能谱CT曲线斜率及碘浓度定量分析鉴别良恶性甲状腺结节的准确率观察

摘要

目的：探讨能谱CT曲线斜率及碘浓度定量分析在良恶性甲状腺结节鉴别诊断中的应用价值。方法选取48例经超声筛查的甲状腺结节患者为研究对象，以病理检查结果为依据，分别纳入恶性组（ n＝21）和良性组（ n＝27）；将同期入院行颈部检查的20例无甲状腺结节正常受试者纳入正常组（ n＝20）。两组受试者均使用能谱CT行能谱CT成像（ GSI）单能模式平扫及增强扫描，后应用GSI Viewer软件计算碘浓度和能谱曲线斜率。记录并对比三组受试者计算结果差异；以病理检查结果为依据分析能谱CT检查对良恶性甲状腺结节的鉴别准确性。结果能谱CT正确诊断良性结节26例，正确诊断恶性结节19例，对良恶性甲状腺结节的鉴别诊断准确率为93．8％（45／48）。恶性组不同期相能谱曲线斜率及动脉期、静脉期碘浓度值检测结果均显著低于其他两组受试者（ P ＜0．05）；平扫期内，良、恶性两组碘浓度值均显著低于正常组（ P ＜0．05），但两组对比无统计学意义（ P ＞0．05）。结论能谱CT在甲状腺结节的良恶性鉴别诊断中具有较高的准确率，临床可将其作为切实可行的影像学检查手段应用于诊疗工作中，为后续治疗方案的拟定提供条件。%Objective To explore the application value of slope of energy spectrum CT curve and iodine concentration quanti-tative analysis in the differential diagnosis of benign and malignant thyroid nodules.Methods 48 patients with thyroid nodules screened by ultrasound were selected as the study objects.Taking the results of pathological examination as basis, the patients were randomized into malignant group (n=21) and benign group (n=27);20 normal subjects without thyroid nodules who un-derwent neck examination in the same period were included in the normal group (n=20).Both of subjects in two groups under-went energy spectrum CT imaging ( GSI) monoenergetic mode scan and enhanced scan by using energy spectrum CT.Then, GSI Viewer software was used to calculate the iodine concentration and slope of energy spectrum curve.The calculated results were compared between the three groups of subjects;Based on the results of pathological examination, the accuracy of energy spectrum CT examination in differential diagnosis of benign and malignant thyroid nodules was analyzed.Results There were 26 cases with benign nodules and 19 cases with malignant ones correctly diagnosed by CT.The accuracy in differential diagnosis of benign and malignant thyroid nodules was 93.8%(45/48).The slop of energy spectrum curve and detection results of iodine concentrations during arterial and venous phase in the malignant group in different phases were significantly lower than those in the other two groups ( P <0.05).In plain scan phase, the iodine concentrations in benign and malignant group were lower than those in the normal group ( P <0.05) but there was no significant difference between the two groups ( P >0.05).Conclusion Energy spectrum CT in differential diagnosis of benign and malignant thyroid nodules is with high accuracy.In clinic, it can be used as a feasible imaging examination means in the diagnosis and treatment, providing basis for development of follow-up treatment regi-men.