Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Radiology, Hangzhou Ninth People's Hospital, Hangzhou, China.
Front Endocrinol (Lausanne). 2023 Mar 22;14:1103434. doi: 10.3389/fendo.2023.1103434. eCollection 2023.
To evaluate the value of computed tomography (CT) enhancement degree in diagnosing lymph node (LN) metastasis in papillary thyroid carcinoma (PTC) by determining the ratio and difference between the Hounsfield units (HU) of CT enhancement and plain scan of the LNs, as well as between the HU of CT-enhanced LNs and the sternocleidomastoid muscle.
The plain and enhanced CT findings of 114 metastasis-positive LNs in 89 cases and 143 metastasis-negative LNs in 114 cases of PTC were analyzed retrospectively. Plain HU of LNs (PN), enhanced HU of LNs (EN), and enhanced HU of the sternocleidomastoid muscle (EM) were measured. The EN, difference between EN and PN (EN-PN), ratio of EN to PN (EN/PN), difference between EN and EM (EN-EM), and ratio of EN to EM (EN/EM) in metastasis-positive and metastasis-negative LN groups were calculated, the corresponding diagnostic efficacy for differentiating metastasis-positive from metastasis-negative LNs in PTC were sought using the receiver-operating curve. The interobserver agreement between readers was assessed using the interobserver correlation coefficient (ICC).
The EN of 114 metastasis-positive LNs and 143 metastasis-negative LNs was 113.39 ± 24.13 and 77.65 ± 15.93, EN-PN was 65.84 ± 21.72 HU and 34.07 ± 13.63 HU, EN/PN was 2.36 (1.98, 2.75) and 1.76 (1.54, 2.02), EN-EM was 49.42 ± 24.59 HU and 13.27 ± 15.41 HU, and EN/EM was 1.79 ± 0.40 and 1.21 ± 0.24, respectively (all < 0.001). The area under the curve, cutoff value, sensitivity, specificity, and accuracy of EN for identifying metastasis-positive and metastasis-negative LNs were 0.895, 97.3 HU, 0.746, 0.895, and 0.829, EN-PN was 0.894, 47.8 HU, 0.807, 0.874, and 0.844, EN/PN was 0.831, 1.9, 0.877, 0.650, and 0.751, EN-EM was 0.890, 26.4 HU, 0.807, 0.839, and 0.825, and EN/EM was 0.888, 1.5, 0.728, 0.902, and 0.825, respectively. The readers had an excellent interobserver agreement on these five parameters (ICC = 0.874-0.994).
In the preoperative evaluation of LN metastasis in PTC, EN, EN-PN, EN-EM, and EN/EM had similarly high diagnostic efficacy, with EN, EN-PN, and EN/EM having higher specificity and EN-PN and EN-EM having higher sensitivity.
通过测定淋巴结（LN）CT 增强程度的比值和差值，评估 CT 增强程度在诊断甲状腺乳头状癌（PTC）淋巴结转移中的价值，其中比值为增强 CT 扫描的 LN 强化程度（EN）与平扫的 LN 强化程度（PN）之比，差值为增强 CT 扫描的 LN 强化程度与胸锁乳突肌（EM）的强化程度（EN）之差。
回顾性分析 89 例 PTC 患者 114 个转移阳性 LN 和 114 例 PTC 患者 143 个转移阴性 LN 的平扫和增强 CT 表现。测量 LN 的平扫 HU（PN）、增强 HU（EN）和 EM 的增强 HU（EM）。计算转移阳性和转移阴性 LN 组中 EN、EN-PN（EN 与 PN 之差）、EN/PN（EN 与 PN 之比）、EN-EM（EN 与 EM 之差）和 EN/EM（EN 与 EM 之比），并利用受试者工作特征曲线寻找鉴别 PTC 转移阳性与转移阴性 LN 的最佳诊断效能。采用组内相关系数（ICC）评估观察者间的一致性。
114 个转移阳性 LN 和 143 个转移阴性 LN 的 EN 分别为 113.39 ± 24.13HU 和 77.65 ± 15.93HU，EN-PN 分别为 65.84 ± 21.72HU 和 34.07 ± 13.63HU，EN/PN 分别为 2.36（1.98，2.75）和 1.76（1.54，2.02），EN-EM 分别为 49.42 ± 24.59HU 和 13.27 ± 15.41HU，EN/EM 分别为 1.79 ± 0.40 和 1.21 ± 0.24（均 P＜0.001）。EN 鉴别转移阳性与转移阴性 LN 的曲线下面积、截断值、敏感度、特异度和准确度分别为 0.895、97.3HU、0.746、0.895、0.829，EN-PN 分别为 0.894、47.8HU、0.807、0.874、0.844，EN/PN 分别为 0.831、1.9、0.877、0.650、0.751，EN-EM 分别为 0.890、26.4HU、0.807、0.839、0.825，EN/EM 分别为 0.888、1.5、0.728、0.902、0.825。这五个参数的观察者间一致性极好（ICC=0.874-0.994）。
在 PTC 淋巴结转移的术前评估中，EN、EN-PN、EN-EM 和 EN/EM 的诊断效能均较高，其中 EN、EN-PN 和 EN/EM 的特异度较高，EN-PN 和 EN-EM 的敏感度较高。
