摘要
目的探讨CT在甲状腺良性结节（BN）和恶性结节（MN）风险评估中的价值。方法回顾分析经组织学证实的447例461枚MN和484例548枚BN的CT征象，包括结节形态、咬饼征、微钙化、增强后范围缩小／模糊、囊变为主和高强化，通过单因素和多因素对各种CT征象进行统计，计算阳性CT征象在BN、MN结节诊断中的敏感度和特异度。结果单因素和多因素分析显示，结节形态不规则、咬饼征、微钙化、增强后范围缩小／模糊均更常见于MN中[x2、P和OR值分别为（509．263、0．000和5．297）、（504．619、0．000和3．467）、（97．793、0．000和1．730）、（361．967、0．000和5．729）]，而囊变为主和高强化则更常见于BN中[x2、P和OR值分别为（223．208、0．000和7．537）、（65．983、0．000和10．782）]。结节形态不规则、咬饼征、微钙化、增强后范围缩小／模糊诊断MN的敏感度和特异度分别为80．5％和90．0％、74．2％和94．3％、35．6％和90．1％、80．7％和79．4％；囊变为主和高强化对BN诊断的敏感度和特异度分别为42．2％和98．1％、19．0％和97．4％。结论形态不规则、咬饼征、微钙化及增强后范围缩小／模糊是CT评估MN的重要征象，囊变为主和高强化是CT评估BN的重要征象，各种CT征象的诊断效能存在较大差异，多征象联合可提高诊断效能。
Objective To evaluate the value of CT in the risk assessment of thyroid benign nodules （BN） and malignant nodules （MN）. Methods The CT signs of 461 pieces of MN in 447 cases and 548 pieces of BN in 484 cases were retrospectively analyzed, the diagnoses were confirmed by histology, including nodular morphology, cookie bite sign, mierocalcification, enhanced range narrow/blurred, cystic changes and enhanced. The signs of CT were analyzed by univariate and multivariate regression analysis. The positive CT signs were calculated to assess sensitivity and specificity in the diagnosis of BN and MN. Results Univariate and multivariate analysis showed that irregular nodular morphology （ X2 = 509. 263, P 〈 0.001, OR =5. 297）, eookie bite sign （ X2 = 504. 619, P 〈 0. 001, OR = 3.467 ） , mieroealeification （ X2 = 97. 793, P 〈 0. 00l, OR = 1. 730） , enhanced range reduction/blur （ X2 = 361. 967, P 〈 0. 001, OR = 5. 729） were more common in MN. Cysts changes （X2 = 223. 208, P 〈 0.001, OR = 7. 537） and enhancement signs （X2 = 65. 983, P 〈 0. 001, OR = 10. 782） were more common in BN. The sensitivity and speeificity of irregular nodular morphology in the diagnosis of MN were 80. 5% and 90% , those in cookie bite sign were 74. 2% and 94. 3% , mierocaleification were 35.6% and 90. 1% , enhanced range reduetion/ blur were 80. 7% and 79.4%. The sensitivity and specifieity of capsule-based and high-enhanced BN diagnosis were 42.2% and 98. 1% , 19. 0% and 97.4% , respectively. Conclusions Irregular shape, cookie bite sign, mierocaleifieation and enhaneed range of narrowing/blur are signifieant CT signs in the assessment of MN, and eystie ehanges and enhancement are significant CT signs in the evaluation of BN. Thediagnostic efficiency of various CT signs varies greatly, and combination of muhiple CT signs can improve the diagnostic efficiency.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第35期2766-2769,共4页
National Medical Journal of China
基金
基金项目：2013杭州市重大科技创新专项项目（20131813A08）
2015浙江省医药卫生计划项目（2015KYB293）
2016浙江省教育厅科研项目（Y201636958）
2017浙江省公益技术应用研究项目（2017C33180）
