能谱CT定量参数结合纹理分析鉴别甲状腺良恶性结节及预测颈部淋巴结转移的研究

能谱CT定量参数结合纹理分析鉴别甲状腺良恶性结节及预测颈部淋巴结转移的研究摘要：甲状腺良恶性结节的鉴别一直是临床难点。本研究旨在探讨能谱CT定量参数结合纹理分析对甲状腺结节良恶性的判定及颈部淋巴结转移的预测作用。纳入2016年1月至2018年12月被诊断为甲状腺结节的91例患者，其中恶性结节48例，良性结节43例。采用SiemensDefinitionEdge128排螺旋CT扫描仪进行能谱CT成像，使用Vitrea软件进行分析。通过分析90KeV和40KeV的CT值、良恶性结节的特征纹理参数及颈部淋巴结体积，比较良恶性结节的定量参数差异，利用ROC曲线分析获得最佳诊断指标，建立多因素Logistic回归模型进行预测颈部淋巴结的转移情况。结果显示，40KeV的CT值、灰度共生矩阵对比度、灰度共生矩阵对比度离散度、颈部淋巴结体积等指标在良恶性结节鉴别方面具有显著差异（P<0.05），其中以灰度共生矩阵对比度离散度和体积最为敏感。利用这些参数建立的多因素Logistic回归模型具有较高的诊断准确性，AUC值为0.937。结论：能谱CT定量参数结合纹理分析可有效鉴别甲状腺良恶性结节，并预测颈部淋巴结的转移情况，对于临床的甲状腺结节诊疗具有一定参考价值。

关键词：甲状腺结节；能谱CT；纹理分析；良恶性鉴别；颈部淋巴结转移

Abstract:Thedifferentialdiagnosisofthyroidbenignandmalignantnoduleshasalwaysbeenaclinicaldifficulty.ThisstudyaimstoexploretheroleofspectralCTquantitativeparameterscombinedwithtextureanalysisinthedeterminationofthebenignandmalignantthyroidnodulesandthepredictionofcervicallymphnodemetastasis.Atotalof91patientswhowerediagnosedwiththyroidnodulesfromJanuary2016toDecember2018wereincluded,amongwhichtherewere48casesofmalignantnodulesand43casesofbenignnodules.TheSiemensDefinitionEdge128-rowspiralCTscannerwasusedforspectralCTimaging,andtheVitreasoftwarewasusedforanalysis.ByanalyzingtheCTvaluesof90KeVand40KeV,thecharacteristictextureparametersofbenignandmalignantnodulesandthevolumeofcervicallymphnodes,thequantitativeparameterdifferencesbetweenbenignandmalignantnoduleswerecompared.ThebestdiagnosticindicatorswereobtainedthroughROCcurveanalysis,andamulti-factorLogisticregressionmodelwasestablishedtopredictthecervicallymphnodemetastasis.TheresultsshowedthattheCTvalueof40KeV,gray-levelco-occurrencematrixcontrast,gray-levelco-occurrencematrixcontrastdissimilarity,andcervicallymphnodevolumehadsignificantdifferencesinthediagnosisofbenignandmalignantnodules(P<0.05),andgray-levelco-occurrencematrixcontrastdissimilarityandvolumewerethemostsensitive.Themulti-factorLogisticregressionmodelestablishedbytheseparametershashighdiagnosticaccuracy,withanAUCvalueof0.937.Conclusion:SpectralCTquantitativeparameterscombinedwithtextureanalysiscaneffectivelydistinguishbenignandmalignantthyroidnodulesandpredictthecervicallymphnodemetastasis,whichhascertainreferencevaluefortheclinicaldiagnosisandtreatmentofthyroidnodules.

Keywords:Thyroidnodules;SpectralCT;Textureanalysis;Benignandmalignantdifferentiation;CervicallymphnodemetastasisThyroidnodulesareacommonclinicalproblem,andaccuratelydifferentiatingbetweenbenignandmalignantnodulesisimportantforpatientmanagement.SpectralCThasbeenshowntoprovidevaluablediagnosticinformationinthyroidnodules,andtheadditionoftextureanalysismayfurtherenhanceaccuracy.

Inthisstudy,quantitativeparametersderivedfromspectralCT,includingiodineconcentration,effectiveatomicnumber,andwaterconcentration,werecombinedwithtextureanalysistodifferentiatebetweenbenignandmalignantthyroidnodules.Theresultsshowedthattheseparametershadhighdiagnosticaccuracy,withanAUCvalueof0.937.

Furthermore,thecombinationoftheseparameterswasabletopredictcervicallymphnodemetastasis,whichisanimportantfactorindeterminingappropriatetreatmentforthyroidcancer.Overall,theresultssuggestthatspectralCTcombinedwithtextureanalysishassignificantclinicalvalueinthediagnosisandmanagementofthyroidnodules.

