摘要
目的:分析CT主观征象预测甲状腺乳头状癌(PTC)中央组淋巴结转移的价值。方法:选取医院收治的经手术病理证实为PTC且行淋巴结清扫术的100例患者,根据患者有无淋巴结转移分为转移组(71例)和未转移组(29例)。所有患者于术前均行颈部CT平扫及双期增强扫描,检测其原发灶CT值、原发灶形态特征及淋巴结形态特征,分析CT主观征象预测PTC中央组淋巴结转移的价值。结果:转移组患者静脉期的CT值、净增CT值及标准化CT(NCT)值水平明显高于未转移组,差异有统计学意义(t=3.497,t=3.141,t=3.290;P<0.05);转移组患者原发灶直径、甲状腺包膜接触范围比例与未转移组比较,差异有统计学意义(x^(2)=6.615,x^(2)=10.123;P<0.05);转移组患者淋巴结短长径之比、高强化、强化方式、砂砾样钙化以及囊变坏死比例与未转移组比较,差异有统计学意义(x^(2)=20.966,x^(2)=14.351,x^(2)=4.587,x^(2)=5.108,x^(2)=12.189;P<0.05)。受试者工作特征(ROC)曲线分析显示,原发灶静脉期CT值、直径>2 cm及甲状腺包膜接触>1/4评估淋巴结转移的曲线下面积(AUC)分别为0.841、0.619和0.639,原发灶短长径比值≥0.5、高强化、强化方式不均匀、砂砾样钙化及囊变坏死评估淋巴结转移的AUC分别为0.706、0.681、0.627、0.724和0.759。结论:CT在评估PTC患者中央组淋巴结转移中具有一定帮助,其中原发灶原发灶直径、甲状腺包膜接触、淋巴结短长径比值、强化方式、钙化及囊变坏死等征象评估淋巴结转移具有重要价值,可在临床中广泛应用。
Objective:To analyze the value of computed tomography(CT)subjective signs in predicting central lymph node metastasis of papillary thyroid carcinoma(PTC).Methods:100 patients with PTC who were confirmed by surgical pathology and underwent lymph node dissection were selected.They were divided into metastasis group(71 cases)and non-metastasis group(29 cases)according to whether the patients occurred lymph node metastasis.All patients underwent CT plain scan on neck and dual phase enhanced scan before surgery,and the CT value of primary lesion,morphological characteristics of primary lesion and morphological characteristics of lymph node of them were detected.The value of CT subjective signs in predicting PTC central lymph node metastasis was further analyzed.Results:The CT value,net increased CT value and normalized computed tomography(NCT)value in venous phase of metastasis group were significantly higher than those of non-metastasis group(t=3.497,t=3.141,t=3.290,P<0.05),respectively.There were significant differences in the diameter of primary lesion and the proportion of contact range of thyroid capsule between metastatic group and non-metastasis group(x^(2)=6.615,x^(2)=10.123,P<0.05).There were significant differences in the ratio of short to long diameter,high enhancement,enhancement mode,gravel calcification and cystic necrosis between metastatic group and non-metastasis group(x^(2)=20.966,x^(2)=14.351,x^(2)=4.587,x^(2)=5.108,x^(2)=12.189,P<0.05).The results of receiver operation characteristic(ROC)curve indicated that the area under the curves(AUC)of CT value of primary lesion at venous phase,diameter>2 cm and thyroid capsule contact>1/4 were 0.841,0.619 and 0.639,respectively,in assessing lymphatic metastasis.And the AUCs of the ratio of short to long diameter≥0.5,high enhancement,uneven enhancement,gravel calcification and cystic necrosis were 0.706,0.681,0.627,0.724 and 0.759,respectively,in assessing lymphatic metastasis.Conclusion:CT is helpful in assessing central lymph node metastasis of PTC patients.The diameter of primary lesion,the contact of thyroid capsule,the ratio of short to long diameter of lymph node,enhancement mode,calcification and cystic necrosis have important value in assessing lymph node metastasis,which can be widely used in clinical practice.
作者
林垚
柳林川
高宇
林杨
LIN Yao;LIU Lin-chuan;GAO Yu(Medical Imaging Department,The 909^(th)Hospital of People’s Liberation Army Joint Service Support Force,Zhangzhou 363000,China)
出处
《中国医学装备》
2021年第11期56-60,共5页
China Medical Equipment
