双能CT碘浓度对甲状腺乳头状癌颈部淋巴结转移的预测价值

Predictive Value of Dual-Energy CT Iodine Concentration in Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma

目的探讨双能CT碘浓度在定量预测甲状腺乳头状癌颈部淋巴结转移的临床价值。方法回顾性分析97例甲状腺癌患者术前双能CT图像,依据病理结果分为非颈部淋巴结转移组与颈部淋巴结转移组。术前均行双能CT平扫加增强扫描,并经Liver VNC软件测量病灶及正常甲状腺组织碘浓度(IC),测得正常甲状腺碘浓度(IC_(甲状腺))、病灶碘浓度(IC_(病灶))、病灶与IC_(甲状腺)差值(ICD)及ICD与IC_(甲状腺)比值(ICDNR_(病灶)),两组间各参数采用两独立样本t检验,绘制受试者工作特征(ROC)曲线并比较其诊断效能。结果分别比较非淋巴结转移组与淋巴结转移组平扫、动脉期及静脉期IC_(病灶)、ICD_(病灶)、ICDNR_(病灶)的值,平扫及动脉期在两组变量的比较中无明显统计学意义(P>0.05),静脉期IC_(病灶)、ICD_(病灶)、ICDNR_(病灶)的值的差异均有统计学意义(P<0.05);根据静脉期结果绘制ROC曲线,曲线下面积(AUC)分别为0.477、0.744、0.730,三者截断值分别为1.65、1.35、0.283,敏感度分别为0.90、0.725、0.825,特异度分别为0.175、0.667、0.579。结论静脉期IC_(病灶)、ICD_(病灶)、ICDNR_(病灶)的值能有效预测甲状腺乳头状癌颈部淋巴结转移,其中静脉期ICD_(病灶)诊断效能最高。

Objective To explore the clinical value of dual-energy CT iodine concentration in quantitatively predicting cervical lymph node metastasis of papillary thyroid carcinoma.Methods The preoperative dual-energy CT images of 97 patients with thyroid cancer were retrospectively analyzed.Based on the pathological results,they were divided into non-neck lymph node metastasis group and cervical lymph node metastasis group.Before operation,dual-energy CT plain scan and enhanced examination were performed,and the iodine concentration of the lesion and normal thyroid tissue were measured by Liver VNC software.The normal thyroid iodine concentration(IC_(thyroid)),the iodine concentration of the lesion(IC_(lesion)),the difference between the lesion and the normal thyroid(Iodine concentration difference,ICD),and the ratio of ICD to normal thyroid iodine concentration(ICDNR_(lesions))were measured.The two independent samples t test was used for each parameter between the two groups,ROC curve was drawn and its diagnostic efficacy was compared.Results The values of plain scan,arterial and venous IC_(lesion),ICD_(lesion) and ICDNR_(lesion) in the non-lymph node metastasis group and the lymph node metastasis group were compared.There was no significant statistical significance in the comparison of the two variables in the plain scan and arterial phase(P>0.05)),the differences in the values of venous phase IC_(lesion),ICD_(lesion) and ICDNR_(lesion) lesions were statistically significant(P<0.05).The ROC curve was drawn based on the results of the venous phase,and the area under the curve was 0.477,0.744,0.730,respectively,the cut-off values of IC_(lesion),ICD_(lesion) and ICDNR_(lesion) were 1.65,1.35,0.283,the sensitivity was 0.90,0.725,0.825,and the specificity was 0.175,0.667,0.579.Conclusion The values of venous phase IC_(lesion),ICD_(lesion) and ICDNR_(lesion) can effectively predict cervical lymph node metastasis of papillary thyroid carcinoma,and venous phase ICD_(lesions) have the highest diagnostic efficiency.