双源CT平扫碘值联合TSH诊断良恶性甲状腺结节的价值

The Application of Iodine-Enhanced Image of Dual-Source Computed Tomography Combined with the Level of Thyroid Stimulating Hormone in Distinguishing the Benign and Malignant Thyroid Nodules

目的探讨双源CT双能量平扫碘浓度联合血清促甲状腺激素（TSH）诊断良恶性甲状腺结节的价值。方法搜集行双能量CT平扫并经手术病理证实的73个甲状腺结节,其中恶性结节42个,良性结节31个。经双能后处理得到碘图,测量甲状腺结节及周围正常甲状腺组织的碘含量;CT检查之前静脉血测量TSH值,采用t检验比较正常、良性、恶性碘浓度及TSH并利用ROC曲线计算独立诊断及联合诊断的效能。结果良、恶性结节碘值分别为-0.4-1.9 mg/ml（中位数0.8 mg/ml）,-3.1-1.2 mg/ml（中位数-1.6 mg/ml）。鉴别良恶性结节的碘值临界值为0.16 mg/ml时,联合形态学其敏感性为78.57%,特异性为80.65%,准确性为75%。恶性结节TSH（2.53±0.76）μIU/ml显著高于良性结节（1.34±0.51）μIU/ml（t=13.24,P〈0.05）,平扫碘值及形态学联合TSH诊断良恶性甲状腺结节的敏感性为90.48%,特异性为87.10%,准确性为81.65%,高于平扫碘值。结论双源CT平扫碘值及形态学对甲状腺结节良恶性的判断有一定价值,术前测量TSH可作为辅助指标联合判断,提高诊断准确性。

Objective To investigate the clinical application of iodine-enhanced image of dual-source computed tomography（ DSCT） combined with the level of thyroid stimulating hormone in distinguishing the benign and malignant thyroid nodules. Methods Patients with a total of 73 pathology proven thyroid nodules（ 42 malignant,31 benign） underwent dualenergy CT scanning. We calculated Iodine concentration of the thyroid nodules and adjacent normal thyroid tissues. The level of thyroid stimulating hormone in venous blood was detected before CT scanning. And we utilized the receiver operating characteristic（ ROC） curves by SPSS software to select the critical value of the optimum sensitivity and specificity,and compared its consistency with the diagnosis result of traditional morphology. Results The iodine concentration range of malignant nodules were-3. 1 - 1. 2 mg/ml（ median-1. 6 mg/ml）,which was lower than those of benign nodules-0. 4 -1. 9 mg/ml（ median 0. 8 mg/ml）. When using iodine concentration of 0. 16 mg/ml to differentiate malignant thyroid nodules,Combining morphology and capsule of nodules on iodine image,the sensitivity was78. 57%,the specificity was80. 65%,the accuracy was 75%. The TSH level in thyroid cancer patients was（ 2. 53 ± 0. 76） μIU/ml and（ 1. 34 ± 0. 51）μIU/ml in patients with thyroid nodules. The TSH level of patients with thyroid carcinoma was significantly higher than that of patients with thyroid nodules（ t = 13. 24,P〈0. 05）. The iodine concentration and TSH level Combining morphology and capsule of nodules on iodine image,the sensitivity was 90. 48%,the specificity was 87. 10%,the accuracy was 81. 65%.Conclusion Iodine concentration with dual-energy CT scanning combining morphology and capsule of nodules can differentiate malignant from benign thyroid nodules,detect the level of thyroid stimulating hormone can improve the accuracy of diagnosis.