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分化型甲状腺癌肺转移的CT影像学表现分析

作者:曹 丽

所属单位:中国核工业北京四0一医院放射科 (北京 102413)

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摘要

目的 探讨CT检查在分化型 甲状腺癌(differentiated thyroid carcinoma,DTC)肺转移中的表现及诊治 价值。方法 回顾性分析121例DTC患者临 床资料,均经CT引导下穿刺活检或外科手 术病理检查确诊,接受胸部CT检查。记 录并分析CT检查对DTC肺转移的诊断敏感 性、特异性和准确性,观察肺转移患者的 CT表现特点。结果 此次入组的121例DTC 患者经穿刺活检或手术病理检查确诊肺 转移9例,所占比例为7.4%;CT检查正确 诊断肺转移6例,正确诊断非肺转移100 例,胸部CT检查对DTC肺转移的诊断敏感 性、特异性和准确性分别为66.7%(6/9)、 89.3%(100/112)和87.6%(106/121);6例 CT正确诊断肺转移患者均显示病灶直径均 >3mm,其中病灶为3-5mm者3例,病灶超过 5mm者3例;图像可见多个大小不等的圆 形、粟粒形结节或肿块影,结节灶密度较 均匀且边界多较为清晰,大部分分布于双 侧肺中、下野外带。结论 胸部CT检查可 作为辅助诊断DTC肺转移的有效手段应用 于临床诊疗工作中,为后续针对性治疗工 作的顺利开展提供依据。

Objective To investigate the findings and diagnostic value of CT in pulmonary metastasis of differentiated thyroid carcinoma. Methods The clinical data of 121 patients with DTC were retrospectively analyzed. All were confirmed by CT guided biopsy or surgical pathology and underwent chest CT examination. The sensitivity, specificity and accuracy of CT examination in the diagnosis of DTC with pulmonary metastasis were recorded and analyzed and the CT findings of patients with pulmonary metastasis were observed. Results Among the 121 cases of DTC patients, 9 cases were diagnosed with pulmonary metastasis by biopsy or surgical pathology, accounting for 7.4%; 6 cases with pulmonary metastasis and 100 cases of non-pulmonary metastasis were correctly diagnosed by CT. The sensitivity, specificity and accuracy of chest CT for DTC with pulmonary metastasis were 66.7% (6/9), 89.3% (100/112) and 87.6% (106/121), respectively; 6 patients with pulmonary metastasis diagnosed by CT showed that the diameter of the lesions was >3mm, including 3 cases with lesions of 3-5mm and 3 cases larger than 5mm; The images showed multiple different sizes of circular, miliary nodules or masses. The nodules density was homogeneous and the boundaries were clear, most of them distributed in the bilateral lung and outside the inferior field. Conclusion Chest CT examination can be used as an effective method for the clinical assistant diagnosis and treatment of DTC with pulmonary metastasis and provide basis for the successful development of the follow-up treatment.

【关键词】CT;分化型甲状腺癌;肺转移;影像学表现

【中图分类号】R445.3;R736.1

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.07.011

前言

甲状腺癌根据组织学可大致分为分化型和未分化型两类。据不完 全资料统计,分化型甲状腺癌以中年女性和儿童为主要发病群体,男 女发病比例为1:2.5[1]。尽管DTC恶性程度较低,积极治疗后5年存活 率可达到95%以上,但仍有研究证实,该恶性肿瘤存在一定的复发及 转移风险,肺部、淋巴器官、骨骼等均为其常见转移位置[2],可影响 131I方案的拟定及整体临床疗效,对患者预后提升不利。当前临床诊 断DTC患者有无肺转移的常规手段为131I全身显像、血清甲状腺球蛋白 (Tg)、胸部X线摄片、胸部CT扫描等[3],诊断准确性、经济价值、所耗 时长、临床适用范围等均存在差异。本次研究从最常规的胸部CT检查 着手,回顾性分析121例确诊DTC患者临床资料,以探讨CT检查在DTC肺 转移中的表现及诊治价值,现报告如下。