CT环状钙化对甲状腺结节鉴别诊断效果的ROC曲线评价

The value of CT annular calcification in identifying benign and malignant thyroid nodules

目的探讨CT环状钙化对甲状腺结节鉴别诊断效果,并行ROC曲线评价,为甲状腺结节诊治提供参考。方法共纳入85例该院甲状腺CT显示甲状腺结节环状钙化的患者作为研究对象,所有患者均行CT平扫、增强检查,并以手术及病理结果为金标准,评价CT环状钙化对甲状腺结节良恶性的诊断价值。结果 85例患者根据病理结果发现良性结节65例,占76.5%,恶性结节20例,占23.5%。恶性结节单个结节比例明显高于良性结节,差异有统计学意义(P<0.05)。以病理诊断为金标准;单独诊断良性结节:高强化灵敏度为90.0%,特异度为92.0%,阳性似然比为0.96,阴性似然比0.79。增强后边缘清晰灵敏度为81.7%,特异度为60.0%,阳性似然比为0.83,阴性似然比0.58;联合诊断良性结节:行并联公式计算显示,灵敏度为98.2%,特异度为55.2%;串联公式计算显示,灵敏度为73.5%,特异度为96.8%。结论环状钙化CT增强后高强化与增强后边缘清晰对甲状腺结节的良恶性有较好的鉴别诊断价值,早期鉴别良恶性结节,可以更好的给予相应的治疗措施,值得临床推广应用。

【Objective】To evaluate the value of CT annular calcification in the diagnosis and differential diagnosis for benign and malignant thyroid nodules.【Methods】85 patients pathologically diagnosed as annular calcifications with CT were retrospectively analyzed.The interior or boundaries of annular calcification before and after contrast-enhancement were compared, and the degree of enhancements of both interior annular calcification and thyroid tissues were observed. After contrast-enhancement, the numbers of lesions showing clearer boundaries and higher degree of enhancement were summarized. 【Results】There were 65 patients with benign nodules in 85 patients, accounting for 76.5%, 20 patients with malignant nodules, accounting for 23.5%. The percentage of single nodule percentage in malignant nodules was significantly higher than that in benign nodules. The difference was statistically significant（P〈0.05）. The sensitivity and specificity of higher degree of enhancement were 90.0%, 92.0%, respectively. The positive likelihood ratio was 0.96, negative likelihood ratio was 0.79. The sensitivity and specificity of clearer boundaries after contrast-enhancement were 81.7%, 60.0%, respectively. The positive likelihood ratio was 0.83, negative likelihood ratio was 0.58. The sensitivity and specificity of Joint diagnosis parallel were 98.2%, 55.2%, respectively. The sensitivity and specificity of Joint diagnosis series were 73.5%, 96.8%, respectively.【Conclusion】CT is important in the diagnosis of thyroid nodules with annular calcification. Clearer boundary after contrast-enhancement and its combination with higher degree of enhancement are helpful for the diagnosis of benign nodules. Boundaries that similar to or more obscure than that of plain scan indicate malignant nodules.