结节性甲状腺肿的MRI表现及与病理分型的对照分析  

MRI findings of nodular goiter and their comparison with pathological classification

作　　者：李文晶 王浩[1] 陈永其[1] 宋彬[1] LI Wen-jing;WANG Hao;CHEN Yong-qi(Department of Radiology,Minhang Hospital,Fudan University,Shanghai 201199,China)

机构地区：[1]复旦大学附属闵行医院(上海市闵行区中心医院),上海201199

出　　处：《放射学实践》2020年第11期1403-1408,共6页Radiologic Practice

基　　金：上海市科学技术委员会自然科学基金面上项目(19ZR1446200)。

摘　　要：目的:探讨结节性甲状腺肿的MRI表现特征及对病理分型的鉴别诊断价值,提高结节性甲状腺肿的MRI诊断水平。方法:回顾性分析38例经手术病理证实的结节性甲状腺肿MRI表现,根据病理结果分为腺瘤样增生组和无腺瘤样增生组,观察病灶的大小、边缘、信号、强化方式、ADC值,结果与手术病理对照。结果:38例患者MRI发现51个结节性甲状腺肿病灶,病灶均呈类圆形、边界清楚(100%)。病灶T1WI以等低信号为主(68.6%),T2WI及DWI以高信号为主(80.4%,74.5%)。早期明显强化24个,轻度到中等强化27个(52.9%),晚期明显强化22个,轻度到中等强化29个(56.9%)。44个病灶可见假包膜(86.3%),29个病灶可见囊变(56.9%)。动态强化曲线呈上升或平台型有24个,流出型或无强化有27个。病灶内充填样强化18个(35.3%)。51个病灶增强前后病灶大小均无变化(100%)。本组19个病灶伴腺瘤样增生,32个病灶无腺瘤样增生,单因素分析显示两组间T1WI信号(P=0.013)、DWI信号(P=0.001)、早期强化程度(P<0.001)、晚期强化程度(P<0.001)、动态强化曲线(P<0.001)、充填样强化(P<0.001)差异有统计学意义。多因素回归分析示早期强化程度(P=0.045,OR值18.692)及充填样强化(P=0.001,OR值93.269)是结节性甲状腺肿伴腺瘤样增生的独立预测因素。结论:结节性甲状腺肿的MRI表现具有一定特征,其中伴腺瘤样增生的结节性甲状腺肿具有早期高强化及充填样强化的特点,掌握其MRI表现有助于提高诊断符合率。Objective:This study aims to investigate the MRI characteristics of nodular goiter and its differential diagnosis value for pathologic classification,and to improve the MRI diagnosis of nodular goiter.Methods:Retrospectively analyzing the MRI manifestations of 38 patients with nodular goiter confirmed by pathology.According to the pathological results,the patients were divided into adenomatous hyperplasia group and non-adenomatous hyperplasia group.The size,edge,signal,enhancement mode and ADC value of the lesion were observed.Results:51 nodular goiter lesions were found in 38 patients on MRI.The lesions were all round and well-defined(100%).The lesions were mainly iso-low signal on T1WI(68.6%),and high signal on T2WI and DWI(80.4%and 74.5%,respectively).After enhanced scan,there were 24 lesions with obvious enhancement at the early stage,27 lesions with moderate or mild enhancement(52.9%);there were 22 lesions with obvious enhancement and 29 lesions with moderate or mild enhancement(56.9%)at the late stage.Pseudocapsules were found in 44 lesions(86.3%)and cystic lesions were observed in 29 lesions(56.9%).There were 24 dynamic strengthening curves with rising or plateau type and 27 with outflow type or no strengthening.Intralesional filling-like enhancement in 18 lesions(35.3%).There was no change(100%)in the size of 51 lesions before and after enhancement.In this group,19 lesions were accompanied by adenomatous hyperplasia,while 32 lesions had no adenomatous hyperplasia.The difference between the two groups was statistically significant in the univariate analysis of T1WI signal(P=0.013),DWI signal(P=0.001),early enhancement degree(P=0.000),late enhancement degree(P=0.000),dynamic enhancement curve(P=0.000)and filling-like enhancement(P=0.000).Multivariate regression analysis revealed that early enhancement(P=0.045,OR=18.692)and filling-like enhancement(P=0.001,OR=93.269)were independent predictors of nodular goiter with adenomatous hyperplasia.Conclusion:The MRI manifestations of nodular goiter have specific cha

关 键 词：结节性甲状腺肿 腺瘤样增生 甲状腺结节 甲状腺肿瘤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]