目的：探讨CT强化模式在甲状腺微小乳头状癌（Papillary thyroid microcarcinoma，PTMC）和微小结节性甲状腺肿（Micronodular goiter，MNG）鉴别诊断中的价值。方法：回顾分析经手术及病理证实的267例共327枚直径在0.5～1.0 cm的甲状腺微小结节的CT资料，其中143例共160枚PTMC， 124例共167枚MNG。分别计算良、恶性结节平扫与增强后静脉期CT值的比值（Plane scan/enhanced scan，PS/ES），以及增强与平扫CT值的差值（ΔCT值），采用t检验对良、恶性结节的PS/ES及ΔCT值进行统计学分析，通过ROC曲线确定PS/ES及ΔCT值鉴别PTMC及MNG的最佳域值。结果：160枚PTMC和167枚MNG中，经t检验，PTMC组和MNG组的PS/ES（t=10.35，df=319.346，P＜0.001）和ΔCT值（t=-10.242，df=322.712，P＜0.001）均具有统计学差异。PS/ES在ROC曲线下面积为0.799，当PS/ES=0.525时，约登指数最大，为0.520，敏感度和特异度分别为83.1%（133/160）和68.9%（115/167）；ΔCT值在ROC曲线下面积为0.808，当ΔCT值=51.5 HU时，约登指数最大，为0.514，敏感度和特异度分别为82.5%（132/160）和68.9%（115/167）；同时具备PS/ES≤0.525且ΔCT值＞51.5 HU诊断PTMC的敏感度和特异度分别为78.1%（125/160）和78.4%（131/167）。结论： PS/ES≤0.525和ΔCT值＞51.5 HU均是诊断PTMC的重要参数，二者联合可以进一步提高诊断特异度，从而减少误诊的发生。
Abstract
Objective: To investigate the value of CT enhancement pattern in differential diagnosis of papillary thyroid microcarcinoma(PTMC) and micronodular goiter(MNG). Methods: The CT data of 267 cases of thyroid nodules with a diameter of 0.5~1.0 cm confirmed by operation and pathology were retrospectively analyzed. Of them, there were 143 cases of 160 PTMC and 124 of 167 MNG. The ratios of CT values(plane scan/enhanced scan, PS/ES) and the difference(ΔCT value) between benign and malignant nodules were calculated respectively, the PS/ES and ΔCT values of benign and malignant nodules were statistically analyzed by t test, and best thresholds of PS/ES and ΔCT to identify PTMC and MNG were determined by ROC curve. Results: Among 160 PTMC and 167 MNG, the PS/ES(t=10.35, df=319.346, P<0.001) and ΔCT values (t=-10.242, df= 322.712, P<0.001) were statistically significant. The area under the ROC curve was 0.799 for PS/ES. When PS/ES was 0.525, the maximum Youden index was 0.520, the sensitivity and specificity were 83.1%(133/160) and 68.9%(115/167), respectively. The ΔCT value under the ROC curve was 0.808. When the ΔCT value was 51.5 HU, the Youden index was the largest (0.514), the sensitivity and specificity were 82.5%(132/160) and 68.9%(115/167), respectively. Meanwhile, the sensitivity and specificity for PTMC with PS/ES≤0.525 and ΔCT value>51.5 HU were 78.1%(125/160) and 78.4%(131/167), respectively. Conclusion: Both PS/ES≤0.525 and ΔCT value>51.5 HU are important parameters in diagnosis of PTMC. The combination of the two can further improve the diagnostic specificity and reduce the misdiagnosis.
关键词
/
甲状腺肿瘤 /
甲状腺肿 /
结节性 /
体层摄影术 /
螺旋计算机
Key words
Thyroid neoplasms /
Goiter, nodular /
Tomography, spiral computed
中图分类号：
Ｒ736.1
Ｒ581.3
Ｒ814.42
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Chen Y, Sadow PM, Suh H, et al. BRAF(V600E) Is Correlated with Recurrence of Papillary Thyroid Microcarcinoma: A Systematic Review, Multi-Institutional Primary Data Analysis, and Meta-Analysis[J]. Thyroid, 2016, 26(2): 248-255.
[2]Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma[J]. Eur J Surg Oncol, 2013, 39(2): 191-196.
[3]Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy[J]. Yonsei Med J, 2014, 55(2): 339-344.
[4]Kim DW. Computed tomography features of papillary thyroid carcinomas[J]. J Comp Assist Tomogr, 2014, 38(6): 936-940.
[5]瞿佳丽，朱妙平，韩志江. 各种CT征象联合应用在甲状腺微小乳头状癌诊断中的价值[J]. 影像诊断与介入放射学，2015，24（2）：151-155.
[6]俞炎平，邝平定，张亮，等. 小甲状腺癌的CT表现分析[J]. 中华放射学杂志，2010，44（10）：1049-1053.
[7]王成伟，陈松平，黄松，等. 螺旋CT对甲状腺乳头状癌及结节性甲状腺肿的诊断价值[J]. 现代实用医学，2016，28（4）：467-468.
[8]Guhne F, Winkens T, Mothes H, et al. Differential diagnosis of thyroid nodules via real-time PET/ultrasound(US) fusion in a case of co-existing medullary thyroid cancer and adenoma[J]. J Clin Endocrinol Metab, 2013, 98(11): 4250-4251.
[9]何兰，黄燕琪，马泽兰，等. CT影像组学在非小细胞肺癌临床分期中的价值[J]. 中华放射学杂志，2017，51（12）：906-911.
[10]胡斌，徐克，张立娜，等. 基于表观扩散系数图像的影像组学模型对MRI乳腺影像报告与数据系统4类病变良恶性的鉴别诊断价值[J]. 中华放射学杂志，2017，51（12）：922-925.
[11]莫威行，周健，韩志江，等. 高强化对甲状腺CT双期增强扫描良恶性结节性质判断的价值[J]. 浙江中西医结合杂志，2016，26（8）：739-741.
[12]韩志江，舒艳艳，陈文辉，等. 高强化CT征象在甲状腺良恶性结节诊断和鉴别诊断中的价值[J]. 中华内分泌外科杂志，2015，9（4）：295-297.
[13]高小幼，韩晓雨，李智勇，等. 甲状腺乳头癌的CT影像研究[J]. 医学影像学杂志，2011，21（3）：335-337.
[14]Han ZJ, Shu YY, Lai XF, et al. Value of computed tomography in determining the nature of papillary thyroid microcarcinomas: evaluation of the computed tomographic characteristics[J]. Clin Imaging, 2013, 37(4): 664-668.
[15]中华医学会放射学分会头颈学组. 甲状腺结节影像检查流程专家共识[J]. 中华放射学杂志，2016，50（12）：911-915.
基金
浙江省公益技术应用研究项目（2017C33180）；杭州市重大科技创新专项项目（20131813A08）；
2015浙江省医药卫生计划项目（2015KYB293）；浙江省教育厅科研项目（Y201636958）；
杭州市科委社会发展自主申报项目（20180533B39）。
