原发性甲状腺淋巴瘤影像表现及误诊分析  

Imaging diagnosis of primary thyroid lymphoma and analysis of misdiagnosis

作　　者：邓凯吉 陈自谦[1,2] 胡永利[1] 陈萍[1] 

机构地区：[1]福建医科大学福总临床医学院,福建福州350025 [2]中国人民解放军南京军区福州总医院医学影像中心,福建福州350025

出　　处：《医学影像学杂志》2018年第1期24-29,共6页Journal of Medical Imaging

摘　　要：目的探讨原发性甲状腺淋巴瘤(PTL)的影像表现,以期进一步提高PTL的诊断准确率。方法回顾性分析经手术病理证实的6例PTL患者的影像表现,其中5例行CT平扫及增强扫描,1例同时行MRI平扫及全身^(18)F-FDG PET/CT检查。结果 6例患者均以发现颈部肿物就诊,病理证实均为非霍奇金淋巴瘤,其中3例合并有桥本甲状腺炎。病灶侵及甲状腺一侧叶4例,侵及甲状腺双侧叶及峡部1例,侵及甲状腺单侧叶及峡部1例。CT表现为单发结节型2例,多发结节型1例,弥漫肿大型3例。CT平扫6例病灶均呈稍低密度,5例密度大致均匀,1例病灶内可见钙化。增强扫描5例病灶呈均匀、轻中度强化。2例出现颈部淋巴结转移。MRI病灶T_1WI呈等信号,T_2WI呈稍高信号,DWI呈高信号。PET/CT病灶表现为高代谢。6例患者术前全部误诊。结论 PTL容易误诊,其影像表现具有一定特征性,结合临床资料,有助于提高诊断准确性,其最终确诊仍需依靠病理学检查。Objective To investigate the imaging features of primary thyroid lymphoma （ PTL）, and to improve its diagnostic accuracy. Methods The CT manifestations of 6 patients with pathologically confirmed PTL were retrospectively analyzed. Plain CT scan and contrast enhanced scan were performed in 5 patients. MRI scan and lSF-FDG PET/CT scan were performed in 1 patient. Results 6 patients were all found with a thyroid mass. They were all non-Hodgkin lymphoma and 3 patients were with Hashimoto＇s thyroiditis pathologically. Unilateral thyroid gland involved in 4 cases. Both bilateral lobe and isthmus involved in 1 case. Both unilateral lobe and isthmus involved in 1 case. For the CT fingings, solitary nodule was seen in 2 patients. 1 had mul- tiple nodules. 3 patients had a diffuse goiter. 6 patients had tumors with slight hypodensity. 5 eases presented with homogeneous density. Calcification was shown in 1 case. 5 cases manifested slight or moderate enhancement. 2 cases presented with cervical lymph node invaded. MR findings were lesions with isointensity on T2WI, slight hyperintensity on T2 WI, and hyperintensity on DWI. Lesion was hypermetabolic in ^18F-FDG PET/ CT imaging. All cases were preoperatively misdiagnosed. Conclusion PTL is easily misdiagnosed and its imaging manifestations have certain characteristics. The accuracy of diagnosis of PTL can be im- proved with a combination of the relevant clinical data. The final diagnosis of PTL depends on pathological examination.

关 键 词：甲状腺 淋巴瘤 体层摄影术 X线计算机 磁共振成像 氟脱氧葡萄糖F18 正电子发射断层显像术 

分 类 号：R736.1[医药卫生—肿瘤] R814.42[医药卫生—临床医学]