纵横比在CT鉴别甲状腺结节良恶性中的价值  

Value of anteroposterior to transverse diameter ratio of thyroid nodules on CT for differentiating benigh and malignant lesions

作　　者：陶全 刘振霞 陈克敏[3] 周永明[1] 罗禹 何文辉 蒋吉美 王明明[1] 马为彬 孙建[4] 祝颖 徐红[4] TAO Quan;LIU Zhenxia;CHEN Kemin;ZHOU Yongming;LUO Yu;HE Wenhui;JIANG Jimei;WANG Mingming;MA Weibin;SUN Jian;ZHU Ying;XU Hong(Department of Radiology,Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine,Shanghai 200434,China;Department of Radiology,Shanghai Hongkou District Community Health Center,Shanghai 200433,China;Department of Radiology,Ruijin Hos pital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Surgery,Shanghai Fourth People's Hospilal Affiliated to Tongji University School of Medicine,Shanghai 200434,China;Department of Pathology,Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine,Shanghai 200434,China)

机构地区：[1]同济大学附属上海市第四人民医院放射科,上海200434 [2]上海市虹口区江湾社区卫生服务中心放射科,上海200433 [3]上海交通大学附属瑞金医院放射科,上海200025 [4]同济大学附属上海市第四人民医院外科,上海200434 [5]同济大学附属上海市第四人民医院病理科,上海200434

出　　处：《实用放射学杂志》2021年第6期897-900,908,共5页Journal of Practical Radiology

基　　金：上海市卫生和计划生育委员会科研课题(20164Y0271);上海市第四人民医院科技创新基金项目(2016SYFYKJ11)。

摘　　要：目的探讨纵横比(A/T)在CT鉴别甲状腺结节良恶性的临床价值.方法选取甲状腺结节患者152例,术前均行甲状腺CT检查,共183个不同性质结节.按照病理结果将其分为良性和恶性2组.由2名有10年以上工作经验放射科医生测量各甲状腺结节前后径、左右径、A/T.应用Kruskal-Wallis检验对比3个指标在良、恶性甲状腺结节之间的统计学差异,绘制A/T鉴别甲状腺良恶性结节的受试者工作特征(ROC)曲线,计算曲线下面积(AUC).通过计算约登指数选择合适的诊断临界值.结果甲状腺良、恶性结节的前后径、左右径及A/T均有统计学差异.良性结节前后径为(18.0±9.7)mm,恶性结节前后径为(14.0±8.1)mm(P=0.032);良性结节左右径为(17.0±9.9)mm,恶性结节左右径为(11.4±6.6)mm(P=0.001);良性结节的A/T为1.0±0.2,恶性结节的A/T为1.3±0.3(P=0.000).A/T诊断甲状腺结节良恶性的AUC为0.742.当参照超声标准,选择1.0为诊断临界值时,约登指数为0.30,敏感性为79.4%,特异性为51.0%.最佳诊断临界值为1.2,约登指数为0.46,敏感性为61.8%,特异性为84.6%.结论在甲状腺结节CT检查中,应用A/T判断甲状腺良恶性结节具有较高的诊断效能及临床意义.CT诊断甲状腺结节良恶性的A/T临界值应选择1.2,即当结节的A/T≥1.2时,结节多为恶性.Objective To evaluate the value of anteroposterior to transverse diameter ratio(A/T)of thyroid nodules on CT for differentiating benign and malignant lesions.Methods 152 patients with thyroid nodules underwent CT scanning before thyroidectomy,and then a total of 183 different nodules were confirmed by pathology and divided into benign and malignant groups.The anteroposterior diameter,transverse diameter,and A/T were measured by two radiologists with more than 10 years Qxpexience.Kruskal-WaUis test was used to analyze the statistical differences of those three values between benign and malignant groups,then receiver operating characteristic(ROC)curves of A/T were obtained to differentiate the thyroid nodules and the area under the curve(AUC)was calculated.The appropriate diagnostic threshold was given by calculating the Yoden index.Results The anteroposterior diameters of the nodule were(18.0±9.7)mm in benign group and(14.0±8.1)mm in malignant group(P=0.032),the transverse diameters were(17.0±9.9)mm and(11.4±6.6)mm respectively(P=0.001),and the A/T were l.OdzO.2 and 1.3±0.3 respectively(P=0.000).The AUC of A/T in differentiating benign and malignant nodules was 0.742.When 1.0 was regarded as a diagnostic threshold refering to the ultrasonic criteria,the Youden index,sensitivity and specificity were 0.30,79.4%and 51.0%respectively.The optimal cutoff value of A/T was 1.2,thus the Youden index,sensitivity and specificity were 0.46,61.8%and 84.6%respectively.Conclusion The application of A/T of thyroid nodules on CT in differential diagnosis of benign and malignant lesions shows high diagnostic efficiency and clinical significance.When the A/T is greater than or equal to 1.2,the nodule will be malignant.

关 键 词：甲状腺结节 计算机体层成像 纵横比 

分 类 号：R581[医药卫生—内分泌] R814.42[医药卫生—内科学]