Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Eur J Radiol. 2024 Sep;178:111623. doi: 10.1016/j.ejrad.2024.111623. Epub 2024 Jul 14.
To determine the optimal virtual monochromatic images (VMIs) from dual-layer spectral detector computed tomography for the visualization and diagnosis of metastatic lateral cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC).
Ninety-five lateral cervical LNs (49 metastatic and 46 non-metastatic) derived from 24 patients (16 females; mean age, 40.0 ± 13.4 years) were included. 40-100 kiloelectron voltage (keV) VMIs, 120 keV VMI and conventional 120 kV peak (kVp) polyenergetic image (PI) were reconstructed. Five-point scale of subjective image quality, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of LNs were assessed and compared among each VMI and 120 kVp PI. Receiver operating characteristic (ROC) curves and Delong tests were used to assess and compare the diagnostic efficacy of arterial enhancement fraction (AEF) based on each VMI and 120 kVp PI.
40 keV VMI showed significantly higher SNR and CNR in both arterial and venous phases, and better image quality in arterial phase than 70-100 keV VMIs, 120 keV VMI, and 120 kVp PI (all p < 0.05). In all sets of images, AEF values of metastatic LNs were significantly higher than those of non-metastatic LNs (all p < 0.05). When using AEF value of 40 keV VMI to diagnose metastatic lateral cervical LNs, an area under ROC curve (AUC) of 0.878, sensitivity of 87.8 % and specificity of 80.4 % could be obtained, while the AUC of AEF value of 120 kVp PI was 0.815 (p = 0.154).
40 keV VMI might be optimal for displaying and diagnosing the metastatic lateral cervical LNs in patients with PTC.
确定双层光谱探测器 CT 虚拟单色图像（VMIs）的最佳参数，以用于可视化和诊断甲状腺乳头状癌（PTC）患者转移性颈侧淋巴结（LNs）。
纳入 24 例（16 例女性；平均年龄 40.0±13.4 岁）患者的 95 个颈侧 LN（49 个转移性，46 个非转移性）。重建 40-100keV VMIs、120keV VMI 和传统 120kV 峰值（kVp）多谱图像（PI）。评估和比较每个 VMIs 和 120kVp PI 的 5 分制主观图像质量评分、LN 的信噪比（SNR）和对比噪声比（CNR）。使用受试者工作特征（ROC）曲线和 Delong 检验评估和比较基于每个 VMIs 和 120kVp PI 的动脉增强分数（AEF）的诊断效能。
40keV VMI 在动脉期和静脉期均显示出更高的 SNR 和 CNR，且在动脉期的图像质量优于 70-100keV VMIs、120keV VMI 和 120kVp PI（均 p<0.05）。在所有图像组中，转移性 LNs 的 AEF 值均显著高于非转移性 LNs（均 p<0.05）。当使用 40keV VMI 的 AEF 值诊断颈侧转移性 LN 时，ROC 曲线下面积（AUC）为 0.878，敏感性为 87.8%，特异性为 80.4%，而 120kVp PI 的 AUC 为 0.815（p=0.154）。
40keV VMI 可能是显示和诊断 PTC 患者颈侧转移性 LN 的最佳参数。
