The Value Of Spectral CT In Diagnosing Of Thyroid Nodules And Predicting Of The Efficacy First Clearance 131I In DTC Postoperative

Objective:To investigate the preliminary application of Un-enhanced GSI?Gemstone Spectral Imaging?on different of thyroid nodules.Methods:Eighty-nine patients with thyroid nodules were recruited in this study.Among these patients,thirty patients were diagnosed as thyroid papillary carcinoma,thirty-eight were nodular goiter and twently-one were Hashimoto's thyroiditis.And twently-seven cases of normal thyroid as a control group.The morphological features of the three groups of lesions on the spectral CT images were observed and analyzed.ROC curve was used to obtain the optimal critical point of 40-140 keV different single-energy CT value and polychromatic CT value.Un-enhanced GSI were analyzed,including optimal CT value and iodine-water concentration,water-iodine concentration,energy spectral curves,Effective-Z and calcium-iodine concentration.Measure and analyze calcium content of calcified foci in the three groups of lesions,and analyze the relevance of calcium content and calcification type.Results:There were significant differences statistically between two groups on morphology,margin,calcification and edge interruption,ervical lymph nodes sign?P<0.01?.The incidence of I type calcifed in malignant nodules?61.5%?was higher than that in benign nodules?20%??P<0.05?.The maximum AUC of 100 keV in each CT value was 0.864,the best diagnostic threshold was 37.46 HU,the sensitivity was 85.7%,and the specificity was 81.8%.In the iodine content,energy spectral curves and calcium content,there was a significant statistical difference between the three groups of lesions?P<0.01?;In the 100 keV single-energy CT value and the Effective-Z,there was significant differences between papillary carcinoma and nodular goiter,nodular goiter and Hashimoto 's thyroiditis?P<0.01?;In the water content,there was no significant difference between the three groups?P>0.05?.And about calcium content,there were significant differences between the three groups?P<0.01?.On calcium content in calcified nodules in the nodules,there were significant differences between papillary carcinoma and nodular thyroid,between papillary carcinoma and thyroiditis?P<0.01?.Conclusion:The spectral imaging parameters and morphological features have certain differential diagnostic ability for different thyroid lesions.Objective:To evaluate the value of spectral CT imaging in efficacy va Iue in the ¹³¹I remnant ablation.Methods:Fifty-three postoperative patients were collected for the¹³¹I remnant ablation.Before treatment,spectral CT scan,serum TSH,Tg and Tg Ab were performed,and after spectral CT scanning and before the treatment of nail clearance,¹³¹I thyroid local and whole body imaging was performed.After ¹³¹I treatment of 3 months,patients were followed to perform the neck spectral CT scan and ¹³¹I thyroid local and whole body imaging,and calculate the internal spectral CT iodine content difference?Di?of residual thyroid tissue before and after ¹³¹I treatment.fifty seven cases were collected as normal thyroid the control group.Analyze the difference of the spectral CT parameters in residual energy between DTC and control group,before and after of ¹³¹I remnant ablation.The patients were divided into the first successful group and the unsuccessful group,analyze gender,age,stimulated serum Tg and postoperative residual size,dose of ¹³¹I by different statistical method.Using ROC curve analysis to obtain the optimal critical point of Di and dose of ¹³¹I.Predictive factors influencing for efficacy of the treatment were analyzed by multivariate logistic regression analysis.Results:Analysis of residual tissue and control group in the postoperative,there was a significant difference in the 100 ke V single energy CT value between the local recurrence / residual cancer group and the control group,between the residual thyroid group and the control group?P<0.01?.The slope of iodine content,energy spectrum curve and Effective-Z,there was a significant difference between the local recurrence / residual cancer grou P and the residual thyroid grou P?P<0.01?.In the 100 ke V single energy CT value and calcium content,local recurrence / residual statistical significance between cancer group and normal control group?P<0.01?.The number of successful cases of the first treatment of 53 cases of DTC in the postoperative and ¹³¹I remnant ablation was 39 cases,the effective rate was 73.6%.The single factor analysis showed that the size of Di?P=0.015?,the first dose of radioiodine therapy?P=0.023?stimulation,the serum level of Tg state?P=0.039?,the size of residual index?P=0.022?are key factors for the first time a clear effect?P< 0.05?.According to the ROC curve,area Di and a clear dose under the curve were 0.837and 0.660;the optimal critical value when Di is 5.39mg/ml,Di less than 5.39 is a clear was significantly lower than that of Di > 5.39,the former is 0.09 times of [OR: 0.09?0.02-0.48?].The dose of radioiodine ablation is high,the success rate is higher;residual size I of a clear success rate than the residual size of II degree is high,the former is the 3.54 times of [OR: 3.54?1.68-6.04?];serum Tg negative thyroidectom success rate than Tg was high,the former is the 2.32 times of [OR: 2.32?1.24-7.97?].Conclusion:The CT imaging of energy spectrum imaging has a certain predictive value in evaluating the residual tissue properties of DTC and the efficacy of the first nail clearance,Which can provide an important reference for the estimation of the dose of clinical nail clearance.