基于双能CT的列线图预测cN1期甲状腺乳头状癌颈侧区淋巴结转移的可行性研究  

A feasibility study of predictive values of lateral cervical lymph node metastasis from cN1-stage papillary thyroid carcinoma based on dual-energy CT nomogram

作　　者：邹颖 刘继华[1] 孙芳[2] 石岩 陆秀娣 宫琰 夏爽[4] Zou Ying;Liu Jihua;Sun Fang;Shi Yan;Lu Xiudi;Gong Yan;Xia Shuang(Department of Radiology,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China;Department of Ultrasonography,Binzhou Medical University Hospital,Binzhou 256600,China;Department of Radiology,Tianjin Hospital of ITCWM Nankai Hospital,Tianjin 300100,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津中医药大学第一附属医院医学影像科,300193 [2]滨州医学院附属医院超声医学科,256600 [3]天津市南开医院放射科,300100 [4]天津市第一中心医院放射科,300192

出　　处：《中华放射学杂志》2021年第7期716-722,共7页Chinese Journal of Radiology

摘　　要：目的探讨基于双能CT构建的列线图评估甲状腺乳头状癌(PTC)患者颈侧区淋巴结转移(LLNM)的可行性。方法回顾性分析2015年1月至2018年12月天津市第一中心医院经手术病理证实的417例PTC患者组成训练组,并进行内部验证,其中LLNM组139例、非LLNM组278例。纳入2019年1月至2020年6月间的169例PTC患者组成外部验证组,其中LLNM组58例、非LLNM组111例。分析甲状腺原发病灶双能CT碘图的形态特征,包括肿瘤位置、最大径、是否存在钙化及是否存在甲状腺包膜外侵犯(ETE)。测量动脉期和静脉期PTC实质成分和同层面颈内动脉的碘浓度(IC),计算标准碘浓度(NIC)。经单因素和多因素logistic回归分析,得到评估LLNM的独立危险因素,基于此构建预测模型,并以列线图的形式表达,并采用ROC曲线对模型进行内部和外部验证。结果多因素二元logistic回归分析结果显示病灶位于甲状腺上极、存在ETE、动脉期原发灶IC>2.9 mg/ml、静脉期原发灶IC>3.2 mg/ml及动脉期NIC>0.21为预测LLNM的独立危险因素。基于此构建的列线图AUC为0.895(95%CI 0.862~0.923),截断值为0.79,灵敏度86.3%,特异度75.2%。外部验证组AUC为0.887(95%CI 0.830~0.931),灵敏度82.8%,特异度81.1%。结论基于双能CT构建的列线图对术前评估PTC患者LLNM具有较大临床价值,可以在一定程度上指导个体化治疗。Objective To investigate the feasibility of predicting lateral cervical lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)based on the nomogram constructed by dual-energy CT data.Methods In total 417 patients with PTC confirmed by pathology in Tianjin First Central Hospital from January 2015 to December 2018 were retrospectively analyzed as a training group.Internal validation was conducted,including 139 patients in the LLNM group and 278 patients in the non-LLNM group.A total of 169 PTC patients from January 2019 to June 2020 were included as an external validation group,including 58 patients in the LLNM group and 111 patients in the non-LLNM group.The morphological characteristics of the primary thyroid lesions on dual-energy CT iodine maps were analyzed,including tumor location,maximum diameter,calcification,and extrathyroidal extension(ETE).Iodine concentration(IC)of the PTC parenchyma and the internal carotid artery on the same level in the arterial and venous phases were measured,and normalized iodine concentration(NIC)was calculated.The independent risk factors for LLNM were obtained by univariate and multivariate logistic regression analysis.Base on the results,a prediction model was constructed and expressed in the form of a nomogram.The internal and external validation of the model was carried out using ROC curve.Results Multivariate binary logistic regression analysis showed that the lesion location in the upper polar of the thyroid,the presence of ETE,IC in arterial phase>2.9 mg/ml,IC in the venous phase>3.2 mg/ml,and NIC in the arterial phase>0.21 were independent risk factors for LLNM prediction.The nomogram based on the above factors was constructed with an area under the ROC curve(AUC)of 0.895(95%CI 0.862-0.923).With a cut-off value of 0.79,the sensitivity and specificity were 86.3%and 75.2%,respectively.As for the external validation group,the AUC of the model was 0.887(95%CI 0.830-0.931),with the sensitivity of 82.8%,and the specificity of 81.1%.Conclusion The applicati

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 列线图 双能CT 

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