CT增强扫描密度测量在甲状旁腺腺瘤、甲状腺和淋巴结鉴别诊断中的临床意义

Value of CT Density Measurements in Distinguishing Parathyroid Adenoma,Thyroid,and Lymph Node

目的通过多期计算机断层增强扫描对甲状旁腺腺瘤、淋巴结及甲状腺进行鉴别诊断。方法分析21例甲状旁腺腺瘤患者的多层螺旋CT增强扫描检查结果,并对其术后的病理标本进行研究。在多层螺旋CT检查过程中,记录CT平扫(D0)及增强扫描造影剂注入后35 s(D35)与65 s(D65)后甲状旁腺腺瘤、淋巴结和甲状腺在3个不同阶段的密度。结果 D0期甲状旁腺腺瘤ct值[(45±12)HU]与甲状腺实质[(90±15)HU]差异有统计学意义(P=0.007);ROC曲线表明,75 HU是区分甲状旁腺腺瘤和甲状腺实质密度的界值,敏感性和特异性均为95.2%。注射对比剂35 s后,甲状旁腺腺瘤的强化程度明显高于淋巴结[(182±39)HU比(80±20)HU,P=0.004];ROC曲线表明,111 HU是区分甲状旁腺腺瘤和淋巴结密度的界值,敏感性和特异性均为95.2%。注射对比剂35 s至65 s,甲状旁腺腺瘤密度下降52 HU,而淋巴结密度升高13 HU,与甲状旁腺腺瘤密度降低差异有统计学意义(P=0.008)。结论增强CT不同时段测量密度可以区分甲状旁腺腺瘤、淋巴结和甲状腺。

Objective To explore the value of multi-phase contrast-enhanced computed tomography in the differential diagnosis of parathyroid adenoma, lymph node, and thyroid. Methods The enhanced multi- slice CT （MSCT） results of 21 parathyroid adenoma patients were analyzed, and their postoperative pathological specimens were examined. During the MSCT, the plain CT scan was recorded, along with the density of thyroid adenoma, lymph nodes, and thyroid at 35 s and 65 s （ DO, D35, D65 ） following the injection of contrast medi- um. Results During the DO phase, there was significant difference in CT values between the parathyroid adeno- maandthyroidparenchyma [ （45±12） HUvs. （90±15） HU, P=0.0071 According to ROC curve, 75 HU, with 95.2% sensitivity and specificity, was the critical value for distinguishing the density of parathy- roid adenoma and that of thyroid parenchyma. At 35 s following the injection of contrast medium, there was sig-nificant difference in the enhancement degree between parathyroid adenoma and lymph node [ （182± 39） HU vs. （80± 20） HU, P = 0. 004 ] . According to ROC curve, 111 HU, with 95.2 % sensitivity and specifici- ty, was the critical value for distinguishing the density of parathyroid adenoma and that of lymph node 35 s fol- lowing the injection of contrast medium. At 35 s to 65 s following the injection of contrast medium, the parathy- roid adenoma experienced a decline in density, which was dramatically different from parathyroid adenoma, how- ever, lymph node experienced a rise in density. Conclusion Enhanced CT measurements at different time points enable the differentiation among parathyroid adenomas, lymph nodes, and thyroid.