能谱CT成像在甲状腺良恶性结节诊断中的应用价值研究

CT gemstone spectral imaging in diagnosis of benign and malignant primary thyroid nodules

目的:对甲状腺结节的能谱CT参数进行分析,探讨能谱CT在甲状腺结节的良恶性诊断中的价值。方法:回顾性分析2016年2月—2019年2月以甲状腺结节病变行颈部CT扫描的患者。所有患者均采用能谱成像模式扫描,并获得常规混合能量图像及一组单能量图像,对所有图像在AW4.6工作站进行能谱参数分析。通过受试者工作特征(ROC)曲线下面积来确定其诊断效能,并获得各参数的最佳诊断阈值。结果:174例甲状腺结节患者中共计132例入组,其中良性54例、恶性78例。良、恶性结节在三期(平扫+动脉期+静脉期)碘浓度、动静脉期动脉标准化碘浓度、平扫能谱曲线斜率及动脉期能谱曲线斜率方面差异有统计学意义(P<0.05)。将ROC曲线获取的最佳诊断阈值平扫碘浓度<3.16μg/mL、动脉期碘浓度<29.73μg/mL、静脉期碘浓度<30.42μg/mL、动脉期标准化碘浓度<0.31、静脉期标准化碘浓度<0.69、平扫能谱曲线斜率<0.74、动脉期能谱曲线斜率<3.15作为诊断甲状腺恶性肿瘤的能谱参数指标,敏感度分别为41.0%、78.2%、71.8%、85.1%、70.5%、74.1%、75.9%,特异度分别为66.7%、78.8%、73.5%、96.4%、77.8%、79.5%、80.8%,其中动脉期标准化碘浓度具有较好的诊断效能。结论:能谱CT能够定量评估甲状腺病变碘含量情况,对良、恶性结节鉴别诊断有一定的价值。

Objective:To discuss the value of gemstone spectral imaging(GSI)in distinguishing malignant thyroid nodules from benign ones through the analysis of parameters like spectral curve and spectral features in patients with thyroid nodules.Methods:The spectral CT imaging in patients who underwent neck CT scans with thyroid lesions between February 2016 and February 2019 were analyzed retrospectively.All the patients underwent spectral CT scanning,and conventional mixed energy images and a group of single energy images were obtained,the energy spectrum parameters of all images were analyzed on AW4.6 workstation.The optimal diagnostic was obtained by receiver operating characteristic curve,sensitivity and specificity were achieved.Results:A total of 132 out of 174 cases were detected,including 54 benign and 78 malignant nodules.on the triple-phase enhanced GSI,the iodine concentration of benign thyroid nodule was significantly higher than that of malignant thyroid nodules(P<0.05);the normalized iodine concentration at arterial phase and venous phase showed difference between the two groups(P<0.05);the slope of spectral curve of benign nodules was significantly larger than that of malignant nodules on plain scan and at arterial phase respectively(P<0.05);however,the water concentration and the normalized water concentration had no difference at each phase between the two group(P>0.05);the slope of spectra curve had no difference between the two groups at nervous phase(P>0.05).Using triple-phase iodine concentration,arterial and genius normalized concentration,plain and arterial phase spectral curve slope to predict malignant nodules,the sensitivity were 41.0%,78.2%,71.8%,85.1%,70.5%,74.1%,75.9%,the specificity were 66.7%,78.8%,73.5%,96.4%,77.8%,79.5%,80.8%,the normalized iodine concentration at arterial phase has better diagnostic efficiency.Conclusion:Gemstone spectral CT imaging can quantitatively evaluate the iodine content of thyroid nodules,having a potential value in differential diagnosis of thyroid nodules.