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At present, CR scanners for the diagnosis of thyroid lesions have been widely used, especially for thyroid tumors where CR qualitative diagnosis is more accurate but not very common. In this paper, we present a preliminary analysis of CR diagnoses of 21 cases of thyroid tumors from our hospital.
1 Data and Method
1.1 In this group of 21 cases of thyroid tumors, CR diagnosed 14 cases as thyroid adenomas, 6 cases as thyroid carcinomas, and 1 case was indeterminate in qualitative diagnosis. Confirmed by surgery and pathology, there were 12 cases of thyroid adenoma and 7 cases of thyroid carcinoma. Among the 21 cases, there were 6 males and 15 females. The maximum age was 74 years, the minimum age was 30 years, with an average age of 40.7 years old. All patients had neck masses; 10 patients experienced palpitations, and 3 cases had difficulty breathing.
1.2 Scanning was performed using a SIEMENS ARC CI scanner. The patient lay supine with hyperextended necks, scanning started thickly from the thyroid cartilage down to the cervical root continuously until the thyroid scan was completed. The scanning time was 5 seconds. In 13 cases only scans were performed, while in 8 cases, after a bolus injection of 80ml of 60% meglumine diatrizoate, enhancement scanning was conducted.
2 Performance
2.1 Thyroid Adenoma (n = 14): In this group of 14 patients with adenomas, different degrees of increase in thyroid morphology were observed. There were 9 cases on the right side and 5 cases on the left side. In circular or oval areas, low-density regions were visible, with Cr values ranging from 40 to 50Hu. The edges were clear. In 3 cases, punctate calcification was visible. In 1 case, an enlarged thyroid with low-density area showing a cystic lower density range was seen, with clear edges and Cr values between 15 - 19Hu. Atypical adenomas of the thyroid showed mild increases, uneven slightly low-density zones were observed, the edges were fuzzy, but the boundary between the thyroid and surrounding soft tissues was clear without infiltration or lymph nodes.
2.2 Thyroid Cancer (n = 7): In 6 cases, the thyroids were significantly increased, while in 1 patient, it was mildly increased. Among these, in 2 cases, downward growth spurted towards the pleura. Scans of all 7 cases showed enlargement of the thyroid with non-uniform mixed density or slightly low-density ranges, with Cr values of 50 - 60Hu, blurred contours and edges. In 2 cases, punctate calcifications within the tumor were visible, which have not been reported in literature as eggshell calcifications. In 6 patients, after enhancement, irregular mild aggrandizement was observed with Cr M D values of 70 - 80Hu, the boundaries of the tumor tissue and the thyroid gland along with surrounding soft tissues were fuzzy. In 2 cases, ipsilateral lymphadenopathy was shown, and in 5 cases, tracheal compression was observed.
3 Discussion
3.1 Value of CR Diagnosis for Thyroid Tumors: Normally, the thyroid gland is located anterolaterally to the larynx and trachea, shaped like a butterfly with left and right lobes and a middle isthmus. CR cross-section is triangular, with clear boundaries, uniform density, and significantly higher than surrounding blood vessels, muscles, and soft tissues, with Cr values ranging from 118 to 12Hu #177. The anteroposterior diameter of the thyroid is 2. cI52.25cm. The transverse diameter is 1.85 - 2.00cm, and the vertical diameter is 4 - 5cm. Morphological enlargement and density decrease are mainly indicative of thyroid abnormalities. According to clinical manifestations and isotopic examinations, thyroid abnormalities may be suggested, B-ultrasound can indicate masses, but characterization of thyroid tumors is difficult.
Due to its high-resolution density, CR clearly displays the size and shape of the tumor, internal structure, and surrounding soft tissues. In this group of 14 inverted thyroid adenomas, preoperative CR diagnoses were made. In 14 cases with thyroid enlargement, the maximal tumor Cr expression level was observed. The diameters ranged from 1.2 - 1.5cm in 4 cases, 1.6 - 2.5cm in 7 cases, and 2.6 - 3.5cm in 3 cases. The sizes indicated by CR were essentially the same as those observed during surgery. Among the 14 cases of thyroid adenomas, 13 cases showed substantive and hybrid density, and 1 case showed cystic degeneration, lower than those reported in literature. Among the 14 patients, 13 cases had clear boundaries, and in 1 case, the edge was unclear before enhancement but became visible after lesion enhancement. In 7 cases of thyroid carcinoma, 6 cases were CR-diagnosed before operation, and 1 case had smaller lesions that failed to be qualitatively diagnosed even after contrast scanning. In 2 cases, chest radiographs were initially diagnosed as mediastinal tumors, but CR scanning indicated lesions that were confirmed by surgery as thyroid papillary adenocarcinoma. In 5 cases, due to larger masses, pronounced tracheal compression was observed. CR not only provides qualitative diagnosis for thyroid tumors but also displays the tumor size, whether single or multiple, presence or absence of calcification and lymph node metastasis, and perineural infiltration, providing a basis for clinical operations and treatment plans.
3.2 Differential Diagnosis of Benign and Malignant Thyroid Tumors: Thyroid adenomas are more commonly seen among benign tumors, whereas malignant tumors include thyroid cancer, lymphatic cancer, and sarcoma, which are less frequently encountered.