| Objectives1. To evaluate the diagnostic value of multi-slice CT enhancement scanning on thyroid disease.2. To explore the clinical value of multi-slice CT enhancement scanning perfusion in diagnosis and differential diagnosis of thyroid disease. After detecting parameters of MSCT enhancement scanning perfusion in normal thyroid and thyroid diseases, which include blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS), we deal with the parameters with image reconstruction and pseudo-color dyeing methods to assess the perfusion status of thyroid.Materials and Methods1. Patients:Based on the criterion, a total of 61 patients were divided into 2 groups, normal group (18 cases) and disease group (43 cases). Among 43 cases, 33 were with benign thyroid diseases. 17 (male: 6, female: 27) of them were with nodular goiter, 16 with thyroid adenoma with mean age of 38.27±9.84 years old (21 to 54). 10 cases (male: 4, female: 6) with thyroid carcinoma with mean age of 34.60±13.50 years old (20 to 59). 2. Examination method:After plan scan, all patients were underwent routine CT scanning and then received single-level dynamic enhanced serial CT scanning with 16-detector row scanner (LightSpeed; GE Healthcare). The table position was decided according to the routine scanning images. The operating parameters were as follows, scan mode: Cine Full, slice thickness: 5mm×4, scan time: Is, total exposure time: 55s, interval time: Is, tube voltage: 80kV, tube current: 60mAs and matrix: 512x512. Abolus of 50ml contrast medium (Iohexol injection) was injected at the rate of 4.0ml/s, then the scanning followed with 8 seconds delay. 220 images were obtained within 55 times of scanning. After that, additional 50ml contrast medium was been injected and routine CT scanning were performed.3. Post image processing and data collection:All sequences were transferred to AW4.2 (GE Healthcare) working station, and then analyzed by Perfusion 3 software package in body mode. Regions of interest (ROI) were drawn in thyroid and the perfusion parameters of BF, BV, MTT and PS could be obtained automatically. To observe the sharp of The time-density curve(TDC) and record all values of perfusion parameters which should be measured 2 times to get the mean values.4.Statistical analysis:Chi-Square test was used to compare the difference of sex, disease counts, shapes, and internal structure.For the parameters of perfusion, values were expressed as the mean±standard deviation (SD) respectively. 2 Paired-Samples T Test was applied to analyze the differences of BF, BV, MTT and PS between two groups. After test of homogeneity of variances, One-way ANOVA was applied to analyze the values as homogeneity of variances, with LSD for two-two comparison, while Welch Test was applied to others, with Dunnett T3 for two-two comparison.(a=0.05, P<0.05). All the statistic analysis was performed in SPSS 13.0 software. Results1. Multi-slice CT enhancement scanning combined with routine CT scanning on thyroid can clearly show the size, shape, density, internal structure, calcification and lymph node infiltration of neck. But there is no statistic significant among them between benign and malignant group. So the differential diagnosis value of above method is limited in clinical.2. Image of multi-slice CT enhancement scanning clearly showed the size and outmine of tumor, and the perfusion status of the internal tissue of tumor. The mean BF, BV, MTT and PS in normal group were 341.21±150.25 mL·min-1·100g-1, 20.53±6.60 mL·100g-1, 5.50±2.07 s and 27.09±13.39 mL·min-1·100g-1 respectively. In nodular goiter cases, the BF, BV, MTT and PS were 321.70±168.90 mL·min-1·100g-1, 12.95±9.55 mL·100g-1, 9.55±5.03 s, and 23.40±11.78 mL·min-1·100g-1, respectively. In thyroid adenoma group, these parameters were 266.05±148.67 mL·min-1·100g-1, 15.81±9.84 mL·100g-1, 8.61±6.72 s and 38.13±24.86 mL·min-1·100g-1, respectively. And in thyroid carcinoma group, they were 75.46±37.52 mL·min-1·100g-1, 10.02±5.72 mL·100g-1, 9.17±3.10 s and 52.44±10.24 mL·min-1·100g-1, respectively. There were significant difference among above four groups in BF, BV, MTT and PS value (P =0.01, 0.001, 0.003 and 0.001, respectively). Especially, BF in malignant group was higher than that in other group, On the other hand, BV, MTT and PS had no significant difference in all groups.Conclusions4,MSCT enhancement scanning can identify the outer limits between thyroid and surrounding tissues. And thus, it is a firstly selected examination method in imaginology.5,MSCT combined with routine CT scanning can determine the shape, size, density and structure of thyroid and surrounding tissues. But the differential diagnosis value of MSCT combined with routine CT scanning is limited.6,MSCT perfusion imaging exactly showed the blood flow features of normal and abnormal thyroid. The analysis of BF, BV, MTT and PS assisted the differential diagnosis between normal and abnormal thyroid. Among them, BF and PS is more useful in distinguish the benign and malignant disease of thyroid. And so MSCT perfusion imaging is worthy for the differential diagnosis in thyroid disease. |
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