双能量CT对甲状腺结节鉴别诊断及甲状腺癌淋巴结转移间接预测的参数：一项回顾性诊断研究
Parameters of dual-energy CT for the differential diagnosis of thyroid nodules and the indirect prediction of lymph node metastasis in thyroid carcinoma: a retrospective diagnostic study.
作者信息
Li Fu, Huang Fuling, Liu Chenmin, Pan Denghua, Tang Xiaoqi, Wen Yan, Chen Zhibai, Qin Yuhong, Chen Junqiang
机构信息
Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
出版信息
Gland Surg. 2022 May;11(5):913-926. doi: 10.21037/gs-22-262.
BACKGROUND
To further investigate the differential diagnosis of thyroid nodules using dual-energy computed tomography (DECT) and explore the relationship between DECT parameters and lymph node metastasis in thyroid carcinoma for clinical practice, especially difficult diagnosis by routine imaging examination.
METHODS
A total of 150 patients with thyroid nodules who underwent preoperative DECT and Thyroid Imaging Report and Data System (TIRADS) classification were enrolled in this study, including 96 patients with malignant tumors and 54 with benign tumors. The DECT parameters were got form regions of interest (ROI) by an experienced radiologist team and thyroid nodules and lymph node status of all patients were identified by cytology and histopathology. Statistical analyses were performed using Student's -test, Chi-squared test, and receiver operating characteristic (ROC) curves.
RESULTS
In the differential diagnosis of benign and malignant thyroid nodules, the optimal iodine concentration (IC) and normalized iodine concentration (NIC) cut-off values were IC (2.835 mg/mL), NIC (0.690), and their corresponding area under the curve (AUC) were 0.940, 0.954 respectively; meantime, the optimal computed tomography (CT) value and slope of the spectral Hounsfield unit curve (λ) cut-off values were 70 keVa (125.05 HU) and λ (1.405), and their corresponding AUC were 0.955, 0.941 respectively. For lymph node status (with or without lymph node metastasis), the optimal IC and NIC thresholds were IC (1.715 mg/mL) and NIC (0.155), and their corresponding AUC were 0.717, 0.720 respectively; meanwhile, the optimal CT value and λ thresholds were 70 keVv (89.635 HU) and λ (1.185), and their corresponding AUC were 0.729, 0.641 respectively.
CONCLUSIONS
Base on our study, we think DECT is useful in differentiating malignant from benign thyroid nodules, which has potential value in the indirect prediction of lymph node metastasis in thyroid carcinoma.
背景
为进一步探讨双能计算机断层扫描（DECT）对甲状腺结节的鉴别诊断价值，并探索DECT参数与甲状腺癌淋巴结转移之间的关系，以应用于临床实践，尤其是常规影像学检查难以诊断的情况。
方法
本研究共纳入150例术前行DECT检查及甲状腺影像报告和数据系统（TIRADS）分类的甲状腺结节患者，其中恶性肿瘤患者96例，良性肿瘤患者54例。由经验丰富的放射科医生团队从感兴趣区（ROI）获取DECT参数，所有患者的甲状腺结节及淋巴结状态均通过细胞学和组织病理学确定。采用Student's -检验、卡方检验和受试者工作特征（ROC）曲线进行统计分析。
结果
在甲状腺良恶性结节的鉴别诊断中，最佳碘浓度（IC）和标准化碘浓度（NIC）的截断值分别为IC（2.835mg/mL）、NIC（0.690），其相应的曲线下面积（AUC）分别为0.940、0.954；同时，最佳计算机断层扫描（CT）值和光谱亨氏单位曲线（λ）的斜率截断值分别为70keV a（125.05HU）和λ（1.405），其相应的AUC分别为0.955、0.941。对于淋巴结状态（有无淋巴结转移），最佳IC和NIC阈值分别为IC（1.715mg/mL）和NIC（0.155），其相应的AUC分别为0.717、0.720；同时，最佳CT值和λ阈值分别为70keV v（89.635HU）和λ（1.185），其相应的AUC分别为0.729、0.641。
结论
基于本研究，我们认为DECT有助于鉴别甲状腺良恶性结节，对甲状腺癌淋巴结转移的间接预测具有潜在价值。
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