CT纹理分析在评估甲状腺乳头状癌颈部淋巴结转移中的价值

Differential diagnostic value of CT texture analysis in cervical lymph node metastasis in papillary thyroid carcinoma

目的:探讨CT纹理分析对甲状腺乳头状癌(PTC)颈部淋巴结转移的鉴别诊断价值。方法:回顾性分析本院于131碘治疗后全身及断层显像中确认存在具有摄碘功能的颈部淋巴结转移病灶的PTC术后患者49例(转移组淋巴结为49个),选取术后病理证实为甲状腺良性肿瘤患者40例作为对照组(对照组淋巴结为46个)。在患者颈部平扫CT影像中分别勾画对应的转移淋巴结及非转移性淋巴结,采用MaZda软件提取淋巴结的CT纹理特征并分析组间差异。对于具有统计学差异的CT纹理特征,绘制ROC曲线并计算曲线下面积(AUC),评价其对PTC颈部淋巴结转移的诊断价值。结果:根据软件自带降维算法及差异性检验,筛选得到具有显著统计学差异的纹理特征参数9个,分别为:梯度方差(P=0.002)、S(0,2)均数和(P=0.000)、S(0,1)均数和(P=0.000)、S(0,5)变异数差(P=0.009)、S(1,-1)均数和(P=0.003)、S(1,1)均数和(P=0.004)、小波变换低低频_s-2(P=0.000)、S(1,0)均数和(P=0.006)、S(5,5)相关性(P=0.003)。其中小波变换低低频_s-2、S(0,1)均数和、S(0,2)均数和和梯度方差4个纹理参数AUC大于0.7,分别为0.747、0.746、0.726、0.701。结论:CT纹理分析用于鉴别PTC颈部淋巴结转移具有较好的诊断价值。

Objective:To investigate the differential diagnostic value of CT texture analysis in cervical lymph node metastasis in papillary thyroid carcinoma(PTC).Methods:Forty-nine Iodine-avid metastatic cervical lymph nodes identified by131I whole body scan and SPECT/CT tomographic images after131I therapy in 49 patients with PTC after thyroidectomy were retrospectively analyzed.Forty-six cervical lymph nodes in 40 patients with benign thyroid tumor were selected as control group.Region of interest(ROI)was drawn for the corresponding metastatic lymph nodes and non metastatic lymph nodes in unenhanced cervical CT images.MaZda software was used to extract the CT texture features of the lymph nodes and the differences between groups were analyzed.For the CT texture feature with statistical significance,the receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate its diagnostic value for PTC cervical lymph node metastasis.Results:After screening with the software’s built-in dimension reduction algorithm and difference test,9 texture feature parameters with significant statistical differences were obtained as follows,GrVariance(P=0.002),S(0,2)SumAverg(P=0.000),S(0,1)SumAverg(P=0.000),S(0,5)DifVarnc(P=0.009),S(1,-1)SumAverg(P=0.003),S(1,1)SumAverg(P=0.004),WavEnLL_s-2(P=0.000),S(1,0)SumAverg(P=0.006),S(5,5)Correlat(P=0.003).Among them,the AUCs of the four texture parameters of WavEnLL_s-2,S(0,1)、SumAverg、S(0,2)SumAverg and GrVariance were greater than 0.7,which were0.747,0.746,0.726,and 0.701,respectively.Conclusion:CT texture analysis has potential diagnostic value for differentiating cervical lymph node metastasis in PTC.