目的 探讨64层螺旋CT平扫、 增强扫描以及灌注成像对甲状腺结节性 病变诊断及鉴别诊断的应用价值。方法 回顾性分析经手术病理证实的甲状腺结 节性病变45例，良性组25例，恶性组20 例。所有病例均在术前行CT常规平扫+灌 注扫描+增强扫描，另外CT灌注测量各兴 趣区的血流量(Blood flow，BF)、Patlak 血容量(Patlak blood volume，P-BV)、 通透性(Permeability，Per)值及生成 时间-密度曲线(Time density curve， TDC)，并各参数进行统计分析。结果 良、恶性结节性病变的形态、边界、内 部囊变发生率、包膜的完整性及肿大淋 巴结的差异具有统计学意义(P<0.05)。 而对于良恶性结节的数目、钙化率无统 计学差异(P>0.05)；组间比较显示甲状 腺良恶性组结节性病变的Per值及TDC差 异具有统计学意义(P<0.05)；良恶性结 节两组间BF、P-BV值差异无统计学意义 (P>0.05)；结论 常规CT平扫、增强扫 描、三维重建、灌注成像能客观反映甲 状腺结节良恶性特征，对临床治疗方案 的选择以及手术方式有重要的指导意义。

Objective To investigate the application value of 64 slice spiral CT plain scan, enhanced scan and perfusion imaging in diagnosis and differential diagnosis of thyroid nodules. Methods 45 cases thyroid nodules(25 benign disease and 20 malignant disease),which were confirmed by surgery and pathology,were analyzed retrospectively. All patients underwent CT plain scan, perfusion scanning and enhanced scan, while the parameters of perfusion such as blood flow (BF), Patlak blood volume (P-BV), permeability (Per)and time-density curve generation (TDC), were measured and statistical analysis. Results The difference of the shape, boundary, internal cyst incidence, membrane integrity and enlarged lymph nodes between Benign and malignant nodules was statistically significant (P<0.05). While the difference of thenumber of nodules and calcification rate was not statistically significant(P>0.05). The inter-group comparison displayed that therewas statistically significant difference in Per value and TDC between benign and malignant nodules (P<0.05), then there was no significant difference between benign group and malignant group in BF and P-BV value (P>0.05). Conclusion The routine CT plain scan, enhanced scan, and perfusion imaging can reflect the characteristics of benign and malignant thyroid nodules, which has an important guiding significance for clinical treatment and the choice of surgical approach.