双能量CT增强碘浓度结合形态学在诊断甲状腺乳头状癌中央组淋巴结转移的价值  

Iodine Concentration on Dual-energy Contrast Enhanced CT in Differential Diagnosis of the Metastatic Central Lymph Nodes in Patients with Papillary Thyroid Cancer

作　　者：金弋人 韩丹[1] 蒋悦[1] 黄益龙[1] 赵雯[1] 赵卫[1] JIN Yiren;HAN Dan;JIANG Yue;et al(Medical Imaging Department,The First Affiliated Hospital, Kunming Medical University Kunming 650032, P. R. Chin)

机构地区：[1]昆明医科大学第一附属医院医学影像科

出　　处：《临床放射学杂志》2018年第3期391-395,共5页Journal of Clinical Radiology

摘　　要：目的探讨双能量CT增强碘浓度与常规形态学联合诊断甲状腺乳头状癌（PTC）中央组淋巴结转移的价值。方法对31例PTC患者术前行颈部双能量CT双期增强扫描,轴位加三维定位标记短径≥5 mm的中央组淋巴结,术中对应取材和标记,再扫描对应术前的淋巴结,术后得到病理结果后回顾性对CT图像进行研究分析。对淋巴结形态学分析并比较动、静脉期原发病灶、转移与非转移性淋巴结碘浓度的差异。采用受试者工作特征（ROC）曲线,选取最佳敏感度及特异度的临界值,并比较其与形态学诊断结果的一致性。结果 31例共获得一一对应的中央组淋巴结73枚,其中转移性淋巴结51枚,非转移性淋巴结22枚。动、静脉期原发病灶与转移性淋巴结标准化碘浓度（NIC）均高于非转移性淋巴结,差异有统计学意义（Z=-4.38、-4.29,P〈0.05;Z=-6.29、-7.31,P〈0.05）,而原发病灶与转移性淋巴结NIC差异无统计学意义（Z=2.17,P〉0.05）。动脉期NIC诊断中央组淋巴结转移的敏感度、特异度分别为66.3%、69.4%,与形态学两者联合诊断淋巴结转移的敏感度达80.2%,特异度为87.8%。结论双能量CT增强碘浓度对PTC中央组淋巴结转移的判断具有一定的价值,联合常规形态学可提高诊断的准确性。Objective To explore the value of Iodine Concentration on dual-energy CT to diagnose metastasis of the Central group lymph nodes in patients with papillary thyroid cancer. Methods This study was approved by the ethics committee and all patients provided written informed consent. In total,31 patients were pathologically confirmed as papillary thyroid cancer and with all the data,and underwent dual energy scan,Analyses of Iodine Concentration were performed by different groups of radiologists. Excised lymph nodes were located and labeled during surgery according to location on preoperative CT images and were evaluated histopathologically. The iodine content of the primary lesions and regional lymph nodes were measured in ＂ Liver VNC＂ mode. The differences of iodine content were compared among primary lesion,metastatic lymph node and non-metastatic lymph node in arterial phase and venous phase. Sensitivity and specificity analyses were performed by using receiver operating characteristic curves and were compared with data from the qualitative analysis. Results In 31 patients with papillary thyroid cancer,73 central lymph nodes were found,including 51 metastasis lymph nodes and22 non-metastasis lymph nodes. The NICnod had statistical differences among this three kinds of lesions in arterial phase and venous phase（ Z =-4. 38、-4. 29,P 0. 05; Z =-6. 29、-7. 31,P 0. 05）,while there were no statistical differences in the primary lesions and metastatic lymph nodes through pairwise comparison（ Z = 2. 17,P 0. 05）. The NICnod in arterial phase diagnosis of the metastatic central lymph nodes,the sensitivity was 66. 3%,and the specificity was 69. 4%. Combining morphology of these lymph nodes,the sensitivity was 80. 2%,and the specificity was 87. 8%. Conclusion Iodine Concentration on dual-energy has a certain value for the diagnosis of the metastatic central lymph nodes in patients with papillary thyroid cancer. Combining morphology improves the accuracy of diagnosis.

关 键 词：体层摄影术 X线计算机 中央组淋巴结 双能量 

分 类 号：R730.44[医药卫生—肿瘤] R736.1[医药卫生—临床医学]