MSCT灌注技术鉴别诊断甲状腺良恶性病变

MSCT perfusion technique in differential diagnosis of benign and malignant thyroid diseases

目的探讨MSCT灌注技术鉴别诊断甲状腺良恶性病变的价值。方法纳入经手术病理证实的甲状腺病变患者69例,分为良性组(58例,包括甲状腺腺瘤亚组36例和结节性甲状腺肿亚组22例)及恶性组(11例,均为甲状腺癌);另选取健康志愿者14名作为对照组。对所有受检者行常规CT平扫及动态增强扫描,采用灌注分析软件处理图像,获得时间-密度曲线(TDC)及血流量(BF)、峰值增强程度(PEI)、达峰时间(TTP)和血容量(BV),比较各组间TDC形态及灌注参数差异。绘制各灌注参数鉴别诊断甲状腺良恶性病变的ROC曲线,计算各指标诊断甲状腺癌的敏感度、特异度及ROC曲线下面积(AUC)。结果对照组TDC以速升速降为主,恶性组TDC以缓升缓降为主,良性组TDC表现为多种类型。恶性组BF和PEI低于对照组和良性组(P均<0.05)、BV低于良性组(P均<0.05),TTP大于对照组及甲状腺腺瘤亚组(P均<0.05)。以0.89ml/(min·g)为界值,BF诊断甲状腺癌的敏感度为91.3%,特异度为79.1%,AUC=0.877。结论多层螺旋CT灌注技术可通过测量灌注参数鉴别诊断甲状腺良恶性病变,具有重要应用价值。

Objective To explore the value of MSCT perfusion technique in differential diagnosis of benign and malignant thyroid diseases. Methods Sixty-nine patients with thyroid diseases confirmed by postoperative pathology were classified into benign group （n=58, including 36 thyroid adenoma and 22 nodular goiter） and malignant group （thyroid carcinoma, n= 11）. Fourteen healthy volunteer were selected as control group. All the subjects underwent regular and dynamic enhanced MSCT scanning. The time-density curve （TDC）, blood flow （BF）, peak enhancement （PEI）, time to peak （TTP） and blood volume （BV） were obtained by postprocessing of CT perfusion imaging using perfusion software. ROC curve of each perfusion parameter in differentially diagnosing benign and malignant thyroid diseases was drawn, and the sensitivity, specificity and area under curve （AUC） were calculated. Results TDC mainly displayed quick rise and quick fall in control group, and slow rise and slow drop in malignant group. TDC of benign group displayed all above kinds of shape. BF and PEI of malignant group were lower than those in control and benign group （all P〈0. 05）. BV of malignant group was low- er than that of benign group （P〈0.05）. TTP of malignant group was longer than that of control group and thyroid adeno- ma subgroup respectively （both P〈0.05）. The sensitivity and specificity of BF in diagnosing thyroid carcinoma was 91.3% and 79.1% taking 0. 89 ml/（min.g） as cut-off value, and the AUC was 0. 877. Conclusion MSCT perfusion tech- nique can differentially diagnose benign and malignant thyroid lesions through measurement of perfusion parameters, which is of great value.