| 邵畅,舒艳艳,魏培英,高颖琪,周虹,韩志江.双期增强CT对甲状腺乳头状癌颈部淋巴结转移的诊断价值[J].浙江中西医结合杂志,2023,33(8): |
| 双期增强CT对甲状腺乳头状癌颈部淋巴结转移的诊断价值 |
| Diagnostic value of dual-phase enhanced CT in cervical lymph node metastasis of papillary thyroid carcinoma |
| 投稿时间：2023-01-31 修订日期：2023-04-13 |
| DOI： |
| 中文关键词: 甲状腺结节 桥本氏甲状腺炎 体层摄影术，X线计算机 淋巴结转移 病理学 |
| 英文关键词:Thyroid nodule, Hashimoto thyroiditis, Tomography, X-ray computer, Lymph node metastasis, Pathology |
| 基金项目:浙江省医药卫生科技计划项目（2021RC024） |
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| 中文摘要: |
| 目的：探讨双期增强（动脉期和静脉期）淋巴结CT值与同侧胸锁乳突肌CT值的差值与比值对甲状腺乳头状癌 (Papillary Thyroid Carcinoma, PTC) 患者颈部淋巴结转移 (cervical lymph node metastasis, CLNM) 的诊断价值。
方法：回顾分析87例138枚PTC转移阳性淋巴结的动脉期和静脉期CT影像资料，并与123例163枚转移阴性淋巴结的CT影像资料对照，所有淋巴结均经手术病理证实。分别测量动脉期、静脉期淋巴结与同侧胸锁乳突肌的CT值，计算二者间的差值与比值，通过操作者执行曲线(ROC)寻找鉴别PTC患者CLNM的最佳CT值阈值和相应的诊断效能。
结果：138枚转移阳性和163枚转移阴性淋巴结中，动脉期和静脉期CT值分别为111.3±33.6Hu和65.6（56.5, 76.8）Hu（Z= -11.238, P<0.01）、99.6±23.5Hu和75.2±14.0Hu （t= 11.119, P<0.01），二者诊断CLNM的AUC、敏感度和特异度分别为0.876和0.823、0.797和0.667、0.877和0.834。动脉期和静脉期淋巴结与胸锁乳突肌CT值的差值分别为49.4±33.3Hu和3.0（-6.2,14.7）Hu（Z= -11.396, P<0.01）、35.0±24.2Hu和10.5±14.3Hu（t=10.822, P<0.01）；二者诊断CLNM的AUC、敏感度和特异度分别为0.881和0.813、0.775和0.667、0.896和0.877，动脉期和静脉期淋巴结与胸锁乳突肌CT值的比值分别为1.8±0.5和1.1 （0.9, 1.2）（Z= -11.369, P<0.01）、 1.6±0.4和1.2±0.2（t=10.584, P<0.01），二者诊断CLNM的AUC、敏感度和特异度分别为分别为0.880和0.809、0.783和0.652、0.890和0.877。
结论：在双期增强CT鉴别PTC患者CLNM中，动脉期淋巴结CT值、淋巴结CT值与胸锁乳突肌的差值或比值具有更高的诊断效能。
关键词：甲状腺结节；桥本氏甲状腺炎；体层摄影术，X线计算机；淋巴结转移；病理学 |
| 英文摘要: |
| Objective: The diagnostic value of dual-phase enhanced computed tomography (CT) in the cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC) was investigated by analyzing the dual-phase enhanced Hounsfield units (HU) of lymph node and sternocleidomastoid muscle, and the ratio and difference.
Methods: Imaging data of 138 metastasis-positive lymph nodes in 87 cases and 163 metastasis-negative lymph nodes in 123 cases with PTC in the arterial phase and venous phase were retrospectively analyzed. All lymph nodes were confirmed by surgical pathology. The arterial-phase HU of lymph nodes (ANHU), venous-phase HU of lymph nodes (VNHU), arterial-phase HU of the sternocleidomastoid muscle (AMHU) and venous-phase HU of the sternocleidomastoid muscle (VMHU) were measured, and their difference and ratio (ANHU-AMHU, ANHU/AMHU, VNHU-
VMHU, VNHU/VMHU) were calculated. The cutoff values and corresponding diagnostic efficacy for
diagnosing CLNM in PTC were sought by performing the receiver operating characteristic curves.
Results: The ANHU and VNHU of 138 metastasis-positive lymph nodes and 163 metastasis-negative lymph nodes were 111.3±33.6Hu and 65.6(56.5, 76.8)Hu (Z= -11.238, P<0.01), 99.6±23.5Hu and 75.2±14.0Hu (t= 11.119, P<0.01), respectively. The ANHU-AMHU and VNHU-VMHU in metastasis-positive and metastasis-negative lymph nodes were 49.4±33.3Hu and 3.0(-6.2,14.7)Hu (Z=-11.396, P<0.01), 35.0±24.2Hu and 10.5±14.3Hu (t=10.822, P<0.01), respectively, and the ANHU/AMHU and VNHU/VMHU were 1.8±0.5 and 1.1 (0.9, 1.2) (Z= -11.369, P<0.01), 1.6±0.4 and 1.2±0.2 (t=10.584, P<0.01). The area under the curve, sensitivity, and specificity of ANHU and VNHU were 0.876 and 0.823, 0.797 and 0.667, 0.87 and 0.834, respectively. The area under the curve, sensitivity, and specificity of ANHU-AMHU and VNHU-VMHU were 0.881 and 0.813, 0.775 and 0.667, 0.896 and 0.877, respectively, and the three parameters of ANHU/AMHU and VNHU/VMHU were 0.88 and 0.809, 0.783 and 0.652, 0.890 and 0.877.
Conclusions: In the differential diagnosis of CLNM of PTC by dual-phase enhanced CT angiography, the arterial-phase HU of lymph node, and the difference and ratio to HU of muscle had higher diagnostic efficacy.
Key words: Thyroid nodule, Hashimoto thyroiditis, Tomography, X-ray computer, Lymph node metastasis, Pathology |
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