Shuiqing Zhuo1, Jiayuan Sun2, Jinyong Chang3, Longzhong Liu4, Sheng Li1. 1. Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 2. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 3. Department of Radiology, Lian Jiang People's Hospital, Lianjiang, China. 4. Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Abstract
BACKGROUND: To evaluate the diagnostic performance of quantitative spectral parameters derived from dual-source dual-energy CT at small field of view (FOV) for small lymph node metastasis in thyroid cancer. METHODS: This was a retrospective diagnostic study. From 2016 to 2019, 280 patients with thyroid disease underwent thin-section dual-source dual-energy thyroid CT and thyroid surgery. The data of patients with lymph nodes having a short diameter of 2-6 mm was analyzed. The quantitative dual-energy CT parameters of targeted lymph nodes were measured, and all parameters between metastatic and non-metastatic lymph nodes were compared. These parameters were then fitted to univariable and multivariable binary logistic regression models. The diagnostic role of spectral parameters was analyzed by receiver operating characteristic (ROC) curves and compared with the McNemar test. Small FOV CT images and a mathematical model were used to judge the status of lymph nodes respectively, and then compared with the golden criterion-pathological diagnosis. The cut-off value of the model was 0.4419, with a sensitivity of 90.2% and a specificity of 92.7%. RESULTS: Of the 216 lymph nodes investigated in this study, 52.3% and 23.6% had a short diameter of 2-3 and 4 mm, respectively. Multiple quantitative CT parameters were significantly different between benign and malignant lymph nodes, and binary regression analysis was performed. The mathematical model was: p=ey/(1+ ey), y=-23.119+0.033× precontrast electron cloud density +0.076× arterial phase normalized iodine concentration +2.156× arterial phase normalized effective atomic number -0.540× venous phase slope of the spectral Hounsfield unit curve +1.676× venous phase iodine concentration. This parameter model had an AUC of 92%, with good discrimination and consistency, and the diagnostic accuracy was 90.3%. The diagnostic accuracy of the CT image model was 43.1%, and for lymph nodes with a short-diameter of 2-3 mm, the diagnostic accuracy was 22.1%. CONCLUSIONS: The parameter model showed higher diagnostic accuracy than the CT image model for diagnosing small lymph node metastasis in thyroid cancer, and quantitative dual-energy CT parameters were very useful for small lymph nodes that were difficult to be diagnosed only on conventional CT images. TRIAL REGISTRATION: This study is retrospectively registered, and we have registered a prospective study (Registration number: ChiCTR2000035195; http://www.chictr.org.cn). 2021 Gland Surgery. All rights reserved.
BACKGROUND: To evaluate the diagnostic performance of quantitative spectral parameters derived from dual-source dual-energy CT at small field of view (FOV) for small lymph node metastasis in thyroid cancer. METHODS: This was a retrospective diagnostic study. From 2016 to 2019, 280 patients with thyroid disease underwent thin-section dual-source dual-energy thyroid CT and thyroid surgery. The data of patients with lymph nodes having a short diameter of 2-6 mm was analyzed. The quantitative dual-energy CT parameters of targeted lymph nodes were measured, and all parameters between metastatic and non-metastatic lymph nodes were compared. These parameters were then fitted to univariable and multivariable binary logistic regression models. The diagnostic role of spectral parameters was analyzed by receiver operating characteristic (ROC) curves and compared with the McNemar test. Small FOV CT images and a mathematical model were used to judge the status of lymph nodes respectively, and then compared with the golden criterion-pathological diagnosis. The cut-off value of the model was 0.4419, with a sensitivity of 90.2% and a specificity of 92.7%. RESULTS: Of the 216 lymph nodes investigated in this study, 52.3% and 23.6% had a short diameter of 2-3 and 4 mm, respectively. Multiple quantitative CT parameters were significantly different between benign and malignant lymph nodes, and binary regression analysis was performed. The mathematical model was: p=ey/(1+ ey), y=-23.119+0.033× precontrast electron cloud density +0.076× arterial phase normalized iodine concentration +2.156× arterial phase normalized effective atomic number -0.540× venous phase slope of the spectral Hounsfield unit curve +1.676× venous phase iodine concentration. This parameter model had an AUC of 92%, with good discrimination and consistency, and the diagnostic accuracy was 90.3%. The diagnostic accuracy of the CT image model was 43.1%, and for lymph nodes with a short-diameter of 2-3 mm, the diagnostic accuracy was 22.1%. CONCLUSIONS: The parameter model showed higher diagnostic accuracy than the CT image model for diagnosing small lymph node metastasis in thyroid cancer, and quantitative dual-energy CT parameters were very useful for small lymph nodes that were difficult to be diagnosed only on conventional CT images. TRIAL REGISTRATION: This study is retrospectively registered, and we have registered a prospective study (Registration number: ChiCTR2000035195; http://www.chictr.org.cn). 2021 Gland Surgery. All rights reserved.
Entities:
Keywords:
Dual-source dual-energy CT; lymph node; radiologic-pathological correlation; small field of view (small FOV); thyroid cancer
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