MRI联合多排螺旋CT诊断甲状腺乳头状癌甲状腺外侵犯的价值

Value of magnetic resonance imaging combined with multiple-detector CT in diagnosis of extrathyroid invasion in papillary thyroid carcinoma

目的探讨MRI联合多排螺旋CT(MDCT)检查在甲状腺乳头状癌(PTC)的甲状腺外侵犯(ETE)中的诊断价值。方法选取进行手术切除的PTC患者80例作为研究对象,根据术后病理诊断结果将患者分为非ETE组(46例)和ETE组(34例)。所有患者在术前均行MRI常规检查、动态增强扫描和弥散加权成像(DWI)序列扫描,获得表观弥散系数(ADC)、分布扩散系数(DDC)及拉伸因子(α)值。结果ETE组患者ADC、DDC及α值均低于非ETE组患者(P<0.05)。ETE组患者PS/ES值低于非ETE组患者(P<0.05),△CT值高于非ETE组患者(P<0.05)。ROC曲线分析显示,ADC、DDC及α值诊断PTC患者发生ETE的曲线下面积分别为0.855、0.895和0.759,三者联合诊断PTC患者发生ETE的曲线下面积为0.951,灵敏度为85.00%,特异度高达92.50%;而PS/ES和△CT值诊断PTC患者发生ETE的曲线下面积分别为0.683和0.840,两者联合诊断PTC患者发生ETE的曲线下面积为0.901,灵敏度为80.00%,特异度为85.00%。MRI联合MDCT指标诊断PTC患者发生ETE的曲线下面积为0.982,高于MDCT指标联合及各单独指标检测。结论术前MRI检查测量的ADC、DDC、α值及MDCT检查测量的PS/ES、△CT值,均可作为评估PTC患者有无ETE的参考指标,其中MRI联合MDCT指标诊断价值最高。

Objective To evaluate the diagnostic value of magnetic resonance imaging(MRI)combined with multiple-detector CT(MDCT)for extrathyroid invasion(ETE)of papillary thyroid carcinoma(PTC).Methods 80 patients with PTC who underwent surgical resection were recruited and divided into the non-ETE group(n=46)and ETE group(n=34)according to the pathological diagnosis.All patients underwent routine MRI examination,dynamic contrast-enhanced scanning and diffusion-weighted imaging(DWI)sequence scanning before operation.Apparent diffusion coefficient(ADC),distribution diffusion coefficient(DDC)and stretch factor(α)were obtained.Results The ADC,DDC andαvalues in the ETE group were significantly lower than those in the non-ETE group(all P<0.05).The PS/ES value in the ETE group was significantly lower than that in the non-ETE group(P<0.05).ROC curve analysis showed that the areas under the ROC curve(AUCs)of ADC,DDC andαfor predicting ETE in PTC patients were 0.855,0.895 and 0.759,respectively.The AUC of the three combined for predicting ETE in PTC patients was 0.951.The sensitivity was 85.00%,and the specificity was 92.50%.The AUCs of PS/ES and△CT values for predicting ETE in PTC patients were 0.683 and 0.840,and 0.901 for the two combined.The sensitivity was 80.00%,and the specificity was 85.00%.The AUC of MRI combined with MDCT for predicting ETE in PTC patients was 0.982,which was higher than that detected by MDCT index combined with each individual index.Conclusions The ADC,DDC andαvalues measured by preoperative MRI,and PS/ES and△CT values measured by MDCT can be used as reference indexes for evaluating ETE in PTC patients.The diagnostic value of MRI combined with MDCT is the highest.