光谱CT定量参数预测术前临床淋巴结阴性甲状腺乳头状癌患者中央区淋巴结转移的研究

Study on quantitative parameters of spectral CT in predicting central lymph node metastasis in patients with preoperative clinical lymph node-negative papillary thyroid carcinoma

摘要

目的：探讨光谱CT定量参数对术前临床淋巴结阴性（clinically node-negative，cN0）甲状腺乳头状癌（papillary thyroid carcinoma，PTC）患者中央区淋巴结转移（central lymph node metastasis，CLNM）的预测效能。方法：回顾性分析术前行光谱CT检查并经手术病理证实的86例PTC患者的临床及影像资料，比较CLNM组和非CLNM组间临床指标和光谱CT特征差异。应用受试者工作特性（receiver operating characteristic，ROC）曲线评估临床特征、光谱CT特征和两者联合模型的预测效能，并计算曲线下面积（area under the curve，AUC）、敏感度和特异度。结果：临床特征方面，性别、甲状腺球蛋白（thyroglobulin，Tg）和囊变在CLNM及非CLNM组间差异具有统计学意义（P均<0.05）。平扫光谱CT参数方面，CLNM组的平扫期CT值40 keVHU、平扫期CT值70 keVHU低于非CLNM组（P<0.05）；动脉期光谱CT参数方面，除动脉期标准化有效原子序数（normalized Zeff，NZeff），其余参数在CLNM和非CLNM组间差异均具有统计学意义（P<0.05）；静脉期光谱CT参数方面，CLNM组的静脉期CT值70 keVHU低于非CLNM组（P=0.014）。联合模型的预测效能最高（AUC为0.896，灵敏度为86.7%，特异度为80.4%），其次为光谱CT参数模型（AUC为0.835，灵敏度为73.3%，特异度为85.7%），最后为临床模型（AUC为0.591，灵敏度为20.0%，特异度为98.2%， P<0.05）。结论：基于病灶的光谱CT定量参数能提高对cN0 PTC患者CLNM的预测效能，指导临床决策。

Abstract

Objective：To evaluate the predictive efficacy of spectral CT quantitative parameters for central lymph node metastasis（CLNM）in preoperative clinical node-negative（cN0）papillary thyroid carcinoma（PTC）patients. Methods：Clinical and imaging data of 86 surgical pathologically confirmed PTC patients who underwent preoperative spectral CT imaging，were retrospectively collected. Differences in clinical and spectral CT features between the CLNM and non-CLNM groups were compared. Receiver operating characteristic（ROC）curve analysis was used to assess the predictive performance of clinical features，spectral CT features，and a combined model，with area under the curve（AUC），sensitivity，and specificity calculated. Results：Among clinical indicators，sex，thyroglobulin（Tg）level，and cystic changes showed statistically significant differences between CLNM and non-CLNM groups（all P<0.05）. Among non-contrast（NC）spectral CT parameters，40 keVHU and 70 keVHU values were significantly lower in CLNM group（all P<0.05）. Among arterial phase（AP）spectral CT parameters，all parameters except arterial normalized effective atomic number（NZeff）differed significantly between two groups（all P<0.05）. Among venous phase spectral CT parameters，70 keVHU value was significantly lower in CLNM group（P=0.014）. Combined model demonstrated the highest predictive efficacy（AUC=0.896，sensitivity=86.7%，specificity=80.4%），followed by spectral CT quantitative parameter model（AUC=0.835，sensitivity=73.3%，specificity=85.7%），and clinical model（AUC=0.591，sensitivity=20.0%，specificity=98.2%；all P<0.05）. Conclusion：Spectral CT quantitative parameters based on lesion characteristics improve the preoperative prediction of CLNM in cN0 PTC patients，and aid in treatment plan.

关键词

甲状腺乳头状癌 / 淋巴结转移 / 临床淋巴结阴性 / 光谱CT

Key words

papillary thyroid carcinoma / lymph node metastasis / clinically node-negative / spectral CT

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基金资助

国家自然科学基金面上项目(82471980)