| Objective: In this study,energy spectrum CT scanning was performed on thyroid nodules and combined with the detection of thyroid stimulating hormone(TSH)and thyroglobulin(Tg)in serum before surgery to explore the diagnostic value of energy spectrum CT parameters combined with serum TSH and TG detection for benign and malignant thyroid nodules,so as to provide reference for the diagnosis and treatment of clinical thyroid diseases.Methods: Subjects were thyroid nodule patients who received energy spectrum CT examination and underwent surgery or needle biopsy in the Affiliated Hospital of Qinghai University from October 2019 to January 2021.All patients received serum TSH and TG examination before surgery.Based on the pathological results,the subjects were divided into benign group and malignant group.Energy spectrum post-processing workstation was used to measure and compare the energy spectrum CT parameters of arterial phase,venous phase and plain scanning phase between the two groups: Iodine concentration(IC),Normalized Iodine concentration(NIC),Slope of Spectral HU cure(λHU),Iodine concentration(IC)and Slope of Spectral HU cure(λHU)in arterial and venous stage.Two independent samples t-test or non-parametric test were used to compare the energy spectrum parameters and the preoperative serum TSH and TG levels of the two groups.0.05 was considered statistically significant.The receiver operating characteristic curve was used to evaluate the diagnostic value of energy spectrum CT parameters,preoperative serum TSH and Tg levels,and energy spectrum CT parameters combined with serological indexes in benign and malignant thyroid nodules.Results:(1)A total of 84 patients were enrolled in the study,including 46 cases in the benign group,including 38 cases of nodular goiter,8 cases of thyroid adenoma,and 38 cases in the malignant group,including 36 cases of thyroid papillary carcinoma and 2 cases of follicular carcinoma;(2)In the arterial and venous phases,the malignant group’s iodine concentration,standardized iodine concentration,and the slope of the energy spectrum curve were all lower than those of the benign group,and the difference was statistically significant.The iodine concentration and the slope of the energy spectrum curve of the malignant group in the plain scan stage were lower than those of the benign group,and the difference was statistically significant;(3)The preoperative serum TSH and Tg levels of the malignant group were higher than those of the benign group,and the difference was statistically significant;(4)When the parameters of energy spectrum CT diagnose thyroid nodules,the venous phase standardized iodine concentration had the best diagnostic efficiency.When the diagnostic threshold was 0.92,the corresponding sensitivity was 71.74% and the specificity was 86.84%.The AUCs of TSH and Tg for the diagnosis of thyroid nodules before surgery were 0.717 and 0.644,respectively,the sensitivity was 78.26%and 56.52%,and the specificity was 63.16% and 78.95%.The area under the ROC curve for the combined diagnosis of benign and malignant thyroid nodules with energy spectrum CT and serum TSH was 0.957,the sensitivity was 93.48%,and the specificity was 94.74%.The combination of energy spectrum CT parameters and serum TSH can increase the area under the ROC curve,while the combination of energy spectrum CT parameters and serum Tg can not increase the area under the ROC curve.Conclusion: Energy spectrum CT parameters,preoperative serum TSH and Tg levels have certain value in the differential diagnosis of benign and malignant thyroid nodules.Energy spectrum CT parameters combined with serum Tg detection can not improve the diagnostic efficiency of thyroid nodules,but energy spectrum CT parameters combined with serum TSH detection can improve the accuracy of the diagnosis of benign and malignant thyroid nodules,which has a certain application value in the clinical diagnosis of thyroid nodules. |
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