【摘要】 目的探讨分化型甲状腺癌转移淋巴结的MRI成像特点及淋巴结的转移规律。方法选取甲状腺癌患者43例,术前均行颈部MRI检查,标记可疑转移淋巴结,按颈部分区定位。同期行颈清扫术并将淋巴结分区送病理检查,MRI标记的可疑淋巴结做病理对照,记录术后颈清扫标本中转移淋巴结的数量及其在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的分布,将所得数据进行统计学分析。结果术前MRI标记阳性淋巴结210枚,术后病理证实194枚,阳性率为92.4%。手术标本中阳性淋巴结285枚,病理证实的MRI标记阳性的淋巴结占手术标本中阳性淋巴结的比例为68%(194/285);转移淋巴结在颈部Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的阳性率间差异有统计学意义(P<0.05),在Ⅵ区的阳性率最高,在Ⅴ区的阳性率最低。结论(1)MRI对转移淋巴结的鉴别有较高的灵敏度,在甲状腺癌颈部淋巴转移的诊断中具有重要的价值。(2)颈Ⅵ区是分化型甲状腺癌的颈部淋巴转移的重要部位,对分化型甲状腺癌患者,无论有无颈部淋巴转移,对颈Ⅵ区进行清扫十分必要。(3)分化型甲状腺癌的颈部淋巴转移为多分区分布,Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主要的转移部位;对cN+的分化型甲状腺癌患者,应进行包括Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的改良性颈清扫术。更多还原

【Abstract】 Objective To analyze the MRI manifestations and the distribution of lymph nodes metastases in patients with well-differentiated thyroid carcinoma(TC).Methods Forty-three TC patients were given pre-operative MRI examination of cervical parts,to mark and localize the suspicious metastatic lymph nodes based on neck zonation.And radical neck dissection was performed,and pathological examinations were done on the dissected lymph nodes.The marked suspicious lymph nodes were compared pathologically.The number of metastatic lymph nodes of the samples and their distributions in areas Ⅱ,Ⅱ,Ⅳ,Ⅴ,Ⅵ were recorded,and the obtained data were analyzed statistically.Results The positive rate of MRI marked lymph nodes was 92.4%(194/210),the pathological detection rate of lymph nodes metastases was 68%(194/285);There was significant difference in positive rate between areas Ⅱ,Ⅱ,Ⅳ,Ⅴ,Ⅵ(P<0.05),the positive rate was the highest in Ⅵ area,the lowest in Ⅴ area.Conclusion 1.MRI,highly sensitive in identification of metastatic lymph nodes,is of important value in diagnoses of lymph node metastasis of thyroid cancers.2.Ⅵ area is an important part of neck lymph node metastasis of well-differentiated TC,and it is necessary for differentiated TC patients(with or without lymph node metastasis) to do neck dissection.3.Neck lymph node metastases of well-differentiated TC are distributed in various areas,with areas Ⅱ,Ⅲ,Ⅳ,Ⅵ as main parts;modified neck dissection should be done in areas Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ in cN+ differentiated TC patients.更多还原