CT径线比鉴别甲状腺微小癌与良性结节的价值  

Differentiation of Papillary Thyroid Microcarcinoma and Benign Thyroid Nodules Using CT Diameter Ratio

作　　者：戴文晖 柴丽萍[1] 孙立新[1] 陈建昌[1] 傅海燕[1] 王莉[1] 于学文[1] 刘善凤[1] 

机构地区：[1]山东大学附属省立医院影像科,山东济南250022

出　　处：《中国医学影像学杂志》2015年第11期819-823,共5页Chinese Journal of Medical Imaging

摘　　要：目的甲状腺乳头状微小癌(PTMC)术前定性诊断比较困难,容易漏诊和误诊,本文旨在探讨CT径线比鉴别诊断PTMC与良性结节的价值。资料与方法选取经手术病理证实为直径≤1.0 cm的甲状腺良恶性微小结节的78例患者共154个结节,分为PTMC组47例共75个结节和良性微小结节组31例共79个结节。测量计算横断面前后径和横径比值(A/T)、矢状面前后径和上下径比值(A/L)和冠状面上下径和横径比值(L/T),绘制A/T、A/L和L/T诊断PTMC的ROC曲线,比较其曲线下面积,计算CT径线比诊断PTMC的灵敏度、特异度、准确度、阳性预测值及阴性预测值。比较两组CT征象及其诊断PTMC的准确率。结果 PTMC组的A/T、A/L显著大于良性结节组(P<0.01),L/T小于良性结节组(P<0.01)。A/T、A/L和L/T ROC曲线下面积分别为0.8841、0.7676和0.4052,A/T和A/L的最佳诊断界值为1.05和1.0,A/T≥1.05诊断PTMC的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为88.00%%、84.81%、86.36%、84.62%和88.12%,A/L≥1.0诊断PTMC的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为66.67%、82.28%、74.68%、78.13%和72.22%。PTMC组CT征象:结节位于腺体表浅部位、类圆形低密度、边界模糊不清、结节内细颗粒钙化和渐进性填充式强化诊断PTMC的准确度分别为71.43%、50.00%、79.22%、68.83%和90.91%。结论 CT径线比对诊断PTMC有较高的价值,A/T≥1.05、A/L≥1.0可以作为CT诊断PTMC的重要指标。Purpose Papillary thyroid microcarcinoma （PTMC） is difficult to diagnose its nature before surgery, thus results in misdiagnosis. This paper aims to determine the best diagnostic cutoff value using anteroposterior and transverse diameter ratio （A/L） and longitudinal and transverse diameter ration （L/T） in PTMC. Materials and Methods The CT data of 154 pathology proven benign and malignant thyroid nodules ≤1.0 cm in diameter in 78 cases were reviewed, including 75 PTMC in 47 patients and 79 benign nodule in 31 patients. The anteroposterior and transverse diaineter ratio （A/T） on axial view, A/L on sagittal view, and L/T on coronal view were measured and calculated. A non-parametric method was used to draw the receiver operating curve of A/T, A/ L and L/T. The mean and standard deviation of CT diameters in benign and malignant nodules were calculated. The area under the curve, sensitivity, specificity and diagnostic accuracy, positive predictive value and negative predictive value were determined. CT manifestations of small benign and malignant thyroid nodules were also analyzed. Results The A/T and A/L ratio were significantly larger for PTMC than benign nodules （P〈0.01 ）, while L/T diameters were significantly smaller than the benign nodules （P〈0.01）. The area under ROC was 0.8841, 0.7676 and 0.4052 lbr A/T, A/L and L/T respectively. The best diagnostic cutoff value of A/T and A/L were 1.05 and 1.0. With A/T ≥1.05, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.00%, 84.81%, 86.36%, 84.62% and 88.12%, respectively. With A/L ≥ 1.0, the sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 66.67%, 82.28%, 74.68%, 78.13% and 72.22%, respectively. CT characteristics of PTMC included superficial location, oval low density, blurry boundary, microcalcification and progressive enhancement with accuracy of 71.43%, 50.00%, 79.22%, 68.83% and 90.91%, respectively. Conclusion The cutoff values

关 键 词：甲状腺肿瘤 甲状腺结节 体层摄影术 螺旋计算机 图像处理 计算机辅助 ROC曲线 诊断 鉴别 

分 类 号：R445.3[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]