平扫、增强CT直方图分析对甲状腺良恶性结节的鉴别诊断价值

The value of plain scan and contrast-enhanced computed tomography histogram analysis in the differential diagnosis of benign and malignant thyroid nodules

目的探讨平扫、增强CT直方图分析在甲状腺良恶性结节鉴别诊断中的价值。方法回顾性分析经手术病理证实的甲状腺结节患者53例,其中良性结节16个,恶性结节37个,患者术前均行颈部平扫和增强CT扫描,将图像导入Artificial Intelligent Kit软件,对病灶的最大层面进行勾画,软件自动计算,提取直方图参数:熵、偏度、峰度、SD值,第50、90、95百分位数。采用独立样本的t检验比较甲状腺良恶性结节直方图各参数的差异,并绘制ROC曲线,计算最佳诊断阈值。结果熵在平扫和增强图像中均具有统计学意义,偏度、峰度和第50百分位数均没有统计学意义;SD值,第90、95百分位数只在平扫图像中没有统计学意义,而在增强图像中具有统计学意义。平扫图像中熵的AUC为0.698(95%CI:0.547~0.848),敏感度、特异度分别为43.8%、89.2%,增强图像中熵的AUC为0.841(95%CI:0.705~0.978),敏感度、特异度分别为81.2%、81.1%;增强图像中SD值,第90和95百分位数AUC分别为0.787(95%CI:0.638~0.937)、0.660(95%CI:0.493~0.828)、0.687(95%CI:0.525~0.850),其敏感度、特异度分别为56.2%、97.3%,50%、83.8%和43.8%、91.9%。结论直方图参数对甲状腺良恶性结节鉴别诊断具有一定的参考价值,增强图像对良恶性结节的鉴别诊断有更高的诊断价值,其中第95百分位数的诊断效能较高。

Objective To investigate the diagnostic value of histogram analysis of plain scan and contrast-enhanced computed tomography(CT)scan in the differential diagnosis of benign and malignant thyroid nodules.Methods 53 patients with thyroid nodules confirmed by operation and pathology,including 16 benign nodules and 37 malignant nodules.All patients underwent plain and contrast-enhanced neck CT scan before surgery.The images were imported into Artificial Intelligent Kit software to delineate the maximum level of the lesion,automatically calculated by software,and get the histogram parameters:entropy,skewness,kurtosis,SD,the 50th,90th and 95th percentiles.The t test of independent samples was used to compare the differences in the histogram parameters of benign and malignant thyroid nodules,and the ROC curve was drawn to calculate the optimal diagnostic threshold.Results Entropy was statistically significant in both plain and contrst-enhanced images.The skewness,kurtosis and the 50th percentile showed no statistically significance.SD,the 90th and the 95th percentiles were not statistically significant in the plain image,but significant in the contrast-enhanced images.The AUC of entropy in the plain image was 0.698(95%CI:0.547~0.848),and the sensitivity and specificity were 43.8%and 89.2%,respectively.The AUC of the entropy in the enhanced image was 0.841(95%CI:0.705~0.978),and the sensitivity and specificity were 81.2%and 81.1%.The SD value in the enhanced image,the 90th and 95th percentiles AUC were 0.787(95%CI:0.638~0.937),0.660(95%CI:0.493~0.828),and 0.687(95%CI:0.525~0.850),respectively.The sensitivity and specificity were 56.2%,97.3%,50%,83.8%and 43.8%,91.9%.Conclusion The histogram parameters may certain reference value for the differential diagnosis of benign and malignant thyroid nodules.The enhanced images have a higher diagnostic value for the differential diagnosis of benign and malignant nodules,the 95th percentiles can have higher diagnostic efficiency.