双源CT双期增强对甲状腺乳头状癌淋巴结转移的诊断价值-东南大学学报医学版

双源CT双期增强对甲状腺乳头状癌淋巴结转移的诊断价值

单位：南京市江宁医院影像科, 江苏南京 211100

分类号：R736.1;R730.44

出版年·卷·期（页码）：2018·37·第四期（673-678）

摘要：

目的：探讨甲状腺乳头状癌结节的CT表现与颈部淋巴结转移的相关性以及淋巴结转移的CT双期增强表现。方法：收集经手术病理证实的40例原发性甲状腺乳头状癌患者及1例复发患者的临床及影像资料，其中20例伴有颈部淋巴结转移。分析甲状腺癌结节的大小、癌结节与甲状腺被膜的关系与颈部淋巴结转移的相关性。观察颈部转移淋巴结CT双期增强表现，分析转移性淋巴结动、静脉期与良性淋巴结CT值变化的差异。结果：41例患者中共发现甲状腺乳头状癌结节43枚，癌结节呈渐进性强化；癌结节径长> 10 mm组对比径长≤5 mm组、5 mm <径长≤10 mm组颈淋巴结转移率差异均有统计学意义（χ²=8.731，P=0.003；χ²=9.779，P=0.002）。CT所示甲状腺癌结节与甲状腺包膜的关系对淋巴结转移无明显相关性（χ²=0.108，P=0.948）。20例患者伴有颈部淋巴结转移，共检出58枚转移性淋巴结，CT双期增强诊断的准确率为91.74%，敏感度为80.30%，特异度为96.71%；转移性、良性淋巴结动、静脉期CT值强化程度存在差异（Z=2.995，P=0.002 7），动脉期与平扫差值和静脉期与平扫差值也存在差异（Z=4.548，P < 0.001）。结论：甲状腺癌结节直径> 10 mm是颈部淋巴结转移的重要危险因素。CT双期增强可明显提高对甲状腺乳头状癌颈部淋巴结转移诊断的准确率，尤其动脉期的高敏感性、高特异性，更能发现微小的转移性淋巴结。

Objective:To explore the correlation between thyroid papillary carcinoma and cervical lymph nodes metastasis,and CT dual-phase enhancement characteristics of lymph node metastasis. Methods:Forty primary thyroid papillary carcinoma cases confirmed by surgery and pathology and 1 relapsed case were enrolled, 20 of whom were accompanied by cervical lymph node metastasis. The relationship between the size of thyroid cancer nodule and thyroid capsule, and lymph node metastasis was investigated. The CT dual-phase enhancement characteristics of lymph node metastasis was observed,and the CT attenuation different between metastatic lymph node movement, venous stage and benign lymph node were analyzed to improve the diagnosis of metastatic lymph nodes. Results:43 thyroid papillary carcinoma nodules with progressive reinforcement in 41 cases, cancer nodules showed progressive enhancement; There was a significant differences of lymph node metastasis between group of thyroid cancer nodule diameter>10 mm, group of diameter ≤ 5 mm and group of 5 mm < diameter ≤ 10 mm(χ²=8.731, P=0.003; χ²=9.779, P=0.002). There was no obvious correlation between thyroid cancer nodule and thyroid capsule to lymph node metastasis in CT(χ²=0.108, P=0.948).A total of 58 cervical metastatic lymph nodes were detected in 20 patients. The accuracy of CT dual-phase enhancement diagnosis was 91.74%,the sensitivity was 80.30%, the specificity was 96.71%.There were statistical differences in the enhancement degree of CT between metastatic and benign lymph nodes(Z=2.995, P=0.002 7).There were statistical differences between the D-value of arterial period and scan and the D-value of venous phase and scan(Z=4.548, P < 0.001). Conclusion:The diameter of the thyroid cancer nodule>10 mm is an impotent hazard for cervical lymph node metastasis. CT double-phase enhancement can significantly improve the accuracy of thyroid papillary carcinoma in the diagnosis of cervical metastatic lymph nodes. In particular, the high sensitivity and specificity of arterial period can detect small metastatic lymph nodes.

参考文献：

[1] STEWART B W,WILD C.World cancer report 2014[M].Switzerland:WHO,2014:630.
[2] QU N,ZHANG L,JI Q H,et al.Risk factors for central compartment lymph node metastasis in papillary thyroid microcarcinoma:a meta-analysis[J].World J Surg,2015,39:2459-2470.
[3] 李晓景,杨乐,马斌林.1988例甲状腺微小乳头状癌颈部中央区淋巴结转移危险因素分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):52-56.
[4] 徐伟,梅天明,陈家更.超声与增强CT对甲状腺癌发生中央区淋巴结转移患者的诊断效果[J].中国CT和MRI杂志,2017,15(3):39-41.
[5] LESNIK D,CUNNANE M E,ZURAKOWSKI D,et al.Papillary thyroid car-cinoma nodal surgery directed by a preoperative radiographic maputilizing CT scan and ultrasound in all primary and reoperative patients[J].Head Neck,2014,36(2):191-202.
[6] YEH M W,BAUER A J,BERNET V A,et al.American Thyroid Association statement on preoperative imaging for thyroid cancer surgery[J].Thyroid,2015,25(1):3-14.
[7] HAUGEN B R,ALEXANDER E K,BIBLE K C.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid,2016,26(1):1-33.
[8] 班允清,杨进军,刘艳.双能量扫描对正常成人甲状腺能谱及辐射剂量的影响[J].中华放射医学与防护杂志,2016,36(4):308-311.
[9] 韩志江,包凌云,陈文辉.甲状腺及甲状腺旁腺病变影像比较诊断学[M].北京:人民卫生出版社,2016:147.
[10] 孙荣昊,李超,樊晋川,等.肿瘤位置等临床病理特征与分化型甲状腺癌淋巴结转移的关系[J].肿瘤防治研究,2014,41(9):993-997.
[11] YING M,BHATIA K S,LEE Y P,et al.Review of ultrasonography of malignant neck nodes:grayscale,Doppler,contrast enhancement and elastography[J].Cancer Imaging,2014,13(4):658-669.
[12] PARK J E,LEE J H,RYU K H,et al.Improved Diagnostic accuracy using arterial phase CT for lateral cervical lymph node metastasis from papillary thyroid cancer[J].AJNR Am J Neuroradiol,2017,38:782-788.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录