Inconclusion,thisstudyhighlightsthepotentialofspectralCTandtextureanalysisasanon-invasiveandaccuratemethodfordifferentiatingbetweenbenignandmalignantthyroidnodules,andpredictingcervicallymphnodemetastasis.ThesefindingsmayhaveimportantimplicationsfortheclinicaldiagnosisandtreatmentofthyroidnodulesinthefutureMoreover,theuseofspectralCTandtextureanalysismayalsoimprovetheaccuracyoffine-needleaspirationcytology(FNAC),whichiscurrentlythestandardmethodfordiagnosingthyroidnodules.FNAChaslimitations,asitreliesonasmallsampleofcellsfromthenoduleandmaynotprovideacomprehensiveevaluationofitscharacteristics.SpectralCTandtextureanalysis,ontheotherhand,canprovideamoredetailedandcomprehensiveassessmentofthenodule'sinternalstructure,metabolism,andvascularity,whichcanaidinthediagnosisandmanagementofthepatient.

AnotheradvantageofspectralCTandtextureanalysisisthattheycanhelptoreduceunnecessaryinvasiveprocedures,suchassurgeryorbiopsy,forpatientswithbenignnodules.Currently,manypatientswiththyroidnodulesundergosurgeryorbiopsytoruleoutmalignancy,evenifthenodulesappeartobebenignonultrasoundorFNAC.However,studieshaveshownthatupto70%ofthyroidnodulesarebenign,andonlyasmallpercentagearemalignant.ByusingspectralCTandtextureanalysistodifferentiatebetweenbenignandmalignantnodules,clinicianscanimprovetheaccuracyoftheirdiagnosisandreducethenumberofunnecessaryinvasiveprocedures.

Overall,thecombinationofspectralCTandtextureanalysisrepresentsapromisingtechnologyforthediagnosisandmanagementofthyroidnodules.Itsnon-invasivenature,highaccuracy,andabilitytoprovideacomprehensiveassessmentofthenodule'scharacteristicsmakeitanattractivealternativetotraditionalmethods.Asthetechnologycontinuestoevolveandbecomemoreaccessible,ithasthepotentialtosignificantlyimprovetheoutcomesofpatientswiththyroidnodules,andreducetheburdenofunnecessaryproceduresonhealthcaresystemsThyroidnodulesareacommonfinding,withaprevalenceofupto68%insomepopulations.Whilethemajorityofnodulesarebenign,distinguishingbetweenbenignandmalignantthyroidnodulesiscrucialforappropriatemanagement.Traditionalmethodsforevaluatingthyroidnodulesincludephysicalexamination,ultrasound,fine-needleaspirationbiopsy(FNAB),andthyroidfunctiontests.WhileFNABisconsideredthegoldstandard,itisinvasiveandhaslimitationsintermsofsampleadequacyandaccuracy.Asaresult,thereisagrowinginterestinalternativediagnostictools,suchasmoleculartestingandimagingtechniques.

Onesuchimagingtechniqueiselastography,whichisbasedonthemeasurementoftissuestiffness.Elastographycanbeperformedusingeitherultrasoundormagneticresonanceimaging(MRI).Inultrasoundelastography,thestiffnessofthenoduleismeasuredusingthestrainratio(SR),whichistheratioofthestraininthenoduletothestraininthesurroundingthyroidtissue.InMRIelastography,thestiffnessofthenoduleisquantifiedusingtheshearwavespeed(SWS).Bothmethodscanprovidevaluableinformationaboutthenodule'scharacteristics,includingitssize,shape,andvascularity.

Elastographyhasbeenshowntohavehighdiagnosticaccuracyforthyroidnoduleevaluation.Ameta-analysisof22studiesshowedthatultrasoundelastographyhadasensitivityof85%andspecificityof85%fordistinguishingbetweenbenignandmalignantthyroidnodules.Similarly,MRIelastographyhasbeenshowntohaveasensitivityof82-91%andspecificityof80-91%forthesametask.Severalstudieshavealsodemonstratedtheutilityofelastographyinpredictingtheriskofmalignancyinindeterminatethyroidnodules,whicharenodulesthatcannotbedefinitivelyclassifiedaseitherbenignormalignantbasedonFNABalone.

Inadditiontoitsdiagnosticutility,elastographyhasthepotentialtoguidethemanagementofthyroidnodules.Forexample,elastographycanbeusedtoidentifynodulesthatareathighriskformalignancyandthereforerequiresurgicalintervention.Itcanalsobeusedtomonitornodulesovertime,aschangesintheSRorSWScanindicatetumorgrowthorregression.

Whileelastographyisapromisingtechnology,itisnotwithoutlimitations.Onelimitationisitsoperatordependence,asthemeasurementoftheSRorSWSrequiresexperiencedandskilledoperators.Anotherlimitationisitsinabilitytodefinitivelydiagnosethyroidcancer,asadefinitivediagnosisstillrequireshistopathologicalexaminationofthenodule.

Inconclusion,elastographypresentsapromisingtechnologyforthediagnosisandmanagementofthyroidnodules.Itsnon-invasivenature,highaccuracy,andabilitytoprovideacomprehensiveassessmentofthenodule'scharacteristicsmakeitanattractivea