双能CT定量参数对甲状腺乳头状癌颈侧区淋巴结转移的预测价值

Value of quantitative dual-energy CT parameters for predicting lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma

目的探讨双能CT(DECT)定量参数对甲状腺乳头状癌(PTC)颈侧区淋巴结转移(LLNM)的预测价值。方法回顾性分析216例(LLNM组174例,非LLNM组42例)经手术病理证实的PTC患者DECT影像资料。比较两组间DECT定量参数差异,包括平扫、动脉期和静脉期碘浓度(IC)、有效原子序数(Zeff)、能谱曲线斜率(λHU)、标准化IC(NIC)和标准化Zeff(NZeff)。将差异有统计学意义的参数纳入二元Logistic回归分析LLNM的独立预测因子。通过受试者工作特征曲线(ROC)评估独立预测因子及其联合对LLNM的预测效能。结果与非LLNM组比较,LLNM组具有更低的平扫NIC(Z=-2.279,P=0.023),更高的动脉期IC、NIC、NZeff、λHU和更高的静脉期IC、NIC、Zeff、λHU(P均<0.05)。二元Logistic回归分析显示,平扫NIC(P=0.006)和静脉期NIC(P=0.002)是LLNM的独立预测因子,其联合模型的预测效能最高,曲线下面积(AUC)为0.672(95%CI:0.605~0.734),敏感度63.79%,特异度66.67%;其次是静脉期NIC(AUC=0.634)和平扫NIC(AUC=0.613)模型。结论DECT定量参数可在一定程度上辅助预测PTC患者有无LLNM。

Objective To explore the value of quantitative dual-energy CT(DECT)parameters for predicting lateral cervical lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC).Methods DECT of 216 patients with pathologically confirmed PTC including 174 with LLNM and 42 without LLNM was retrospectively analyzed.Quantitative DECT parameters including iodine concentration(IC),effective atomic number(Zeff),slope of spectral Hounsfield unit curve(λHU),normalized IC(NIC)and normalized Zeff(NZeff)in the non-contrast,arterial and venous phases were compared.Binary logistic regression was applied to analyze the independent predictors.Receiver operating characteristic(ROC)curve analysis was used to evaluate the performance of independent predictors and their combinations for predicting the LLNM.Results Compared with the non-LLNM group,LLNM group showed significantly lower NIC(Z=-2.279,P=0.023)in the non-contrast phase,higher IC,NIC,NZeff andλHU in the arterial phase(all P<0.05),and higher IC,NIC,Zeff andλHU in the venous phase(all P<0.05).Binary logistic regression analysis showed that NICs in the non-contrast and venous phases were independent predictors of LLNM.The predictive performance of the combined non-contrast and venous phase model is optimal with an area under ROC curves(AUC)of 0.672(95%CI:0.605-0.734),sensitivity of 63.79%,specificity of 66.67%,followed by NIC in the venous phase(AUC=0.634)and NIC in the non-contrast phase(AUC=0.613).Conclusion DECT derived quantitative parameters can assist in predicting LLNM in patients with PTC.