CAJ | 학술논문

目的分析甲状腺间变癌的CT表现,评价CT在明确甲状腺间变癌诊断及鉴别诊断中的价值.方法回顾性分析经手术、病理证实的10例甲状腺间变癌的临床及CT资料,女7例、男3例；发病年龄25～78岁,中位年龄为61岁；均采用MSCT行平扫及增强扫描.结果 10例中8例为单侧病灶,其中2例病灶较大侵及峡部；2例病灶累及双侧甲状腺.肿瘤最大径为2.9～12.8 cm,平均(4.5±1.4)cm;病灶边缘均不光整且有甲状腺被膜外侵征象；病灶平扫密度不均匀,病灶内均可见坏死区；病灶内伴钙化者7枚,钙化形态各异,以单发粗颗粒钙化状较多见(5个病灶).增强后病灶均呈明显不均匀强化,实性部分明显强化(强化幅度＞40 HU)；平扫及增强后病灶与对侧胸锁乳突肌CT值比值分别为0.69～0.82(0.76±0.18),1.25～1.41(1.33±0.28).伴颈部淋巴结肿大者6例,增强后不规则环形强化或均匀明显强化,1例淋巴结内见砂粒状钙化.结论直径较大、单发、粗颗粒钙化、甲状腺包膜不完整,并见坏死及明显不均匀强化伴颈部肿大淋巴结是甲状腺间变癌CT较为特征性的表现.
목적 분석갑상선간변암적CT표현,평개CT재명학갑상선간변암진단급감별진단중적개치.방법 회고성분석경수술、병리증실적10례갑상선간변암적림상급CT자료,녀7례、남3례；발병년령25～78세,중위년령위61세；균채용MSCT행평소급증강소묘.결과 10례중8례위단측병조,기중2례병조교대침급협부；2례병조루급쌍측갑상선.종류최대경위2.9～12.8 cm,평균(4.5±1.4)cm;병조변연균불광정차유갑상선피막외침정상；병조평소밀도불균균,병조내균가견배사구；병조내반개화자7매,개화형태각이,이단발조과립개화상교다견(5개병조).증강후병조균정명현불균균강화,실성부분명현강화(강화폭도＞40 HU)；평소급증강후병조여대측흉쇄유돌기CT치비치분별위0.69～0.82(0.76±0.18),1.25～1.41(1.33±0.28).반경부림파결종대자6례,증강후불규칙배형강화혹균균명현강화,1례림파결내견사립상개화.결론 직경교대、단발、조과립개화、갑상선포막불완정,병견배사급명현불균균강화반경부종대림파결시갑상선간변암CT교위특정성적표현.
Objective To investigate the CT characteristics of anaplastic thyroid carcinoma and evaluate the diagnostic value of CT in this disease.Methods The CT findings of 10 patients with pathologically proved anaplastic thyroid carcinoma were retrospectively reviewed.The patients included 7 females and 3 males.Their age ranged from 25.0 to 78 years with median of 61 years.Multi-slices plain and post contrast CT scans were performed in all patients.Results Unilateral thyroid was involved in 6 patients.Unilateral thyroid and thyroid isthmus were both involved in 2 patients due to big size.Bilateral thyroid were involved in 2 patients.The maximum diameter of anaplastic thyroid carcinoma ranged from 2.9-12.8 cm with mean of (4.5 ± 1.4) cm.All lesions demonstrated unclear margins and envelope invasion.The densities of all lesions were heterogeneous and obvious necrosis areas were noted on precontrast images.Seven lesions showed varied calcifications,and coarse granular calcifications were found in 5 lesions among them.All lesions showed remarkable heterogenous enhancement on post-contrast CT.The CT value of solid portion of the tumor increased 40 HU after contrast media administration.The ratios of CT value which comparing of the tumor with contralateral sternocleidomastoid muscle were 0.69-0.82 (0.76 ± 0.18)and 1.25-1.41 (1.33 ± 0.28)on pre and post CT,respectively.Enlarged cervical lymph nodes were found in 6 cases (60.0％).It showed obvious homogeneous enhancement or irregular ring-like enhancement on post-contrast images and dot calcifications were seen in 1 case.Conclusions Relative larger single thyroid masses with coarse granular calcifications,necrosis,envelope invasion,remarkable heterogeneous enhancing and enlarged lymph nodes on CT are suggestive of anaplastic thyroid carcinoma.