CT纹理分析参数对桥本氏甲状腺炎伴发甲状腺结节良恶性的鉴别诊断价值

Value of CT texture analysis parameters in differential diagnosis of benign and malignant thyroid nodules in Hashimoto’s thyroiditis

目的研究CT纹理分析(computed tomography texture analysis,CTTA)参数对桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)伴发甲状腺结节良恶性的鉴别诊断价值。方法选取2020年5月至2021年10月南京市中西医结合医院放射科HT伴发甲状腺结节患者110例均行CTTA,统计CTTA参数(熵值、峰态及偏度),以病理诊断结果为"金标准"。统计病理检查结果,比较良恶性甲状腺结节的一般临床特征及CTTA参数,采用受试者工作特征(receiver operating characteristic,ROC)分析CTTA参数对甲状腺结节的诊断价值。结果经临床病理检查,110例HT背景下甲状腺结节患者中恶性43(39.09%)例,其中乳头状癌22例、滤泡癌13例、髓样癌6例、恶性淋巴瘤2例;良性67(60.91%)例,其中结节性甲状腺肿32例、HT结节20例、甲状腺腺瘤8例、局灶性炎症7例。恶性甲状腺结节患者促甲状腺激素水平、形态不规则、边界模糊、钙化占比均高于良性患者(t/χ^(2)=13.167、18.364、20.180、17.621,P均<0.001);HT背景下良恶性甲状腺结节患者CTTA参数峰态、偏度比较,差异无统计学意义(t=1.633、1.382,P=0.105、0.170);恶性甲状腺结节患者熵值高于良性,差异有统计学意义(t=9.862,P<0.001)。经ROC分析显示,熵值诊断甲状腺结节良恶性的Cut-off值为6.28,AUC值分别为0.909,95%CI为0.839~0.955,灵敏度为86.05%(37/43),特异度为88.06%(69/67)。结论HT伴发良恶性甲状腺结节患者CTTA参数具有一定差异,且CTTA参数对甲状腺结节良恶性具有一定诊断价值。

Objective To study the value of CT texture analysis(CTTA)parameters in differential diagnosis of benign and malignant thyroid nodules in Hashimoto’s thyroiditis.Methods From May.2020 to Oct.2021,110 patients with thyroid nodules in the background of Hashimoto’s thyroiditis in the Radiology Department of Nanjing Integrated Hospital of Traditional Chinese and Western Medicine were selected,and CTTA was performed.CTTA parameters(entropy value,peak state and skewness)were counted.The pathological diagnosis results were taken as the"gold standard".Statistical pathological examination results were used to compare the general clinical characteristics and CTTA parameters of benign and malignant thyroid nodules.The receiver operating characteristic(ROC)was used to analyze the diagnostic value of CTTA parameters for thyroid nodules.Results According to the clinicopathological examination,43 of 110 patients with Hashimoto’s thyroiditis were malignant,accounting for 39.09%.Among them,22 were papillary carcinoma,13 were follicular carcinoma,6 were medullary carcinoma,and 2 were malignant lymphoma;67 cases were benign,accounting for 60.91%,including 32 nodular goiters,20 Hashimoto’s nodules,8 thyroid adenomas,and 7 focal inflammation.The levels of TSH,irregular shape,blurry border and calcification in patients with malignant thyroid nodules were higher than those in patients with benign thyroid nodules(t/χ^(2)=13.167,18.364,20.180,17.621,P<0.001).In the background of Hashimoto’s thyroiditis,there was no significant difference in the peak and skewness of CTTA parameters between benign and malignant thyroid nodules(t=1.633,1.382,P=0.105,0.170).The entropy value of patients with malignant thyroid nodules was higher than that of patients with benign thyroid nodules,and the difference was statistically significant(t=9.862,P<0.001).ROC analysis showed that the cut-off value of entropy value for diagnosing benign and malignant thyroid nodules was 6.28,AUC value was 0.909,95%CI was 0.839-0.955,sensitivity was 86.05%(37/43),and specificity was 88.06%(69/67).Conclusion CTTA parameters in Hashimoto’s thyroiditis patients with benign and malignant thyroid nodules are different,and CTTA parameters have certain diagnostic value for benign and malignant thyroid nodules.