甲状腺常见单发结节CT多征象联合鉴别诊断  

Differential Diagnosis of Common Thyroid Solitary Nodules with Combined Multiple Signs of CT

作　　者：卢绍辉[1] 吴颋[1] 吴迪[1] 郭少华[1] 刘少强[1] 

机构地区：[1]赣南医学院第一附属医院影像中心,赣州341000

出　　处：《临床放射学杂志》2016年第7期1018-1022,共5页Journal of Clinical Radiology

基　　金：江西省教育厅青年科学基金项目(编号:GJJ14701)

摘　　要：目的探讨甲状腺常见良、恶性单发结节的CT平扫及单期增强影像特征,应用多征象联合的方法提高鉴别诊断水平。方法搜集甲状腺单发结节患者61例（其中结节性甲状腺肿27例,腺瘤7例,甲状腺癌27例）,比较分析良、恶性结节的影像征象（包括是否囊变、增强后结节与甲状腺组织的边界、钙化、甲状腺边缘腺体的完整性、增强扫描结节实性成分密度是否均匀及颈部有无异常淋巴结）,进行χ~2检验及Logistic回归区分主要征象及次要征象,使用主次多征象联合方法判断结节性质。结果经χ~2检验良恶性甲状腺结节以上影像征象的差异均有统计学意义（P〈0.05）;Logistic回归分析显示,无囊变、增强后结节与正常甲状腺组织边界不清晰及颈部异常淋巴结为甲状腺恶性结节的危险征象（OR值分别为10.672、27.188、94.000）,上述3个征象作为鉴别甲状腺结节性质的主要征象,其他3个征象作为次要征象,以2个主要征象加1个次要征象或1个主要征象加3个次要征象作为诊断恶性结节的最低标准,诊断本组恶性结节敏感度为88.9%,特异度为88.2%,阳性预测值为85.7%,阴性预测值为90.9%,总体诊断符合率为88.5%。结论 CT平扫及单期增强检查对评估甲状腺常见单发结节性质具有重要价值,应用主次多征象联合判断的方法可获得较高的诊断准确率。Objective To study plain and single-phase enhanced CT image features of common benign and malignant thyroid solitary nodules,and to improve the level of differential diagnosis with combined multiple signs. Methods 61 ca-ses of thyroid solitary nodules were collected,including 27 nodular goiter,7 thyroid adenoma and 27 thyroid carcinoma. The imaging signs of benign and malignant nodules were compared and analyzed,and the focus were cystic change,calcification,the border with normal thyroid after contrast enhancement,integrity of thyroid capsule,homogeneity of solid component after contrast enhancement,and abnormal lymph nodes in the neck. χ~2 test and Logistic regression were used to differentiate between main signs and secondary signs,and the method of combined multiple signs was used to judge the nature of nodules.Results χ~2 test results showed that differences of all the above imaging signs between benign and malignant thyroid nodules were statistically significant（ P〈0. 05）. Logistic regression analysis showed that no cystic change,unclearly defined border with normal thyroid after contrast enhancement and abnormal lymph nodes in the neck were risk signs of malignant thyroid nodules,and OR was 10. 672,27. 188 and 94. 000,respectively. When taking the above three signs as main signs and the other three signs as secondary signs of judging the nature of thyroid nodules,and using the minimum standard,namely,two main signs with one secondary sign or one main sign with three secondary signs,as the basis of diagnosing malignant nodules,the sensitivity of diagnosis of malignant nodules in our group of cases was 88. 9%,the specificity was 88. 2%,the positive predictive value was 85. 7%,the negative predictive value was 90. 9%,and the overall diagnostic accordance rate was88. 5%. Conclusion Plain and single-phase enhanced CT scans play an important role in evaluating the nature of common thyroid solitary nodules,and high diagnostic accuracy can be obtained with combined main and secondary signs.

关 键 词：单发甲状腺结节 体层摄影术 X线计算机 

分 类 号：R736.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]