Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2021 Dec 13;16(12):e0261233. doi: 10.1371/journal.pone.0261233. eCollection 2021.
To determine whether dual-energy CT (DECT) has incremental diagnostic value when combined with ultrasound (US) in the diagnosis of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC).
This was a single-center retrospective cohort study of patients diagnosed with PTC between October 2019 and August 2020. US features of LNs to include hyperechogenicity, round shape, microcalcification, cystic component, and homogeneous/peripheral vascularity were considered suggestive of metastasis. The HU of arterial phase (HUarterial) and DECT-derived CT images [contrast media (CM) and areas under the 100 keV monoenergetic curve (AUC100keV)] were measured. Effective atomic numbers (Zeff), iodine concentration (mg/mL), and slope of the HU curve (λHU) were also obtained. The values for metastatic and benign LNs were compared using Student's t-test with false-discovery correction. Logistic regression with areas under the receiver operating characteristic curves (AUCs) were performed for predicting metastatic LNs.
A total of 102 patients were included (49 metastatic and 53 benign LNs; mean age, 46±15 years). Metastatic LNs showed significantly higher values for HUarterial, CM, Zeff, λHU, AUC100keV, and iodine concentration (all, P = 0.001). In logistic regression, the HUarterial demonstrated the highest AUC (0.824; 95% confidence interval [CI], 0.751-0.897), followed by CM HU (0.762; 95% CI, 0.679-0.846). Combination of DECT parameters with US features improved the AUC from 0.890 to 0.941.
Compared to US features alone, combination with DECT-derived quantitative parameters improved diagnostic performance in predicting metastatic cervical LNs in patients with PTC.
探讨双能 CT（DECT）联合超声（US）在诊断甲状腺乳头状癌（PTC）患者转移性颈淋巴结（LNs）中的应用价值。
这是一项单中心回顾性队列研究，纳入 2019 年 10 月至 2020 年 8 月间诊断为 PTC 的患者。LN 的 US 特征包括高回声、圆形、微钙化、囊性成分和均匀/周边血流，这些特征提示转移。测量动脉期（HUarterial）和 DECT 衍生 CT 图像[对比剂（CM）和 100keV 单能曲线下面积（AUC100keV）]的 HU 值。还获得有效原子数（Zeff）、碘浓度（mg/mL）和 HU 曲线斜率（λHU）。采用 Student's t 检验（带错误发现率校正）比较转移性和良性 LNs 的测量值。采用受试者工作特征曲线（AUC）下面积的 logistic 回归分析预测转移性 LNs。
共纳入 102 例患者（49 例转移性 LNs，53 例良性 LNs；平均年龄 46±15 岁）。转移性 LNs 的 HUarterial、CM、Zeff、λHU、AUC100keV 和碘浓度均显著高于良性 LNs（均 P=0.001）。logistic 回归分析显示，HUarterial 的 AUC 最高（0.824；95%CI，0.751-0.897），其次是 CM HU（0.762；95%CI，0.679-0.846）。与单纯 US 特征相比，DECT 参数联合使用可提高预测 PTC 患者转移性颈 LNs 的 AUC 从 0.890 至 0.941。
与单纯 US 特征相比，联合 DECT 衍生的定量参数可提高预测 PTC 患者转移性颈 LNs 的诊断性能。
