CT能谱成像对常见甲状腺结节良恶性鉴别价值的初步研究  

Preliminary study on gemstone spectral imaging in differential diagnosis of thyroid nodules

作　　者：贾永军[1,3] 张志远[2] 潘自兵[2] 马凤[1] 任翔[1] 刘磊[1] 薛龙梅 

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院心脑血管病医院 [3]陕西中医学院附属医院

出　　处：《实用放射学杂志》2014年第3期394-398,共5页Journal of Practical Radiology

摘　　要：目的 通过对常见甲状腺结节病灶CT平扫能谱成像（gemstone spectral imaging，GSI）各参数进行对比分析，初步探讨能谱CT在其鉴别诊断中的价值。方法 对经病理证实的8例甲状腺癌 （2例合并结节性甲状腺肿）、28例结节性甲状腺肿和8例甲状腺腺瘤共44例甲状腺结节患者行宝石能谱CT平扫检查后，分析图像上结节病灶的最佳对比噪声比（contrast-to-noise，CNR）单能量图像、混合能量图像、能谱曲线、碘/水基物质含量及有效原子序数。结果 最佳CNR单能量图像可使甲状腺结节病灶显示更清楚，并能发现更多结节病灶，主观评价发现其与混合能量图像质量相比差异具有统计学意义（P=0.000）。能谱曲线上：良性结节斜率均为正值，甲状腺癌能谱曲线斜率为负值或较小正值；结节性甲状腺肿与腺瘤斜率差别无统计学意义（P=0.093），结节性甲状腺肿与甲状腺癌衰减曲线斜率差别有统计学意义（P=0.000），甲状腺腺瘤与甲状腺癌衰减曲线斜率差别也有统计学意义（P=0.047）。碘/水基物质测量显示良性结节组碘含量之间差别无统计学意义（P=0.187），但均高于甲状腺癌碘含量，差异有统计学意义（P =0.032及P=0.000）；水含量三者之间差异无统计学意义；有效原子序数（Effective-Z）方面，结节性甲状腺肿大于甲状腺癌，有统计学意义（P=0.021），其余各2组间均无统计学差异。 结论 常见良恶性甲状腺结节具有不同CT平扫GSI特征，应用GSI的多种参数对鉴别常见甲状腺结节良恶性具有很大的潜能。Objective To investigate the preliminary application of unenhanced gemstone spectral imaging （GSI） in differential diagnosis of thyroid nodules. Methods Forty-four patients with thyroid nodules were recruited in this study. Among these patients, eight patients were diagnosed as thyroid carcinoma （2 with nodular goiter）, twenty-eight were nodular goiter and eight were thyroid adenoma. The nodules of unenhanced GSI were analyzed, including optimal CNR monochromatic images and polychromatic images, energy spectral curves, iodine water concentration and Effective-Z. Results （）primal CNR monochromatic images was better in de- tection of more nodules than the polychromatie ones （P=0. 000）. The types of energy spectral curves of thyroid adenoma and thy- roid adenoma were fast descending type, while that of thyroid carcinoma was slow-descending or ascending type; iodine water con- centr;ttion of benign thyroid nodule was more than that of malignant thyroid nodules （P= 0.0：{2 and P= 0. 000）, whereas the thyroid adenoma and thyroid adenoma were similar （P=0. 187）; water iodine concentration without a significant difference was found be- tween them; Effective Z in nodular goiter was greater than the thyroid carcinoma, exhibiting a statistical significance （ P = 0.021 ）, whereas there was no significant differences in other types of thyroid nodules. Conclusion It is promising to apply GSI with multiple parameters in differential diagnosis of thyroid nodules.

关 键 词：计算机体层成像 能谱成像 甲状腺结节 

分 类 号：R814.42[医药卫生—影像医学与核医学] R581[医药卫生—放射医学]