能谱CT定量分析在甲状腺恶性结节诊断及颈部淋巴结转移评估中的应用

doi:10.11958/20250052

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 654-658.doi: 10.11958/20250052

能谱CT定量分析在甲状腺恶性结节诊断及颈部淋巴结转移评估中的应用

王明扬(), 李丽(), 李玲玲, 吴钺

六安市中医院影像科（邮编237000）

收稿日期:2025-01-13 修回日期:2025-03-25 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：bennixiaode@163.com
作者简介:王明扬（1991），男，主治医师，主要从事能谱CT在甲状腺结节病理分类预测中的应用及临床研究。E-mail：wangmingyang199112@163.com
基金资助:
北京医学奖励基金会资助项目(YXJL-2022-0665-0206)

Application of energy spectrum CT quantitative analysis in the diagnosis of malignant thyroid nodules and evaluation of cervical lymph node metastasis

WANG Mingyang(), LI Li(), LI Lingling, WU Yue

Imaging Department of Lu'an Municipal Hospital of Traditional Chinese Medicine, Lu‘an 237000, China

Received:2025-01-13 Revised:2025-03-25 Published:2025-06-15 Online:2025-06-20
Contact: >E-mail： bennixiaode@163.com

王明扬, 李丽, 李玲玲, 吴钺. 能谱CT定量分析在甲状腺恶性结节诊断及颈部淋巴结转移评估中的应用[J]. 天津医药, 2025, 53(6): 654-658.

WANG Mingyang, LI Li, LI Lingling, WU Yue. Application of energy spectrum CT quantitative analysis in the diagnosis of malignant thyroid nodules and evaluation of cervical lymph node metastasis[J]. Tianjin Medical Journal, 2025, 53(6): 654-658.

摘要/Abstract

摘要：

目的探究能谱CT定量分析在甲状腺恶性结节诊断及颈部淋巴结转移评估中的应用价值。方法选取经超声初筛显示单发甲状腺结节的100例患者为研究对象，依据病理检查结果将其分为甲状腺结节良性组（n=42）和恶性组（n=58），并以甲状腺恶性结节患者是否存在颈部淋巴结转移分为转移组（n=26）和未转移组（n=32），所有患者均行能谱CT检查，测定能谱CT定量参数碘含量（IC）、标准化碘含量（NIC）和能谱曲线斜率（λHU）。采用受试者工作特征（ROC）曲线分析能谱CT定量对甲状腺恶性结节诊断及颈部淋巴结转移评估的应用价值。结果甲状腺良恶性结节形态、边缘、囊变及周围组织侵犯CT征象比较差异有统计学意义（P<0.05），最大直径、数目、强化程度及钙化比较差异无统计学意义（P>0.05）。恶性组IC_病灶、NIC和λHU均低于良性组，转移组IC_病灶、NIC和λHU均低于未转移组（P<0.05）；ROC曲线结果示，IC_病灶、NIC和λHU三者联合诊断甲状腺恶性结节及评估颈部淋巴结转移的曲线下面积（AUC）、敏感度、特异度及约登指数均高于单一指标。结论能谱CT定量分析在甲状腺恶性结节诊断及颈部淋巴结转移评估中具有较高的应用价值。

关键词: 甲状腺结节, 颈, 淋巴转移, 能谱CT定量分析

Abstract:

Objective To explore the application value of energy spectrum CT quantitative analysis in the diagnosis of malignant thyroid nodules and evaluation of cervical lymph node metastasis. Methods A total of 100 patients with thyroid nodules screened by ultrasound were selected as the study subjects. They were divided into the benign group (n=42) and the malignant group (n=58) according to pathological results. Patients in the malignant group were sub-divided into the metastasis group (n=26) and the non-metastasis group (n=32) according to the presence or absence of cervical lymph node metastasis. All patients received energy spectrum CT examination. The iodine concentration (IC), normalized iodine concentration (NIC) and the slope of the spectral Hounsfield unit curve (λHU) were measured. The receiver operating characteristic (ROC) curve was used to analyze the application value of energy spectrum CT quantitation in diagnosing malignant thyroid nodules and evaluating cervical lymph node metastasis. Results There were statistically significant differences in CT features (shape, edge, cystic changes and surrounding tissue invasion) between benign and malignant thyroid nodules (P<0.05). However, there were no statistically significant differences in the maximum diameter, number, enhancement degree and calcification (P>0.05). IC_lesion, NIC and λHU were lower in the benign group than those of the malignant group. IC_lesion, NIC and λHU of the metastasis group were lower than those of the non-metastasis group (P<0.05). ROC curve analysis results showed that the AUCs, specificity, sensitivity and Youden index of the combination of IC_lesion, NIC and λHU for diagnosing malignant thyroid nodules and evaluating cervical lymph node metastasis were higher than those of each parameter (P<0.05). Conclusion Energy spectrum CT quantitative analysis is of high value in the diagnosis of malignant thyroid nodules and evaluation of cervical lymph node metastasis.

