Diagnostic value of dual-energy CT imaging for cervical lymph nodes metastasis in the patients with papillary thyroid cancer

何慕真; 马明平; 林　阳

doi:10.19401/j.cnki.1007-3639.2018.07.004

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Diagnostic value of dual-energy CT imaging for cervical lymph nodes metastasis in the patients with papillary thyroid cancer

更新时间：2026-01-27

- Diagnostic value of dual-energy CT imaging for cervical lymph nodes metastasis in the patients with papillary thyroid cancer
- China Oncology Vol. 28, Issue 7, Pages: 497-504(2018)
- 作者机构：
  
  1. 福建医科大学省立临床学院，福建省立医院放射科,福建,福州,350000
  2. 西门子医疗系统有限公司,上海,201318
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2018.07.004
  CLC： R736.1
- Published Online：10 August 2018，
  
  Published：10 August 2018
- 稿件说明：
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何慕真,马明平,林　阳,等. 双能量CT成像在诊断甲状腺乳头状癌颈部淋巴结转移中的临床应用价值[J]. 中国癌症杂志, 2018, 28(7): 497-504.

何慕真, 马明平, 林　阳. Diagnostic value of dual-energy CT imaging for cervical lymph nodes metastasis in the patients with papillary thyroid cancer[J]. China Oncology, 2018, 28(7): 497-504.
何慕真,马明平,林　阳,等. 双能量CT成像在诊断甲状腺乳头状癌颈部淋巴结转移中的临床应用价值[J]. 中国癌症杂志, 2018, 28(7): 497-504. DOI： 10.19401/j.cnki.1007-3639.2018.07.004.

何慕真, 马明平, 林　阳. Diagnostic value of dual-energy CT imaging for cervical lymph nodes metastasis in the patients with papillary thyroid cancer[J]. China Oncology, 2018, 28(7): 497-504. DOI： 10.19401/j.cnki.1007-3639.2018.07.004.

摘要

背景与目的：术前影像学检查指导甲状腺乳头状癌（papillary thyroid carcinoma，PTC）手术方式选择。该研究探讨双能量CT成像在术前诊断PTC颈部淋巴结转移中的临床应用价值。方法：前瞻性收集2016年8月—2017年5月55例临床可疑甲状腺癌拟手术治疗的患者，进行颈部双能量增强CT扫描及定量分析，并与常规CT征象对比。测量及计算短径≥5 mm的淋巴结感兴趣区动脉期、静脉期标准化碘浓度（normalized iodine concentration，NIC）及能谱曲线斜率（λ

）。对比分析经手术病理证实的转移组及未转移组淋巴结的常规CT表现和双能量CT中动脉期、静脉期NIC及λ

差异是否有统计学意义。采用受试者工作特征（receiver operating characteristic，ROC）曲线分析NIC及λ

的最佳诊断阈值，评价诊断效能。结果：以术后病理学检查结果为金标准，与术前CT准确配对淋巴结212枚，包括转移淋巴结124枚（58.5%）和未转移淋巴结88枚（41.5%）。通过常规CT形态学征象包括淋巴结短径（＞10 mm）、明显强化、不均匀强化、淋巴结坏死（囊变）、淋巴结内钙化及侵犯周围组织等对PTC转移淋巴结进行诊断的灵敏度为4.0%~79.0%，特异度为63.6%~100.0%。PTC颈部淋巴结转移组和未转移组的动脉期NIC、静脉期NIC、动脉期λHU及静脉期λ

差异均有统计学意义（P＜0.001）。其中动脉期NIC对PTC颈部转移淋巴结诊断效能最高，以25.8%为最佳诊断阈值，其灵敏度为90.3%，特异度为96.6%，曲线下面积（area under curve，AUC）为0.986。动脉期NIC及λ

的诊断效能均高于静脉期（P＜0.001）。结论：双能量CT成像的定量参数NIC及λ

较常规CT形态学征象在诊断PTC颈部淋巴结转移中具有更高的准确性。

Abstract

Background and purpose: Pre-operative imaging examination is especially

critical to the guidance on the selection of surgical methods of papillary thyroid cancer. This study aimed to quantitatively assess the diagnostic value of dual-energy computed tomography (CT) imaging for cervical lymph nodes metastasis in patients with papillary thyroid cancer. Methods: This study was approved by the ethics committee

and all patients were provided with written informed consent. Fifty-five consecutive patients with suspected thyroid cancer were prospectively enrolled

and underwent enhanced dual-energy spectral CT scan from August 2016 to May 2017. The quantitative dual-energy CT imaging and qualitative conventional CT scanning data were analyzed and compared by different groups of radiologists. A region of interest was drawn in the cervical lymph nodes with a maximal short axial diameter of greater than or equal to 5 mm. The normalized iodine concentration (NIC) and the slope of the spectral Hounsfield unit curve (λ

) during both arterial and venous phases were measured respectively from iodine overlay images and spectral curves. Two-sample t test was performed to compare quantitative parameters at dual-energy CT between the histopathologically proven benign and metastatic lymph nodes. Receiver operating characteristic (ROC) curves were generated for sensitivity and specificity analyses as well as evaluating the diagnostic value of dual-energy CT imaging and conventional CT features. Results: A total of 212 nodes were detected

including 88 benign and 124 metastatic lymph nodes which were successfully matched and labeled during surgery. By using the conventional CT features including node size

degree and pattern of enhancement

necrosis

as well as extranodal extension for detection of metastatic lymph nodes

sensitivity

specificity and accuracy were 4.0%-79.0%

63.6%-100.0% and 43.9%-72.6%

respectively. Both arterial and venous phases NIC and λ

were significantly higher in metastatic than in benign lymph nodes (all P0.001). The best quantitative parameter for detec

tion of lymph nodes metastasis was arterial phase NIC with optimal threshold value of 25.8%. The sensitivity

specificity

accuracy

positive predictive value and negative predictive value were 90.3%

96.6%

92.9%

97.4% and 87.6%

respectively. The area under curve (AUC) of arterial phase NIC and λ

were significantly higher than those of venous phases (all P0.001). Conclusion: Compared with qualitative conventional CT features

quantitative parameters associated with NIC and λHU at dual-energy CT showed higher accuracy and better diagnostic performance for cervical lymph nodes metastasis in patients with papillary thyroid cancer.

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