MSCT征象鉴别诊断微小甲状腺乳头状癌与微小结节性甲状腺肿的临床价值  

Clinical value of MSCT signs in the differential diagnosis of papillary thyroid microcarcinoma and micronodular goiter

作　　者：倪城 蒋华东 杨健惠 杨波 薛春华 NI Cheng;JIANG Hua-dong;YANG Jian-hui;YANG Bo;XUE Chun-hua(Qidong People's Hospital/Qidong Institute of Liver Cancer Prevention and Treatment/Imaging Department of Qidong Hospital Afiliated to Nantong University,Nantong Jiangsu 226200,China)

机构地区：[1]启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院影像科,江苏东南通226200

出　　处：《中国临床医学影像杂志》2024年第7期467-470,475,共5页Journal of China Clinic Medical Imaging

基　　金：2023年度南通市卫生健康委员会科研课题专项(编号:MSZ2023104)。

摘　　要：目的:探究多层螺旋CT(MSCT)征象对微小甲状腺乳头状癌(Papillary thyroid microcarcinoma,PTMC)与微小结节性甲状腺肿(Micronodular goiter,MNG)的鉴别诊断价值。方法:回顾性分析启东市人民医院2018年1月—2023年5月收治的50例PTMC和50例MNG患者临床资料,所有患者均行MSCT检查,评价MSCT对PTMC与MNG的鉴别诊断价值,对比两组患者MSCT征象。并基于MSCT征象,采用多因素Logistic回归分析探究PTMC影响因素。结果:MSCT鉴别诊断PTMC与MNG的敏感度为92.00%(46/50)、特异度为96.00%(48/50)、准确度为94.00%(94/100),与病理诊断一致性Kappa值为0.880;PTMC与MNG的MSCT征象中病灶数目、结节边界、有无钙化、钙化形态、包膜完整性、强化方式、强化程度、颈部淋巴结异常情况及有无囊变比较差异均有统计学意义(P<0.05);PTMC的MSCT征象以单发病灶、边缘模糊、包膜中断、增强扫描后明显强化为主要特征,MNG患者的MSCT征象以多发病灶、边界清楚、包膜完整、囊变为主要特征。多因素Logistic回归分析显示,MSCT征象中,单发病灶、边界模糊、包膜中断、△CT值>60 HU、颈部淋巴结异常、无囊变是PTMC的独立影响因素(P<0.05)。结论:PTMC与MNG的MSCT征象中单发病灶、结节边界、包膜完整性、强化程度、淋巴结异常等情况均存在明显差异,MSCT对二者表现出较高的鉴别诊断价值。Objective:To explore the differential diagnostic value of multi-slice spiral CT(MSCT)signs on papillary thyroid microcarcinoma(PTMC)and micronodular goiter(MNG).Methods:Clinical data of 50 patients with PTMC and 50 patients with MNG admitted to Qidong People's Hospital were retrospectively analyzed from January 2018 to May 2023.All patients underwent MSCT examination,and the differential diagnostic value of MSCT on PTMC and MNG was evaluated.MSCT signs of the two groups were compared.Multivariate Logistic regression analysis was used to explore the influencing factors of PTMC based on MSCT signs.Results:The sensitivity,specificity and accuracy of MSCT in the differential diagnosis of PTMC and MNG were 92.00%(46/50),96.00%(48/50)and 94.00%(94/100),and the consistency Kappa value with pathological diagnosis was 0.880.There were statistical differences between PTMC and MNG in MSCT signs such as lesion count,nodule boundary,presence or absence of calcification,morphology of calcification,envelope integrity,enhancement pattern,enhancement degree,cervical lymph node abnormalities and presence or absence of cystic change(P<0.05).The MSCT signs of PTMC were mainly characterized by single lesion,blurred boundary,envelope interruption and obvious enhancement after enhanced scan,while the MSCT signs of MNG patients were mainly characterized by multiple lesions,clear boundary,intact envelope and cystic change.Multivariate Logistic regression analysis showed that among the MSCT signs,single lesion,blurred boundary,envelope interruption,△CT value>60 HU,cervical lymph node abnormality and absence of cystic change were independent influencing factors of PTMC(P<0.05).Conclusion:There are obvious differences between PTMC and MNG in single lesion,nodule boundary,envelope integrity,enhancement degree and lymph node abnormality.MSCT is of high value in the differential diagnosis of PTMC and MNG.

关 键 词：甲状腺肿瘤 癌 乳头状 甲状腺肿 体层摄影术 X线计算机 

分 类 号：R736.1[医药卫生—肿瘤] R730.261[医药卫生—临床医学] R814.42