Key words: thyroid nodule, neck, lymphatic metastasis, energy spectrum CT quantitative analysis

中图分类号:

R736.1，R445.9

图/表 7

参考文献 19

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组别		n	最大直径/mm	数目（单发/ 多发）		形态（规则/ 不规则）			边缘（清楚/ 模糊）
良性组		42	2.36±0.41	18/24		31/11			34/8
恶性组		58	2.28±0.52	30/28		22/36			16/42
t或χ²			0.828	0.767		12.588^＊			27.750^＊
组别	强化程度（轻中度强化/显著强化）				钙化（有/无）		囊变（有/无）	周围组织侵犯（有/无）
良性组	20/22				17/25		25/17	5/37
恶性组	31/27				20/38		10/48	32/26
χ²	0.331				0.375		19.143^＊	19.564^＊

组别		n	最大直径/mm	数目（单发/ 多发）		形态（规则/ 不规则）			边缘（清楚/ 模糊）
良性组		42	2.36±0.41	18/24		31/11			34/8
恶性组		58	2.28±0.52	30/28		22/36			16/42
t或χ²			0.828	0.767		12.588^＊			27.750^＊
组别	强化程度（轻中度强化/显著强化）				钙化（有/无）		囊变（有/无）	周围组织侵犯（有/无）
良性组	20/22				17/25		25/17	5/37
恶性组	31/27				20/38		10/48	32/26
χ²	0.331				0.375		19.143^＊	19.564^＊

组别	n	IC_病灶/（g/L）	NIC/（g/L）	λHU/（HU/KeV）
良性组	42	3.65±0.45	0.73±0.12	3.58±0.40
恶性组	58	2.75±0.37	0.62±0.09	3.07±0.35
t		10.872^＊	5.152^＊	6.751^＊

组别	n	IC_病灶/（g/L）	NIC/（g/L）	λHU/（HU/KeV）
良性组	42	3.65±0.45	0.73±0.12	3.58±0.40
恶性组	58	2.75±0.37	0.62±0.09	3.07±0.35
t		10.872^＊	5.152^＊	6.751^＊

组别	n	IC_病灶/（g/L）	NIC/（g/L）	λHU/（HU/KeV）
未转移组	26	3.14±0.41	0.70±0.11	3.42±0.42
转移组	32	2.42±0.32	0.57±0.08	2.75±0.38
t		10.151^＊	4.002^＊	4.415^＊

能谱CT定量分析在甲状腺恶性结节诊断及颈部淋巴结转移评估中的应用

Application of energy spectrum CT quantitative analysis in the diagnosis of malignant thyroid nodules and evaluation of cervical lymph node metastasis

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参考文献 19

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指标		AUC	95%CI		临界值		敏感度/%
IC_病灶		0.836	0.756~0.917		3.13 g/L		79.20
NIC		0.748	0.653~0.843		0.74 g/L		89.60
λHU		0.812	0.730~0.894		3.53 HU/KeV		91.70
三者联合		0.930	0.873~0.988		-		93.50
指标	特异度/%			阳性预测值/%		阴性预测值/%		约登指数
IC_病灶	76.90			86.21		92.86		0.561
NIC	53.80			77.59		88.10		0.434
λHU	55.80			79.31		88.10		0.475
三者联合	92.30			89.66		92.86		0.856

指标		AUC	95%CI		临界值		敏感度/%
IC_病灶		0.746	0.599~0.892		2.66 g/L		81.20
NIC		0.715	0.562~0.868		0.62 g/L		77.85
λHU		0.790	0.658~0.922		3.29 HU/KeV		83.10
三者联合		0.916	0.824~1.000		-		91.93
指标	特异度/ %			阳性预测值/%		阴性预测值/%		约登指数
IC_病灶	72.50			86.21		92.86		0.479
NIC	70.21			77.59		88.10		0.500
λHU	73.57			79.31		88.10		0.521
三者联合	92.01			89.66		92.86		0.832

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