CT能谱曲线结合形态学诊断甲状腺乳头状癌中央组淋巴结转移的价值

Diagnosis of CT Spectrum Curve Combined with Morphology in Central Lymph Node Metastasis of Papillary Thyroid Carcinoma

目的探讨双能量CT能谱曲线与CT形态学联合诊断甲状腺乳头状癌(PTC)中央组淋巴结转移的价值。资料与方法 31例PTC术前行颈部双能量CT双期增强扫描,轴位加3D定位标记短径≥5 mm的中央组淋巴结,术中对应取材和标记,CT扫描对应术前标记的淋巴结。分析转移性淋巴结CT形态学并比较动、静脉期原发病灶转移与非转移性淋巴结能谱曲线斜率(K)的差异。根据受试者工作特性(ROC)曲线得出K值临界值及K值结合形态学的诊断效能。结果 31例共获得一一对应的中央组淋巴结73枚,其中转移性淋巴结51枚,非转移性淋巴结22枚。动脉期转移与非转移性淋巴结K值差异无统计学意义(P>0.05),静脉期转移与非转移性淋巴结K值差异有统计学意义(P<0.05)。静脉期K值诊断中央组淋巴结转移的敏感度、特异度分别为62.7%、59.1%,与形态学两者联合诊断淋巴结转移的敏感度为76.5%,特异度为81.8%。结论 CT能谱曲线K值对PTC中央组淋巴结转移的判断具有一定的价值,K值联合CT形态学可提高诊断的准确性。

Purpose To investigate the diagnostic value of dual energy CT spectrum curve combined with CT morphology in central lymph node metastasis of papillary thyroid carcinoma（PTC）. Materials and Methods Thirty-one PTC patients who accepted dual energy CT double-phase enhanced scan before surgery were analyzed. Central lymph nodes with short diameter ≥ 5 mm were labelled using axial plus 3D positioning. Preoperative labelled lymph nodes were collected and marked during operation. The CT morphology of metastatic lymph nodes was analyzed. The spectrum curve slope（K） difference between metastatic and non-metastatic lymph nodes of arterial-phase and venous-phase primary lesion was compared. The critical K value and the diagnostic efficacy of K value combined with morphology were obtained according to receiver operating characteristic（ROC） curve. Results A total of 73 central lymph nodes were obtained from 31 patients, among which 51 were metastatic and 22 were non-metastatic. There was no significant difference in K value between metastatic and non-metastatic lymph nodes of arterial phase group（P〉0.05）. While, there was a significant difference in K value between metastatic and non-metastatic lymph nodes of venous phase group（P〈0.05）. For venous phase, the sensitivity and specificity of the K value in diagnosing central lymph node metastasis were 62.7% and 59.1%, respectively, and combined with morphology, the sensitivity and specificity reached 76.5% and 81.8%, respectively. Conclusion The K value of CT spectrum curve is of certain significance in predicting PTC central lymph node metastasis, and the K value combined with CT morphology can improve the accuracy of diagnosis.