Yao Chun, Chen Xiaofeng, Yang Zhiqi, Huang Ruibin, Zhang Sheng, Liao Yuting, Chen Xiangguang, Dai Zhuozhi
Department of Radiology, Meizhou People's Hospital, Meizhou 514031, China.
Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou 514031, China.
Int J Endocrinol. 2023 Feb 27;2023:8220034. doi: 10.1155/2023/8220034. eCollection 2023.
Gemstone spectral contrast-enhanced CT with virtual noncontrast (VNC) images and iodine maps can potentially reduce the number of required CT scans for thyroid lesions. However, data regarding the clinical utility of VNC images and iodine maps in characterizing thyroid lesions and distinguishing thyroid papillary carcinoma from nodular goiter are still limited.
To determine whether VNC images and iodine density could reliably aid in characterizing thyroid lesions and distinguishing thyroid papillary carcinoma from nodular goiter compared with true noncontrast (TNC) images.
This retrospective study included patients with thyroid papillary carcinoma or nodular goiter who underwent TNC and contrast-enhanced gemstone spectral CT scans. The consistency of qualitative parameters, including intralesional calcification, necrosis, lesion boundary, thyroid edge interruption, and lymph node metastasis, between TNC and VNC images, was analyzed using the kappa statistic. TNC attenuation, VNC attenuation, absolute attenuation between TNC and VNC, and iodine density were compared between thyroid papillary carcinoma and nodular goiter by using Student's -test. The diagnostic performance for distinguishing papillary carcinoma from nodular goiter was evaluated by using the area under the receiver operating characteristic curve (AUC) value, sensitivity, and specificity.
VNC and TNC imaging showed comparable performance in delineating calcification, necrosis, lesion boundary, thyroid edge interruption, and lymph node metastasis (all > 0.75). Papillary carcinoma showed significantly lower absolute attenuation between VNC and TNC than nodular goiter (7.86 ± 6.74 vs. 13.43 ± 10.53, =0.026), which was similarly observed for iodine density (31.45 ± 8.51 vs. 37.27 ± 10.34, =0.016). The iodine density showed higher diagnostic performance (AUC = 0.727), accuracy (0.773 vs. 0.667), sensitivity (0.750 vs. 0.708), and specificity (0.786 vs. 0.643) than the absolute attenuation between TNC and VNC images (AUC = 0.683).
VNC imaging, a promising substitute for TNC imaging, has comparable diagnostic efficacy for reliably characterizing thyroid lesions. Iodine density could be valuable for distinguishing thyroid papillary carcinoma from nodular goiter.
宝石光谱对比增强CT的虚拟平扫（VNC）图像和碘图有可能减少甲状腺病变所需的CT扫描次数。然而，关于VNC图像和碘图在甲状腺病变特征描述以及鉴别甲状腺乳头状癌与结节性甲状腺肿方面的临床应用数据仍然有限。
与真实平扫（TNC）图像相比，确定VNC图像和碘密度是否能可靠地辅助甲状腺病变特征描述以及鉴别甲状腺乳头状癌与结节性甲状腺肿。
这项回顾性研究纳入了接受TNC和对比增强宝石光谱CT扫描的甲状腺乳头状癌或结节性甲状腺肿患者。使用kappa统计分析TNC和VNC图像之间定性参数的一致性，包括病灶内钙化、坏死、病灶边界、甲状腺边缘中断和淋巴结转移。通过Student's t检验比较甲状腺乳头状癌和结节性甲状腺肿之间的TNC衰减、VNC衰减、TNC和VNC之间的绝对衰减以及碘密度。使用受试者操作特征曲线（AUC）下面积、敏感性和特异性评估鉴别乳头状癌与结节性甲状腺肿的诊断性能。
VNC和TNC成像在描绘钙化、坏死、病灶边界、甲状腺边缘中断和淋巴结转移方面表现相当（均>0.75）。乳头状癌的VNC和TNC之间的绝对衰减明显低于结节性甲状腺肿（7.86±6.74 vs. 13.43±10.53，P = 0.026），碘密度情况类似（31.45±8.51 vs. 37.27±10.34，P = 0.016）。碘密度的诊断性能（AUC = 0.727）、准确性（0.773 vs. 0.667）、敏感性（0.750 vs. 0.708）和特异性（0.786 vs. 0.643）均高于TNC和VNC图像之间的绝对衰减（AUC = 0.683）。
VNC成像作为TNC成像有前景的替代方法，在可靠地描述甲状腺病变方面具有相当的诊断效能。碘密度对于鉴别甲状腺乳头状癌与结节性甲状腺肿可能有价值。
