目的 探討CT檢齣甲狀腺內鈣化竈對良、噁性病變的鑒彆診斷價值.方法 搜集手術切除併經病理證實的甲狀腺佔位性病變318例,均有完整的CT及臨床資料.CT平掃後行雙期增彊掃描,延遲時間為35、50 s.甲狀腺鈣化竈直徑≤2 mm者定義為細顆粒鈣化;鈣化竈直徑>2 mm者或呈殼狀、大片不規則者定義為粗顆粒鈣化;兩種鈣化兼有者歸于混閤性鈣化.鈣化數目為1箇的定義為單髮;鈣化數目>1箇的定義為多髮.根據鈣化在病竈內的分佈分為內部鈣化和邊緣鈣化.採用χ~2檢驗對良、噁性病變中鈣化的多少、大小及分佈進行統計學分析.結果 318例甲狀腺佔位性病變中甲狀腺癌48例(乳頭狀癌26例,濾泡狀癌7例,髓樣癌3例,隱竈癌12例).甲狀腺良性病變270例(包括結節性甲狀腺腫36例,甲狀腺腺瘤170例,結節性甲狀腺腫伴腺瘤38例,腺瘤閤併橋本甲狀腺炎26例).共60例(18.9%)病竈髮現鈣化,包括甲狀腺癌21例(43.8%),其中乳頭狀癌12例,隱竈癌6例,濾泡細胞癌2例,髓樣癌1例;甲狀腺良性病變39例(14.4%),其中甲狀腺腫6例,腺瘤13例,甲狀腺腫伴腺瘤19例,橋本甲狀腺炎伴腺瘤1例,良性病變與噁性病變的鈣化率差異有統計學意義(P<0.01);以甲狀腺病竈鈣化為標準診斷甲狀腺癌的敏感度為43.8%(21/48),特異度為85.6%(231/270).細顆粒鈣化37例,其中甲狀腺癌8例,甲狀腺良性病變29例;粗顆粒鈣化23例,其中甲狀腺癌13例,甲狀腺良性病變10例,兩者差異有統計學意義(P<0.01);以粗顆粒鈣化為標準診斷甲狀腺癌的敏感度為61.9%(13/21),特異度為74.4%(29/39).單髮鈣化的病竈31例,其中甲狀腺癌13例,甲狀腺良性病變18例;多髮鈣化的病竈29例,其中甲狀腺癌8例,甲狀腺良性病變21例,兩者差異無統計學意義(P>0.05).噁性病變中鈣化位于病竈內部的15例(71.4%),位于病竈邊緣的6例;良性病變中鈣化位于病竈內部的有12例(30.8%),位于病竈邊緣的27例,兩者差異有統計學意義(P<0.01);以鈣化位于病竈內部作為標準診斷甲狀腺癌的敏感度為71.4%(15/21),特異度為69.2%(27/39).結論 CT檢查在甲狀腺病竈中髮現鈣化且鈣化位于病竈內部,和(或)為粗顆粒鈣化時,攷慮甲狀腺癌的可能性大,應進一步行穿刺活檢或手術切除.
