采用甲状腺专用表面线圈的术前多参数MRI特征对甲状腺癌区域淋巴结转移状态的预测价值  

The value of preoperative multi-parametric MR features using surface coil exclusive designed for thyroid gland in predicting the metastatic status of regional lymph nodes in thyroid cancer

作　　者：谢永生 王士旭 张妙如 刘周 胡尔曼•巴合提别克 梁龙飞 龙莉 邓文明 魏明辉 罗德红 XIE Yongsheng;WANG Shixu;ZHANG Miaoru;LIU Zhou;Huerman•Bahebietike;LIANG Longfei;LONG Li;DENG Wenming;WEI Minghui;LUO Dehong(National Cancer Center/National Clinical Research Center for Cancer/Department of Radiology,Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518000,China;National Cancer Center/National Clinical Research Center for Cancer/Department of Head and Neck Surgery,Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518000,China;National Cancer Center/National Clinical Research Center for Cancer/Department of Radiology,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院放射诊断科,深圳518000 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院头颈外科,深圳518000 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院影像诊断科,北京100021

出　　处：《磁共振成像》2021年第4期17-22,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：中国医学科学院肿瘤医院深圳医院院内科研课题(编号:SZ2020ZD005)。

摘　　要：目的探讨采用甲状腺专用表面线圈的术前多参数MRI特征对甲状腺癌区域淋巴结转移的预测价值。材料与方法回顾性分析中国医学科学院肿瘤医院深圳医院经手术病理证实的甲状腺癌51例,均行甲状腺病灶切除及颈部淋巴结清扫,术前均行3.0 T增强MRI扫描。以术后病理为对照,分析比较转移淋巴结和非转移淋巴结的MRI征象,构建转移淋巴结的预测模型。计量资料的比较采用t检验或U检验,计数资料比较采用χ^(2)检验,多元逻辑回归分析用于构建预测模型,ROC曲线用于评估预测模型的诊断效能。结果51例甲状腺癌患者共135枚淋巴结纳入研究,其中转移淋巴结74枚,非转移淋巴结61枚。转移与非转移淋巴结的长短径、ADC值、T1WI和抑脂T2WI信号、形状、边缘、是否囊变、强化程度等差异具有统计学意义(P均<0.05)。其中抑脂T2WI呈混杂信号、明显强化、低ADC值(<0.91×10^(-3)mm^(2)/s)是转移淋巴结的独立预测因子,联合这3个MRI征象所建立的预测模型其AUC为0.93,敏感度为82.4%,特异度为88.5%。甲状腺癌伴有桥本氏甲状腺炎时,其Ⅵ区非转移淋巴结的长径、短径均大于不伴桥本氏甲状腺炎组(P<0.05)。结论术前多参数MRI特征对甲状腺癌区域淋巴结转移有较高的预测价值,转移淋巴结多表现为抑脂T2WI呈混杂信号、明显强化、更低的ADC值,为甲状腺癌的术前临床决策提供非常有价值的依据。Objective:To investigate the value of preoperative multi-parametric magnetic resonance imaging(MRI)features using surface coil exclusively designed for thyroid gland in predicting the metastatic status of regional lymph nodes in thyroid cancer.Materials and Methods:In this retrospective analysis,51 patients with pathologically confirmed thyroid cancer was enrolled.All patients had undertaken thyroid lesion resection with radical neck dissection and preoperative 3.0 T contrast enhanced MRI scan.With pathology as reference,MR findings of non-metastatic and metastatic lymph nodes had been analyzed to construct a predicting model for diagnosing the metastatic status of each lymph node.The quantitative data were compared by Mann-Whitney U test or t test,while the categorical data were compared byχ^(2)test.Multivariate logistic regression was used to construct a combined model for predicting the metastatic status of each lymph node,with diagnostic performance evaluated using receiver operating characteristic curve.Results:In total,we analyzed 135 lymph nodes in 51 patients,including 74 metastatic lymph nodes and 61 non-metastatic lymph nodes.There was statistically significant difference between metastatic and non-metastatic lymph nodes in size,ADC value,signal intensity on T1-wighted and fat-suppression T2-weighted imaging,shape,margin,presence of cystic degeneration,the degree of enhancement(all P<0.05).Furthermore,heterogeneous signal intensity on fat-suppression T2-weighted imaging,marked enhancement,and low ADC value(<0.91×10^(-3)mm^(2)/s)were identified as three independent predictive factors of metastatic lymph nodes.A model combining these independent factors yielded the diagnostic performance with an area under the curve of 0.93,a sensitivity of 82.4%and a specificity of 88.5%.The size including long and short-axis diameter of non-metastatic level VI lymph nodes in cases of thyroid cancer complicated with Hashimoto’s thyroiditis were larger than that of thyroid cancer cases without Hashimoto’s thyroiditi

关 键 词：甲状腺癌 淋巴结转移 磁共振成像 表面线圈 

分 类 号：R445.2[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]