| Objective To investigate the diagnostic value of gemstone energy spectrum CT in identifying benign and malignant thyroid nodules,and to compare the pathological results with conventional ultrasound.Methods Fifty-five patients(17 males and 38 females)with an average age of 56 years were enrolled in our hospital from August 2015 to August 2016,with a total of 80 nodules.According to the pathological results,it was divided into benign group and malignant group.35 patients with cervical non-thyroid disease were selected as the normal control group.All patients underwent thyroid and bilateral lymph node ultrasonography and cervical gemstones with enhanced CT scan,and CT scan and enhanced scan images and data were sent to ADW4.6 workstation for processing.Application of GSI Viewer software in the thyroid nodule lesions and the surrounding normal tissue placed in the sensor area,should try to avoid the clavicle produced by the artifact area,if the density is uneven,should avoid the cystic, bleeding and calcification area.The iodine concentration in the same sensing region of the lesion area and the surrounding normal thyroid tissue was recorded on the iodine map generated by the post-treatment.In the enhanced scan,in order to eliminate the contrast agent injection and the impact of different factors caused by individual circulation,should be calculated in the arterial phase,intravenous normalized iodine concentration(the slope was defined as iodine concentration/ipsilateral normal thyroid tissue's average iodine concentration).In this study,40 and 100 ke V were selected as the reference point,and the slope of the spectral curve was calculated from the level of iodine in the plain,arterial and venous phases.The slope was defined as=(HU40ke V-HU100 ke V)/60.By observing the single energy image and iodine map obtained at 70 ke V,the boundary of thyroid nodules,the density(with or without cystic change),the calcified morphology and some nodular papillary structures.By analyzing the ultrasonography of patients included in the analysis of the nodules were recorded contours,boundaries,with or without cystic changes,peripheral sound halo and other parameters.The data obtained by energy spectrum CT were compared by one-way ANOVA and q-test respectively.The differences of iodine concentration and pulse rate between arterial phase and venous phase were compared with those of normalized iodine concentration in arterial phase and venous phase.Multivariate logistic regression analysis was used to analyze the changes of morphological changes,iodine concentration and energy spectrum of multispectral group and ultrasound image data group.According to the data of the two groups,the working characteristic(ROC)curve of the subject was drawn,and the sensitivity and specificity were calculated according to the sum of sensitivity and specificity,and the corresponding sensitivity and specificity were calculated.Results55 patients were included in the study,male 17 cases,female 38 cases,age 21-77 years,mean(54.6±1.0)years,mean BM = 18.1 ± 3.2kg / m2.A total of X nodules,of which benign nodules 45 cases,are nodular goiter;malignant nodules 35 cases,including thyroid papillary carcinoma 31 cases,follicular carcinoma 2 cases, medullary carcinoma 1 cases,undifferentiated carcinoma in 1 case.There were 35 patients,15 males and 20 females with an average(61.2 ± 7.2)years,mean BMI(19.9 ± 3.0)kg / m2.The iodine concentration in the plain,arterial and venous,normal,benign and malignant groups was statistically significant(Table 1,P <0.05).The normalized iodine concentrations in the arterial phase,the normal group,the benign group and the malignant group were 0.84 ± 0.22 and 0.43 ± 0.14 and 0.23 ± 0.15 respectively.There was significant difference between the two groups(P <0.05).The normalized iodine concentrations in benign and malignant groups were 1.13 ± 0.23,0.64 ± 0.15 and 0.47 ± 0.18,respectively.There was significant difference between the two groups(P <0.05).The sensitivity and specificity of diagnosis of thyroid malignant nodules were 66.42% and 79.49 respectively by morphological imaging.In the intravenous stage,the iodine concentration was less than 0.56 and the absolute slope of the spectral curve was less than 1.48.Nodules,and the pathological results have a good consistency,through the intravenous iodine concentration area of less than 0.56 and the absolute value of intravenous slope less than 1.48 threshold for the diagnosis of thyroid malignant nodules,respectively,the sensitivity and specificity were 79.6%,78.8% and 83.3% respectively,81.10%.Combined with morphological,iodine concentration,standardized iodine concentration and energy spectrum curve multi-parameter analysis,diagnosis of thyroid nodules benign and malignant sensitivity of 91.4%,specificity of 93.3%.The distribution of blood flow in the malignant group was 2 and 3,the benign group was 1 and 2,and the difference was statistically significant(P <0.05).The regression equation is as follows: logit(P)=-3.076+form×1.965 + microcalcification×2.996 + halo×2.679-?blood flow×2.174-?blood flow×2.645 +?blood flow×0.197.The sensitivity was 77.1%,the specificity was 68.9%,the area under the curve was 0.757,and the 95% confidence interval was(0.643,0.870)when P <0.50 was judged to be benign as the criterion.The sensitivity and specificity of intravenous combined morphological,standardized iodine concentration and energy spectrum curve in the diagnosis of thyroid nodules were superior to conventional ultrasound.ConclusionThe use of energy spectrum CT and ultrasonography in the identification of benign and malignant thyroid nodules have shown their respective values.Thyroid benign and malignant nodules of iodine concentration and slope of the spectrum is different,this study shows thyroid nodule diameter?1cm,the comprehensive thyroid nodule morphology,iodine concentration and slope of the spectrum can help improve the benign thyroid nodules.The accuracy and specificity of the identification is better than that of ultrasound.Multi-parameter Combined Application of Spectrum CT Technique to Produce Differential Diagnosis of Benign and Malignant Thyroid Nodules. |
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