双期增强CT对甲状腺微小乳头状癌中央区淋巴结转移的预测价值

Predictive value of dual-phase enhanced CT for central lymph node metastasis in papillary thyroid microcarcinoma

目的探讨双期增强CT对甲状腺微小乳头状癌(papillarythyroid microcarcinoma,PTMC)中央区淋巴结转移(central lymphnodemetastasis,CLNM)的预测价值。方法回顾性分析浙江大学医学院附属杭州市第一人民医院放射科2021年1月至2022年2月经手术和病理证实的182例PTMC中220枚中央区淋巴结的CT资料,依据淋巴结短径将其分为0.3~0.4cm组、0.4~0.5cm组和≥0.5cm组,分别测量3组淋巴结动脉期CT值和静脉期CT值,采用t检验分析3组淋巴结双期CT值的分布,通过受试者工作特异度曲线(re-ceiveroperating characteristic,ROC)获得各组淋巴结双期增强CT值的最佳阈值。结果动脉期CT值在3组中预测CLNM的R0C曲线下面积分别为0.717.0.707、0.761最佳值分别为71.4、63.3及72.9Hu,敏感度和特异度分别为50.0%和92.3%、63.6%和81.0%、52.4%和82.9%。静脉期CT值在3组中预测CLNM的R0C曲线下面积分别为0.744、0.729、0.662,最佳阅值分别为71.1、80.3及61.3Hu,敏感度和特异度分别为52.8%和87.2%、54.2%和86.7%、82.6%和46.7%。双期联合CT值在3组中预测CLNM的敏感度和特异度分别为44.1%和94.7%、50.0%和88.1%、52.4%和85.4%。结论双期增强CT值可一定程度预测PTMCCLNM情况,二者联合可进一步提高预测CLNM的特异度,为减少不必要的手术提供重要依据。

Objective To investigate the predictive value of dual-phase enhanced CT for central lymph node metastasis(CLNM)in papillary thyroid microcarcinoma(PTMC).Methods The CT data of 220 central lymph nodes in 182 cases of PTMC confirmed by surgery and pathology were retrospectively analyzed.The lymph nodes were divided into 0.3 cm-0.4 cm group,0.4 cm-0.5 cm and≥0.5 cm groups according to the size of them.The CT values of arterial phase and venous phase of lymph nodes were measured,respectively.The distribution of dual-phase CT values of lymph nodes in the three groups was analyzed by t test.The optimal threshold values of du-al-phase enhanced CT values of lymph nodes in each group were obtained by receiver operating characteristic(ROC).Results The area under ROC curve of arterial phase CT in predicting CLNM was 0.717,0.707 and 0.761,the optimal threshold was 71.4Hu,63.3Hu and 72.9Hu,and the sensitivity and specificity were 50.0% and 92.3%,63.6% and 81.0%,52.4% and 82.9%,respectively.The area under the R0C curve of venous phase CT val-ue in predicting CLNM was 0.744,0.729,and 0.662,the optimal thresholds were 71.1 HU,80.3 HU,and 61.3 HU,and the sensitivity and specificity were 52.8% and 87.2%,54.2%and 86.7%,82.6% and 46.7%,respectively.The sensitivity and specificity of dual-phase combined CT values in predicting CLNM in 3 groups were 44.1% and 94.7%,50.0% and 88.1%,52.4% and 85.4%,respectively.Conclusion Dual-phase enhanced CT can effectively predict central lymph node metastasis of PTMC,and the combination of the two can further improve the specificity of predicting CLNM and provide an important basis for reducing unnecessary surgical trauma.