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目的 :评价甲状腺显像鉴别诊断甲状腺结节良、恶性的临床价值。方法 :180例甲状腺结节患者行甲状腺99mTcO-4 显像 ,并将其与病理结果进行对比研究。结果 :甲状腺结节显像呈冷结节者 15 8例 ( 87 8% ) ,温结节者 7例( 3 9% ) ,热结节者 3例 ( 1 7% ) ,甲状腺不显影或显影极淡者 12例 (其病理诊断为“亚急性甲状腺炎”) ( 6 7% )。冷结节癌发生率 18 4% ( 2 9/ 15 8例 ) ,1例热结节手术病理诊断乳头状癌 0～ 1级。良、恶性甲状腺结节患者在甲状腺功能及大小上存在显著性差异 ( χ2 =5 70 ,11 49;P <0 0 5 ) 2 0岁以下患者发生癌变的比率较大 ( χ2 =7 0 7;P <0 0 5 )。甲状腺良性病变 15 0例 ,其中 5 4例伴囊性变 ,囊变率 3 6 % ;甲状腺癌 3 0例 ,仅 2例伴囊性变 ,囊变率 6 7%。结论 :甲状腺显像仅从影像特征去区分甲状腺结节的良、恶性还很困难 ,但可结合临床及其它辅助检查资料作出初步诊断 ,并能避免某些不必要的有创性检查或治疗。
Objective: To evaluate the clinical value of thyroid scintigraphy in differential diagnosis of benign and malignant thyroid nodules. Methods: Thyroid 99mTcO-4 imaging was performed in 180 cases of thyroid nodules and compared with histopathologic results. Results: Thyroid nodular imaging showed 158 cases of cold nodules (87 8%), 7 cases of warm nodules (39%), 3 cases of hot nodules (1 7%), no thyroid imaging or imaging. 12 cases were very dilute (the pathological diagnosis was “subacute thyroiditis”) (6 7%). The incidence of cold nodule cancer was 18 4% (29/158), and 1 case of thermal nodule pathological diagnosis of papillary carcinoma 0 to 1 grade. There was significant difference in thyroid function and size between patients with benign and malignant thyroid nodules (χ2 = 5 70, 11 49; P <0 05). The incidence of canceration was higher in patients under 20 years of age (χ2 = 7 0 7; P <0 0 5 ). Thyroid benign lesions in 150 cases, of which 54 cases with cystic degeneration, cystic degeneration rate of 36%; thyroid cancer in 30 cases, only 2 cases with cystic degeneration, cystic degeneration rate of 6 7%. Conclusion: Thyroid scintigraphy is difficult to discriminate between benign and malignant thyroid nodules only from imaging features, but it can be combined with clinical and other auxiliary examination data to make a preliminary diagnosis, and some unnecessary invasive examinations or treatments can be avoided.