基于双能CT列线图模型预测甲状腺乳头状癌淋巴结转移的研究  

Study on the Nomogram Model Based on Dual-energy Computed Tomography for Predicting Lymph Node Metastasis in Papillary Thyroid Carcinoma

作　　者：高波[1] 张婧彬 米惠枝 孙海乔 李晓会[1] 吴佳星 张柯欣 王少彤 苏轩 崔新悦 GAO Bo;ZHANG Jingbin;MI Huizhi;SUN Haiqiao;LI Xiaohui;WU Jiaxing;ZHANG Kexin;WANG Shaotong;SU Xuan;CUI Xinyue(Department of Medical Imaging,Second Affiliated Hospitalof Xi’an Jiaotong University,Xi’an 710004,China;Department of Radiation Oncology,Second Affiliated Hospitalof Xi’an Jiaotong University,Xi’an 710004,China;Siemens Healthineers No.399,West Haiyang Road,Shanghai 200126,ChinaAbstract)

机构地区：[1]西安交通大学第二附属医院医学影像科,西安7100042 [2]西安交通大学第二附属医院肿瘤放疗科,西安7100042 [3]西门子医疗CT科研市场部,上海200126

出　　处：《CT理论与应用研究(中英文)》2025年第1期31-36,共6页Computerized Tomography Theory and Applications

基　　金：陕西省“双链”融合国家医学中心医工交叉项目(微剂量CT算法应用验证(2021LL-JB-06))。

摘　　要：目的:探讨基于双能CT定量参数结合淋巴结临床信息构建列线图模型对转移淋巴结与非转移淋巴结的鉴别作用。方法:回顾性收集2021年至2023年甲状腺乳头状癌的患者103例,术前患者均行颈部双能量增强CT,结合术后病理结果,将淋巴结分为转移淋巴结与非转移淋巴结两组,其中转移淋巴结105粒,非转移淋巴结136粒。分析两组淋巴结的动脉期碘浓度(IC)、形状、短径、边缘、强化程度、囊变、钙化、动脉期强化方式、甲状腺结节包膜完整度。经过单因素和多因素Logistic分析,得到判断淋巴结转移的独立风险因素,基于此结果构建模型,并绘制列线图及校准曲线。结果:多因素二元Logistic回归结果显示,淋巴结动脉期碘浓度≥2.6 mg/mL、动脉期强化程度明显、动脉期强化方式不均匀、短径≥10 mm、边缘不清楚、形状不规则、甲状腺结节包膜不完整为预测淋巴结是否为转移的淋巴结的独立危险因素。列线图AUC为0.996(95%CI 0.993~0.996),截断值0.09,灵敏度99%,特异度95%。结论:基于双能CT构建的列线图,对术前评估甲状腺乳头状癌患者的淋巴结有无转移,可以辅助手术医生在术前制定手术方案。Objective:This study aimed to evaluate the effectiveness of a nomogram model based on dual-energy computed tomography(CT)quantitative parameters combined with clinical information for distinguishing metastatic from non-metastatic lymph nodes in patients with papillary thyroid carcinoma(PTC).Methods:This retrospective study was conducted in 103 patients with PTC from 2021 to 2023.Each patient underwent preoperative neck dual-energy-enhanced CT,and postoperative pathological results revealed 105 lymph nodes as metastatic and 136 as non-metastatic.Parameters,such as iodine concentration(IC),in the arterial phase,lymph node shape,short diameter,margin,degree of enhancement,cystic changes,calcification,arterial phase enhancement pattern,and thyroid nodule capsule integrity were analyzed.Univariate and multivariate logistic regression analyses identified independent risk factors for lymph node metastasis that were incorporated into the nomogram.The model performance was evaluated using a calibration curve.Results:Multivariate logistic regression analysis showed IC in the arterial phase≥2.6 mg/mL,significant arterial phase enhancement,uneven arterial phase enhancement pattern,diameter≥10 mm,unclear margins,irregular shape,and incomplete thyroid nodule capsule as independent risk factors for lymph node metastasis.The nomogram achieved an area under the curve of 0.996(95%confidence interval(CI);0.993~0.996)with a cutoff value of 0.09,sensitivity of 99%,and specificity of 95%.Conclusion:The dual-energy CT-based nomogram demonstrated a significant clinical value in the preoperative assessment of lymph node metastasis in patients with PTC,potentially assisting in the formulation of individualized surgical plans.

关 键 词：双能量CT 甲状腺肿瘤 列线图 颈部淋巴结转移 

分 类 号：R814.42[医药卫生—影像医学与核医学]