The Clinical Utility Of DSCT With Dual Energy Scan In The Differentiation Of Benign And Malignant Thyroid Nodule

Part One The clinical utility of CT enhancement scanningin the differentiation of benign and malignant thyroid noduleObjective: To discuss the clinical utility of CT enhancement scanningin the differentiation of benign and malignant thyroid nodule.Methods:64cases with thyroid nodule accepted the thyroid enhancedCT examination were selected. All the cases were confirmed bypathohistology,operation or puncture biopsy.All64cases including19female and45male,whose mean age is48years. There are totally84nodules of these patients,diameters from0.5cm to8.8cm, which mean diameters is3.3cm.84thyroid nodules were divided intotwo groups,35malignant nodules (which included25papillary carcinoma,7focus papillary carcinoma,2follicular carcinoma,1medullary carcinoma) and49benign nodules (which included36nodular goiter, of the total19case withadenomatoid hyperplasia,11adenomas,2hashimoto's thyroiditis).Firstly, all patients were performed routine non-enhanced scan(tubevoltage80KV and140KV,slice thickness is5mm)using DSCT with dualenergy mode, then underwent the enhanced scanning with dual energy modeafter injection of iodinated contrast material (iohexol,300mg/ml,1.5-2ml/kg,injective rate3ml/s,at30s,60s).To observe the shape, boundary appearance,cystic change;calcifications, micro-calcificatio,enhanced characteristics,andthe character of lymph node of cervical part.The SPSS for Windows version13.0software package was used forstatistical data analysis. The x2test was performed to numeration datacompare.If one or more of the expected count were less than5,Fisher's ExactTest was used.P<0.05was considered with statistically significance.The pathology diagnosis was considered as the gold standard, thesensitivity,specificity and accuracy of all signs (including the shape,boundary appearance, cystic change; micro-calcification, enhancedcharacteristics) that was diagnosised thyroid cancer with CT enhancedscanning were calculated.Results: Malignant nodules were more often showed irregular shape,obscure boundary, contained micro-calcification, showed no completeenhanced ring around the tumor or crab-foot shaped enhancement. Differencesof the CT characteristics between the benign and malignant nodules of thethyroid gland showed statistical significance (P<0.05). Enhanced CT can beone implemental method for differentiate malignant thyroid nodules frombenign ones(x2=36.668,p=0.000,P<0.05).The sensitivity, specificity, accuracyof enhanced CT in the diagnosis of thyroid lesions were82.9%,83.7%,83.3%respectively.Conclusion: Enhanced CT is an efficient and reliable imaging methodfor detection and differential diagnosis of thyroid nodules. Mastering theenhanced CT features of various thyroid nodules can improve the accuracy ofdiagnosis. Part Two The clinical utility of iodine-enhanced image ofdual-energy computed tomography(CT) in evaluating the benignand malignant thyroid noduleObjective: To investigate the clinical utility of iodine-enhanced image ofdual-energy computed tomography(CT)in evaluating the benign and malignantthyroid nodule.Methods: Excepted8complete cystic change nodules,because ofnodules capsule wall was thin,impossible accurate choose nodules true component as region of interest,not enter this study,other the same to part One.Transfer the two groups dual energy data into Dual-Energy software of theworkstation,Choose "Thyroid" mode to obtained the iodine-enhancedimages.Iodine content of thyroid nodule as well as normal thyroid gland thatsurrounding lesion in nonenhanced weighted images were measured.Results: Iodine content between the benign and malignant thyroidnodules in nonenhanced weighted images showed statistical significance(P<0.05). Iodine content of benign thyroid nodules is more than that ofmalignant thyroid nodules.Iodine content of normal thyroid gland thatsurrounding lesion did not showed statistical significance (P>0.05).To utilizereceiver operator characteristic curve(ROCcurve)in SPSS software to selectcritical value of optimum sensitivity and specificity,when critical value is0.20mg/ml, sensitivity is65.7%,specificity is97.6%,critical value is0.35mg/ml,sensitivity is71.4%,specificity is90.2%.Conclusion: Iodine-enhanced images with DECT in nonenhancedweighted images may be a implemental tool for differential diagnosis ofbenign and malignant nodules of the thyroid gland. Part Three The clinical utility of dual-energy energy spectrumanalyzing technology in evaluating the benign and malignantthyroid nodulesObjective: To investigate the clinical utility of dual-energy computedtomography(CT) energy spectrum analyzing technology in evaluating thebenign and malignant thyroid nodules.Methods: Excepted8complete cystic change nodules,because ofnodules capsule wall was thin,impossible accurate choose nodules truecomponent as region of interest,not enter this study,other the same to part One. Transfer the two groups dual energy data of nonenhanced weighted imagesinto Dual-Energy software of the workstation,choose"Monoenergetic"mode toobtained images under different Kev(40Kev-190Kev), then make energyspectrum analysis, bring about energy spcetrum curve of different lesion.Results: Energy spectrum curve of benign thyroid nodules mainlyrepresent as "descent model". Energy spcetrum curve of malignantthyroid nodules represent as either"rise model"(57.1%)or "descent model"(42.9%).Curve model between the benign and malignant thyroid nodules innonenhanced weighted images showed statistical significance (P<0.05).Thesensitivity,specificity,accuracy of curve model in the diagnosis of thyroidlesions were57.1%,100.0%,80.3%respectively.To utilize receiver operator characteristic curve(ROCcurve)in SPSSsoftware and energy spectrum analyzing technology, both have higherdiagnostic specificity,have an advantage compared routine CT enhancedscanning.Conclusion: Energy spectrum analyzing with DECT may be aimplemental tool for differential diagnosis of benign and malignant nodules ofthe thyroid gland.