목적 탐토CT검출갑상선내개화조대량、악성병변적감별진단개치.방법 수집수술절제병경병리증실적갑상선점위성병변318례,균유완정적CT급림상자료.CT평소후행쌍기증강소묘,연지시간위35、50 s.갑상선개화조직경≤2 mm자정의위세과립개화;개화조직경>2 mm자혹정각상、대편불규칙자정의위조과립개화;량충개화겸유자귀우혼합성개화.개화수목위1개적정의위단발;개화수목>1개적정의위다발.근거개화재병조내적분포분위내부개화화변연개화.채용χ~2검험대량、악성병변중개화적다소、대소급분포진행통계학분석.결과 318례갑상선점위성병변중갑상선암48례(유두상암26례,려포상암7례,수양암3례,은조암12례).갑상선량성병변270례(포괄결절성갑상선종36례,갑상선선류170례,결절성갑상선종반선류38례,선류합병교본갑상선염26례).공60례(18.9%)병조발현개화,포괄갑상선암21례(43.8%),기중유두상암12례,은조암6례,려포세포암2례,수양암1례;갑상선량성병변39례(14.4%),기중갑상선종6례,선류13례,갑상선종반선류19례,교본갑상선염반선류1례,량성병변여악성병변적개화솔차이유통계학의의(P<0.01);이갑상선병조개화위표준진단갑상선암적민감도위43.8%(21/48),특이도위85.6%(231/270).세과립개화37례,기중갑상선암8례,갑상선량성병변29례;조과립개화23례,기중갑상선암13례,갑상선량성병변10례,량자차이유통계학의의(P<0.01);이조과립개화위표준진단갑상선암적민감도위61.9%(13/21),특이도위74.4%(29/39).단발개화적병조31례,기중갑상선암13례,갑상선량성병변18례;다발개화적병조29례,기중갑상선암8례,갑상선량성병변21례,량자차이무통계학의의(P>0.05).악성병변중개화위우병조내부적15례(71.4%),위우병조변연적6례;량성병변중개화위우병조내부적유12례(30.8%),위우병조변연적27례,량자차이유통계학의의(P<0.01);이개화위우병조내부작위표준진단갑상선암적민감도위71.4%(15/21),특이도위69.2%(27/39).결론 CT검사재갑상선병조중발현개화차개화위우병조내부,화(혹)위조과립개화시,고필갑상선암적가능성대,응진일보행천자활검혹수술절제.
Objective To study the diagnostic value of calcification in differentiating benign and malignant thyroid lesions. Methods CT images of 318 consecutive patients with pathologically proven thyroid lesions were retrospectively reviewed by two radiologists. The following characteristics of calcification on CT images were evaluated: (1) size (≤2 mm indicating microcalcification and > 2 mm or shelly and irregular shape indicating macrocalcification, and both features indicating mixed calcification), (2) number (single or multiple) and (3)location (internal or edge). χ~2 test was used for statistical analysis. Results Oft he 318 cases, 48 were diagnosed as malignant (papillary carcinoma 26, follicular carcinoma 7, medullary carcinoma 3 and microcarcinoma 12) and 270 were benign (nodular goiter 36, adenoma 170, nodular goiter with adenoma 38 and adenoma with Hashimoto's thyroiditis 26). Calcification was found in 60 cases (18.9%). Among them 21 (papillary carcinoma 12,microcarcinoma 6,follicular carcinoma 2 and medullary carcinoma 1) were malignant(43.8%) and 39(nodular goiter 6, adenoma 13,nodular goiter with adenoma 19 and adenoma with Hashimoto's thyroiditis 1) were benign (14.4%) (P < 0.01). Sensitivity and specificity for diagnosing thyroid carcinoma were 43.8% (21/48) and 85.6% (231/270), respectively. Microcalcification was found in 37 cases (malignant 8, benign 29) and macrocalcification was found in 23 cases(malignant 13, benign 10) (P < 0.01) . Sensitivity and specificity of macrecalcification for diagnosing thyroid carcinoma were 61.9% (13/21) and 74.4% (29/39), respectively. Single calcification was found in 31 cases (malignant 13, benign 18) and multiple calcification was found in 29 cases(malignant 8, benign 21) (P >0.05). Internal calcification was found in 15 cases of malignant lesions(71.4%) and 12 of benign lesions(30.8%); Edge calcification was found in 6 cases of malignant and 27 of benign, (P <0.01). Sensitivity and specificity of internal calcification for diagnosing thyroid carcinoma were 71.4% (15/21) and 69.2% (27/39), respectively. Conclusion Internal calcification or(and) macrocalcification of the thyroid lesions may strongly suspect thyroid carcinoma and fine-needle aspiration or surgery should be further performed.
