CT双期增强影像征象在单发性甲状腺结节良恶性诊断中的价值  

The Value of Dual-phase Enhanced CT Images in Benign and Malignant Diagnosis of Single Thyroid Nodules

作　　者：吴猛 孟玉莲 刘鹏 李春志[1] 任华[1] Wu Meng;Meng Yu-lian;Liu Peng;Li Chun-zhi;Ren Hua(Department of Radiology,Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]中国中医科学院西苑医院放射科,北京100091

出　　处：《中国CT和MRI杂志》2023年第10期46-48,83,共4页Chinese Journal of CT and MRI

摘　　要：目的探究CT双期增强扫描的影像征象在单发性甲状腺结节良恶性鉴别的价值。方法回顾性分析经组织病理学证实的甲状腺单发结节患者48例,采用χ^(2)检验或t检验比较两组良恶性结节的影像征象(钙化、囊变、咬饼征,动脉期包膜,平扫期/动脉期/静脉期结节边界变化,平扫期/动脉期/静脉期结节的CT值)的差异性,并对这些影像征象与恶性病变进行单因素、多因素回归分析。结果48例单发甲状腺结节患者中良性病变20例(结节性甲状腺肿13例,局灶性纤维化、钙化1例,腺瘤6例),恶性病变28例(均为甲状腺乳头状癌)。良性病变与恶性瘤变的组间年龄、囊变、静脉期相对动脉期结节边界的变化具有差异性(P<0.05)。单因素和多因素分析发现囊变是发生良性病变的独立保护因素分别为(OR=0.07 P=0.0009,OR=0.08 P=0.0011),静脉期相对动脉期结节边界的变不清是发生恶性病变的独立危险因素(分别为OR=8.33 P=0.0023,OR=8.05P=0.0049)。年龄与甲状腺良恶性病变进行平滑曲线拟合发现,年龄与单发性甲状腺结节发生恶性病变的概率相关,50岁和65岁左右是结节发生恶性病变概率变化的拐点。结论本研究发现单发性甲状腺结节发生恶性病变与年龄具有相关性,囊变是单发性甲状腺良性病变的独立保护因素,静脉期结节边界模糊是甲状腺单发结节恶性病变的独立危险因素。Objective To evaluate the value of dual-phase enhanced CT in differential diagnosis of benign and malignant thyroid nodules.Methods 48 cases of thyroid nodules confirmed by histopathology were retrospectively analyzed.χ^(2) or t test was used to compare the imaging features of benign and malignant nodules(Calcification,cystic change,bite cake sign,capsule in arterial phase,nodular boundary changes in plain scan/arterial/venous phase and the CT values of nodules in plain/arterial/venous phase).The univariate and multivariate regression analysis were performed on the imaging characteristic and malignant lesions.Results There were 20 benign lesions(13 cases of nodular goiter,1 case of focal fibrosis and calcification,6 cases of adenoma were included)and 28 malignant lesions(all of them were papillary thyroid carcinoma)in 48 patients with single thyroid nodules.There were significant differences in age,cystic changes and nodule boundaries between the benign and malignant groups(P<0.05).Univariate and multivariate analysis showed that the absence of cystic lesions was an independent protective factor for benign lesions(OR=0.07 P=0.0009,OR=0.08 P=0.0011,respectively),and the indistinct nodule boundary between venous and arterial phase was an independent risk factor for malignant lesions(OR=8.33 P=0.0023,OR=8.05,P=0.0049,respectively).Smooth curve fitting between age and the risk of malignant thyroid lesions showed that age was correlated with the probability of malignant lesions in single thyroid nodules,and the inflection point of malignant lesions in nodules was about 50 and 65 years old.Conclusion In this study,it was found that the occurrence of malignant lesions in single thyroid nodule was correlated with age,cystic lesions was an independent protective factor of single benign thyroid lesion,and venous nodular boundary ambiguity was an independent risk factor in single malignant lesion.

关 键 词：甲状腺单发结节 增强扫描 囊变 良恶性鉴别 

分 类 号：R581[医药卫生—内分泌]