| Part ⅠThe value of CT Morphology in the diagnosis of the metastatic central lymph nodes in patients with papillary thyroid cancerObjective:To explore CT to diagnose metastasis of the Central group lymph nodes in patients with papillary thyroid cancer.Methods:Totally 31 patients was pathologically confirmed as papillary thyroid cancer and with complete information and underwent dual energy scan.Excised lymph nodes were located and labeled during surgery according to location on preoperative CT images and were evaluated histopathologically.Positive and negative coincidence rate of CT were evaluated regarding central lymph node metastasis.The distribution central lymph node metastasis as the minimum diameter/maximum diameter≥ 1/2,highly enhancement,Inhomogeneous enhancement,degeneration and microcalcification were observed.The pathology diagnosis was considered as the gold standard,the sensitivity,specificity and accuracy of all signs that was diagnosed metastasis of the Central group lymph nodes in patients with papillary thyroid cancer with CT enhanced scanning were calculated.Results:In 31 patients with papillary thyroid cancer,73 central lymph nodes were found,including 51 metastasis lymph nodes(51/73,69.86%)and 22 non-metastasis lymph nodes(22/73,30.13%).There were 8 cases degeneration(10.96%),microcalcification in 7 cases(9.59%),highly enhancement in 14 cases(19.18%),Inhomogeneous enhancement in 11 cases(15.07%),the minimum diameter/maximum diameter≥1/2 in 41 cases(56.16%)in CT morphology.Pathology in metastatic lymph nodes in the above signs,respectively,9,8,5,14,38 cases of metastatic lymph nodes of these signs,respectively,100%,71.42%,100%,81.82%,90.24%.the sensitivity,the specificity,and the accuracy of the metastatic lymph nodes CT morphology,were 74.50%,76.19%and 73.97%respectively.Conclusion:CT has a certain value for the diagnosis of the metastatic central lymph nodes in patients with papillary thyroid cancer,the minimum diameter/maximum diameter≥1/2,highly enhancement,Inhomogeneous enhancement,degeneration and microcalcification improves the accuracy of diagnosis.Part IIThe value of Iodine Concentration and spectral imaging technique of dual-energy CT in the diagnosis of the metastatic central lymph nodes in patients with papillary thyroid cancerObjective:To explore the value of Iodine Concentration and spectral imaging technique of dual-energy CT to diagnose metastasis of the Central group lymph nodes in patients with papillary thyroid cancer.Methods:This study was approved by the ethics committee and all patients provided written informed consent.Totally 31 patients was pathologically confirmed as papillary thyroid cancer and with complete information and underwent dual energy scan,Analyses of Iodine Concentration and spectral imaging data were performed by different groups of radiologists.Excised lymph nodes were located and labeled during surgery according to location on preoperative CT images and were evaluated histopathologically.The iodine content of the primary lesions and regional lymph nodes were measured in "Liver VNC" mode,Then the change trend of the spectrum curve were analyzed in "Mono Energetic" mode.The differences of iodine content and spectral curve were compared among primary lesion,metastatic lymph node and non-metastatic lymph node in arterial phase and venous phase.Sensitivity and specificity analyses were performed by using receiver operating characteristic curves and were compared with data from the qualitative analysis.Results:In 31 patients with papillary thyroid cancer,73 central lymph nodes were found,including 51 metastasis lymph nodes and 22 non-metastasis lymph nodes.the normalized iodine concentration(NICnod)in arterial phase of the primary lesion and the metastatic lymph node were 0.35±0.28,0.36±0.21.the NICnod in venous phase of the primary lesion and the metastatic lymph node were 0.49±0.29,0.47±0.27 respectively,the arterial phase and venous phase NICnod of the non-metastatic lymph node were 0.23±0.18,0.3 5±0.22.while there were no statistical differences in the primary lesions and the metastatic lymph nodes through pairwise comparison.And the slope spectrum curve in arterial phase had no statistical differences(P>0.05),while there were statistical differences in venous phase(P<0.05).The best combination of parameters was arterial phase NICnod and venous phase spectrum curve which showed a good consistency with morphology(Kappa=0.712,0.643).Combining morphology of these lymph nodes,the sensitivity was 82.4%,and the specificity was 86.4%.Conclusion:Iodine Concentration and spectral imaging technique on dual-energy CT has a certain value for the diagnosis of the metastatic central lymph nodes in patients with papillary thyroid cancer,combining morphology improves the accuracy of diagnosis. |
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