Comparison of single and dual phase of enhanced CT diagnostic values in thyroid nodules
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摘要:
目的 比较单、双期CT增强对甲状腺结节的诊断价值，探索最佳扫描方案。 方法 按纳入及排除标准，选取我院2020年1月~2022年6月因甲状腺结节行平扫及双期CT增强的153个病例，共171枚结节，单期CT增强组取延迟50 s的图像序列作诊断，双期CT增强组取延迟25 s和50 s两组图像序列作诊断。主要评价指标为甲状腺结节良恶性诊断的准确率、结节特征的显示率、阳性淋巴结的显示率及结节的强化特点。 结果 单、双期CT增强对甲状腺结节良恶性的诊断准确率差异无统计学意义（P=0.152），对甲状腺结节的边缘、形态、包膜、密度、钙化、淋巴结等特征的显示差异均无统计学意义（P>0.05）。不同密度的良恶性的甲状腺结节在两组间差异无统计学意义（P=0.418）。双期CT增强的强化方式在良恶性甲状腺结节之间差异无统计学意义（P=0.075）。 结论 单、双期CT增强对甲状腺结节的诊断价值无明显差异，单期CT增强辐射剂量低，适合临床推广和应用。 Abstract:Objective To compare the diagnostic value of single and dual phase of enhanced CT in thyroid nodules, and explore the best scanning scheme. Methods A total of 171 nodules in 153 patients were included from January 2020 to June 2022 according to inclusion and exclusion criteria. Image sequence with a delay of 50 seconds was taken for diagnosis in the group of single phase of enhanced CT, then image sequences with a delay of 25 and 50 seconds were taken for diagnosis in the group of dual phase of enhanced CT. Diagnostic accuracy of benign and malignant thyroid nodules, characteristics of thyroid nodules, positive lymph node and enhanced CT features of thyroid nodules in two scanning schemes were the main evaluation indicators. Results There was no statistical significance in diagnostic accuracy of benign and malignant thyroid nodules between single and dual phase of enhanced CT. There was no statistical significance in edge, morphology, capsule, density, calcification and lymph node of thyroid nodules between two scanning scheme. There was no statistical significance in different densities of benign and malignant thyroid nodules between two scanning scheme. There was no statistical significance in enhancement mode of benign and malignant thyroid nodules in dual phase of enhanced CT. Conclusion There is no significant difference in the diagnostic value of single and dual phase of enhanced CT in thyroid nodules, and single phase of enhanced CT would be more suitable for clinical promotion and application by its lower radiation dose. -
Key words:
- thyroid nodule /
- phase of CT enhancement /
- diagnostic value /
- computed tomography
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图 1 甲状腺左叶乳头状癌，边缘“模糊征”、轮廓缩小
Figure 1. "Fuzzy sign"and reduction of lesion contour in Papillary thyroid carcinoma. A: Axial image of plain CT; B: Axial image of Ⅰ phase enhanced CT; C: Axial image of Ⅱ phase enhanced CT.
图 2 甲状腺左叶乳头状癌，形态不规则、边缘毛刺、包膜“咬饼征”
Figure 2. Irregular shape, spiculated margin and"cake bite sign"of envelope in Papillary thyroid carcinoma. A: Axial image of plain CT; B: Coronal image of Ⅰ phase enhanced CT; C: Coronal image of Ⅱ phase enhanced CT.
图 3 甲状腺左叶乳头状癌，边缘模糊的簇状钙化，转移性淋巴结囊变、钙化（箭头）
Figure 3. Clustered calcification with fuzzy edges and calcified metastatic lymph node with cystic degeneration (arrows) in Papillary thyroid carcinoma. A: Axial image of plain CT; B: Coronal image of Ⅰ phase enhanced CT; C: Coronal image of Ⅱ phase enhanced CT.
表 1 单、双期CT增强甲状腺结节良恶性诊断准确率比较
Table 1. Comparison of single and dual phase of enhanced CT's diagnostic accuracy in differentiate benign and malignant thyroid nodules (n)
Dual-phase CT enhancement Single-phase CT enhancement Total + - + 129 16 145 - 8 18 26 Total 137 34 171 +: Correct diagnosis; -: Incorrect diagnosis. 
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表 2 单、双期CT增强甲状腺结节特征的比较
Table 2. Comparison of thyroid nodules'features in single and dual phase of enhanced CT (n)
Dual-phase CT Single-phase CT enhancement P + - Edge 0.115 + 69 14 - 6 82 Morphology 0.481 + 65 11 - 7 88 Capsule 0.388 + 53 8 - 4 106 Density 0.077 + 101 12 - 4 54 Calcification 0.167 + 37 13 - 6 25 Lymph node 0.344 + 26 7 - 3 135 +: Positive signs; -: Negative signs.
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表 3 单、双期CT增强中甲状腺不同密度的良恶性结节比较
Table 3. Comparison of thyroid nodules with different densities and properties in single and dual phase of enhanced CT (n)
Group High-density benign nodules Equal or low-density benign nodules High-density malignant nodules Equal or low-density malignant nodules Single-phase CT enhancement 16 61 5 89 Dual-phase CT enhancement 9 68 3 91 χ2 2.840 P 0.418
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表 4 双期CT增强甲状腺良、恶性结节强化方式比较
Table 4. Comparison of benign and malignant thyroid nodules' enhancement mode in dual phase of enhanced CT (n)
Group Progressive enhancement Withdrawal enhancement Continuous enhancement Benign nodules 12 61 4 Malignant nodules 28 60 6 χ2 5.169 P 0.075
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