Value of calcification in CT diagnosis of benign and malignant thyroid nodules
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摘要:
目的 分析甲状腺结节钙化的CT特点，探讨甲状腺结节的钙化特征对其良恶性诊断与鉴别诊断中的价值。 方法 回顾性分析259例277个经病理证实的甲状腺钙化结节的CT特点，重点观察结节钙化的大小、边缘、位置及数量。 结果 纳入259例患者，年龄16~84岁（54.73±12.43岁），男性66例，女性193例。总277个钙化结节，良性钙化结节205个，占总钙化结节74.01%，恶性钙化结节72个，占总钙化结节25.99%。边缘毛糙、微小钙化（直径<2 mm）的恶性率明显高于边缘光滑、粗大结节样的钙化组（χ2=13.669~13.950，P<0.001）。边缘毛糙、细颗粒微钙化对恶性结节诊断的敏感度分别为30.56%、59.72%，特异度分别为88.29%、65.36%，准确度分别为73.29%、63.90%，阳性预测值分别为47.83%、37.72%，阴性预测值分别为78.35%、82.21%。良恶性结节平均年龄差异具有统计学意义（t=4.452，P<0.001）。良恶性钙化结节在位置、数量、形状及性别之间差异无统计学意义（P>0.05）。 结论 MSCT检查甲状腺结节钙化特点对鉴别甲状腺良恶性病变有重要指导意义，微钙化、钙化结节边缘毛糙提示恶性结节，临床医生对这类结节应提高警惕并应进一步细针穿刺检查。 Abstract:Objective To investigate the diagnostic value of X-ray computed tomography detection for calcification in benign and malignant thyroid nodules. Methods A total of 277 thyroid calcification nodules confirmed either by surgery or histopathological examination in 259 cases were evaluated.The size, margin and quantity of nodular calcification were observed. Results In 277 calcified nodules,there were 205 benign calcified nodules (74.01%) and 72 malignant calcified nodules (25.99%) in 66 males and 193 females.The average age was 54.73 ±12.43 years. Overall, the malignant rate in patients with microcalcification (<2 mm in diameter) and margin calcification was significantly higher than the smooth edge in coarse calcification group (χ2=13.669~13.950, P<0.001). The accuracy, sensitivity, specificity, positive predictive value (PPV)and the negative predictive value (NPV) of microcalcification and marginal rough calcified nodules to diagnosis of malignant nodules were 73.29%, 63.90%, 30.56% and 59.72%, 88.29%, and 65.36%, 47.83% and 37.72%, 78.35% and 82.21%, respectively.In terms of age, the mean age of benign and malignant nodules was significantly different (t=4.452, P<0.001). There was no significant difference in location, quantity, shape and sex between benign and malignant calcified nodules (P>0.05). Conclusion The calcification characteristics of thyroid nodules by MSCT have important guiding significance in differentiating benign and malignant thyroid lesions. Microcalcification and rough calcified nodules with rough edges suggest malignant nodules. Clinicians should be alert to such nodules and further FNA examination should be performed in these patients. -
Key words:
- thyroid nodule /
- thyroid carcinoma /
- calcification /
- tomography /
- X-ray computed
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表 1 良恶性结节钙化征的比较
结节类型 数量（个） 钙化数量 钙化边缘 钙化大小 钙化位置 钙化形状 单发 多发 光滑 毛糙 细 粗 混合 内部 边缘 混合 结节 蛋壳状 环形 良性 205 84 121 181 24 35 134 36 51 99 55 140 25 14 恶性 72 27 45 50 22 20 29 23 27 34 11 39 4 9 χ2 - 0.268 13.669 13.950 6.012 4.959 P - 0.605 <0.001 0.001 0.05 0.084 
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