双能量CT增强碘浓度测定在鉴别甲状腺良恶性结节中的应用

发布时间：2018-04-15 05:09

本文选题：甲状腺肿瘤 + 甲状腺结节　；参考：《中国医学影像学杂志》2015年11期

【摘要】：目的通过对甲状腺良恶性结节双能量CT增强扫描的参数分析,探讨碘浓度测定对甲状腺结节鉴别的价值。资料与方法选取经手术病理证实为甲状腺良恶性结节的82例患者共90个结节,行双能量CT增强扫描,测量动脉期和静脉期正常甲状腺组织、良恶性结节的碘浓度及CT值,比较3组标准化碘浓度(NIC)值及标准化CT值。计算双能量CT增强碘浓度测定甲状腺良恶性结节的敏感度和特异度,绘制受试者工作特征(ROC)曲线,计算其曲线下面积,选取最佳敏感度及特异度的临界值。结果 90个结节中,病理检查恶性结节60个,良性结节30个;CT检查良性结节57个,恶性结节33个,碘图诊断恶性结节的敏感度为78.33%、特异度为66.67%,包膜是否完整诊断良恶性结节的差异有统计学意义(Z=-4.55,P0.05)。3组动脉期、静脉期NIC及标准化CT值差异均有统计学意义(F=36.87~69.89,P0.05);良性组与恶性组动脉期NIC及标准化CT值均低于正常组(Z=-3.48~-2.33,P0.05);正常组、良性组及恶性组静脉期NIC值及标准化CT值两两组间比较,差异均有统计学意义(Z=-7.01~-4.87,P0.05)。动脉期、静脉期各组间NIC与标准化CT值有相关性(r=0.89、0.74、0.75,P0.05)。静脉期鉴别良恶性结节最佳临界NIC、标准化CT值分别为0.76、0.79,恶性结节小于该值时其ROC曲线AUC值分别为0.91、0.92。静脉期结节NIC、标准化CT值与碘图形态学诊断结果一致性较高(Kappa=0.762、0.768),三者结合诊断甲状腺结节的敏感度、特异度分别为90.01%、93.60%。结论双源CT双能量增强扫描静脉期NIC及标准化CT值对诊断甲状腺良恶性结节有一定的价值,结合碘图形态学可提高结节定性诊断的准确率。
[Abstract]:Objective to evaluate the value of iodine concentration determination in differentiating thyroid nodules from thyroid nodules by analyzing the parameters of dual energy CT enhanced CT scan for benign and malignant thyroid nodules.Materials and methods A total of 90 thyroid nodules were selected from 82 patients with benign and malignant thyroid nodules confirmed by surgery and pathology. The iodine concentration and CT value of benign and malignant thyroid nodules in arterial and venous phases were measured by dual-energy CT enhanced scanning.The NICs and CT values of the three groups were compared.The sensitivity and specificity of thyroid benign and malignant nodules were measured by dual-energy CT enhanced iodine concentration. The operating characteristics of the subjects were drawn and the area under the curve was calculated. The critical value of the best sensitivity and specificity was selected.Results among the 90 nodules, 60 were examined by pathology, 57 by CT and 33 by CT.The sensitivity and specificity of iodograms in the diagnosis of malignant nodules were 78.33 and 66.67, respectively. There was significant difference in the diagnosis of benign and malignant nodules by the capsule.The differences of NIC and standardized CT in venous phase were statistically significant (P 0.05), the NIC and standardized CT values in arterial phase of benign group and malignant group were lower than those in normal group (P 0.05), and the NIC value and standardized CT value in venous phase in normal group, benign group and malignant group were compared between the two groups.The difference was statistically significant (P 0.05).There was a correlation between NIC and standardized CT value in arterial and venous phases.The best critical value of ROC for differentiating benign and malignant nodules in venous phase was 0.76 ~ 0.79, respectively. The AUC value of ROC curve of malignant nodules was 0.91 ~ 0.92 when the nodule was smaller than this value.The NICs of venous nodule, standardized CT value and the results of morphologic diagnosis of iodide were highly consistent. The sensitivity of the three combined diagnosis of thyroid nodule was 90.01 and 93.600.The sensitivity of the three combined diagnosis was 90.01 and 93.600.The sensitivity of the three methods was 90.01 and 93.600.The sensitivity of the three methods in diagnosing thyroid nodules was 90.01.Conclusion Dual-source CT dual-energy enhanced NIC and standardized CT are valuable in the diagnosis of benign and malignant thyroid nodules. The accuracy of qualitative diagnosis of thyroid nodules can be improved by combining with the morphology of iodograms.
【作者单位】：昆明医科大学第一附属医院影像科;
【基金】：云南省创新团队基金项目(2014HC018)
【分类号】：R736.1;R730.44

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