中国中西医结合影像学杂志

目的：探讨超声联合CT增强扫描对甲状腺乳头状癌（PTC）术前颈部淋巴结转移（CLNM）的诊断价值。方法：回顾性选取82例PTC患者，均于术前行超声、颈部CT。以手术病理结果作为判断CLNM的金标准，将患者分为CLNM组（50例）和无CLNM组（32例），分析2组颈部超声、CT增强扫描特征。比较超声、CT检查及两者联合的诊断准确率、敏感度、特异度及符合率。结果：CLNM组钙化、纵横比<2、囊性变及特征性血流占比均高于无CLNM组，淋巴结门占比低于无CLNM组（均P<0.05）。CLNM组囊性病变、侵犯周围组织、Ⅳ区淋巴结直径>5 mm、不均匀强化和明显强化占比均高于无CLNM组（均P<0.05）。超声、CT增强扫描及两者联合诊断CLNM的敏感度分别为74.00%(37/50)、78.00%(39/50)及86.00%(43/50)，特异度分别为75.00%(24/32)、78.12%(25/32)及84.38%(27/32)，准确率分别为74.39%(61/82)、78.05%(64/82)及85.37%(70/82),K值分别为0.420、0.549及0.696。超声、CT增强扫描及两者联合诊断颈中央区及颈侧区转移的符合率比较，差异均无统计学意义（均P>0.05）。结论：超声可有效识别颈内淋巴结钙化、囊性变等特征；CT增强扫描可有效识别淋巴结的囊性病变、侵犯情况等；两者联合用于PTC患者，可提高术前CLNM诊断的敏感度、特异度及准确率，对临床制订、调整PTC治疗方案具有一定指导价值。

Objective:To investigate the diagnostic value of ultrasound combined with contrast-enhanced CT for preoperative cervical lymph node metastasis(CLNM) in papillary thyroid carcinoma(PTC). Methods:A total of 82 PTC patients who underwent preoperative ultrasound and cervical CT scan were retrospectively selected. Taking the surgical pathological results as the gold standard,82 patients were divided into the CLNM group(50 cases) and the non-CLNM group(32 cases). The ultrasonic and cervical CT characteristics of the two groups were analyzed. The diagnostic accuracy,sensitivity,specificity,and consistency rate of ultrasound,CT examination,and their combination were compared. Results:The proportions of calcification,aspect ratio <2,cystic change,and characteristic blood flow in the CLNM group were higher than those in the non-CLNM group,while the proportion of an echogenic hilum was lower(all P<0.05). The proportions of cystic lesions,adjacent tissue invasion,region Ⅳ CLN diameter >5 mm,heterogeneous enhancement and obvious enhancement in the CLNM group were significantly higher than those in the non-CLNM group(all P<0.05). For the diagnosis of CLNM,the sensitivities of ultrasound,contrast-enhanced CT and their combination were 74.00%(37/50),78.00%(39/50) and 86.00%(43/50),the specificities were 75.00%(24/32),78.12%(25/32) and 84.38%(27/32),the accuracies were 74.39%(61/82),78.05%(64/82) and 85.37%(70/82),and the K values were 0.420,0.549 and 0.696,respectively. There were no statistically significant differences in the consistency rates of ultrasound,contrast-enhanced CT or their combination in diagnosing metastases in the central or lateral cervical compartments(both P>0.05). Conclusions:Ultrasound can effectively identify characteristics such as calcification and cystic change of CLN,while contrast-enhanced CT can effectively identify cystic lesions and adjacent tissue invasion. The combination of the two in PTC patients can improve the sensitivity,specificity and accuracy of preoperative CLNM diagnosis,and has certain guiding value for clinical formulation and adjustment of PTC treatment plans.