定量化评估甲状腺结节恶性风险的CT预测模型
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摘要
目的:探讨不同CT征象对甲状腺结节恶性风险的预测价值,建立定量化甲状腺结节CT报告系统。方法:回顾性分析经病理证实的186例甲状腺结节CT资料。根据病理结果将结节分为良性结节和恶性结节。观察结节多发、性质、位置、规则、纵横比、咬饼征、晕圈、壁结节、钙化,增强后边界、甲状腺包膜完整、强化均匀在良恶性结节中的分布差异。应用单因素及多因素分析CT征象对恶性结节的预测价值及OR值,并且以与甲状腺恶性结节独立相关因素建立预测甲状腺结节恶性风险的CT预测模型。结果:多因素回归分析中四项CT征象(咬饼征、微钙化、纵横比、增强后边缘清晰程度)与甲状腺恶性结节独立相关,根据四项CT征象OR值建立定量化预测模型,模型预测曲线下面积82.8%,敏感性和特异性分别为71.0%和83.8%。结论:CT预测模型有助于定量化评估甲状腺结节的恶性风险,提高CT检查的临床应用价值。
Purpose: To study the CT findings of thyroid nodules, in order to develop CT risk stratification model of thyroid cancer. Methods: We evaluated 186 nodules with pathologic diagnosis. Univariate and multivariate analyses were performed to investigate the relationship between suspicious CT features and thyroid cancers.Quantitative CT risk stratification model was developed for evaluating the risk of malignant thyroid tumor. Results: Multivariate logistic regression analysis showed microcalcification, cake biting sign, aspect ratio and enhanced shrinkage/blurring were independently related to the malignant thyroid tumor. The sensitivity and specificity of CT risk stratification model was 71% and 83.8%. Conclusion: CT risk stratification model may be used to assess the risk of malignancy of thyroid nodules and facilitate patient management.
Purpose: To study the CT findings of thyroid nodules, in order to develop CT risk stratification model of thyroid cancer. Methods: We evaluated 186 nodules with pathologic diagnosis. Univariate and multivariate analyses were performed to investigate the relationship between suspicious CT features and thyroid cancers.Quantitative CT risk stratification model was developed for evaluating the risk of malignant thyroid tumor. Results: Multivariate logistic regression analysis showed microcalcification, cake biting sign, aspect ratio and enhanced shrinkage/blurring were independently related to the malignant thyroid tumor. The sensitivity and specificity of CT risk stratification model was 71% and 83.8%. Conclusion: CT risk stratification model may be used to assess the risk of malignancy of thyroid nodules and facilitate patient management.
引文
[1]Haugen BR,Alexander EK,Bible KC,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.Thyroid,2016,26:1-133.
[2]沈伟明,张黄华,倪耿欢.多层螺旋CT+对甲状腺良恶性肿瘤的诊断及鉴别诊断价值.医学影像学杂志,2015,25:1690-1693.
[3]夏俊,陈金凤.甲状腺良恶性结节CT常规扫描及灌注分析.中国CT和MRI杂志,201,15:1-4.
[4]张伽铭,韩志江.甲状腺微小乳头状癌多种CT征象的多因素分析.国际医学放射学杂志,2017,40:6-9.
[5]Stoian D,Timar B,Derban M,et al.Thyroid Imaging Reporting and Data System(TI-RADS):the impact of Quantitative Strain Elastography for better stratification of cancer risks.Med Ultrason,2015,17:327-332.
[6]成建明,詹松华,周俊,等.甲状腺微小乳头状癌的CT诊断价值分析.医学影像学杂志,2017,27:1447-1450.
[7]骆洪浩,彭玉兰,赵海娜.不同类型的钙化对甲状腺良恶性肿瘤的诊断价值.中国医学计算机成像杂志,2016,22:162-166.
[8]瞿佳丽,朱妙平,韩志江.各种CT征象联合应用在甲状腺微小乳头状癌诊断中的价值,2015,24:151-155.
[9]李鹏.CT在乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断中的价值分析.中国CT和MRI杂志,2015,13:30-32.
[10]朱妙平,周秀艳,韩志江.不同CT征象及其联合应用在甲状腺乳头状癌诊断中的价值.中国临床医学影像杂志,2014,25:840-843.
[11]周健,赖旭峰,韩志江,等.多种CT征象对甲状腺良、恶性结节的预测价值.中华全科医师杂志,2018,17:44-49.
[12]王永胜,蔡剑波,何俊林,等.1-MSCT动态增强在甲状腺乳头状微小癌诊断中的应用价值.医学前沿,2015,5:40-42.
[13]Choi SY,Shin JH.Prevalence and prediction for malignancy of additional thyroid nodules coexisting with proven papillary throid microcarcinoma.0tolaryngol Head Neck Surg,2013,139:53-59.
[2]沈伟明,张黄华,倪耿欢.多层螺旋CT+对甲状腺良恶性肿瘤的诊断及鉴别诊断价值.医学影像学杂志,2015,25:1690-1693.
[3]夏俊,陈金凤.甲状腺良恶性结节CT常规扫描及灌注分析.中国CT和MRI杂志,201,15:1-4.
[4]张伽铭,韩志江.甲状腺微小乳头状癌多种CT征象的多因素分析.国际医学放射学杂志,2017,40:6-9.
[5]Stoian D,Timar B,Derban M,et al.Thyroid Imaging Reporting and Data System(TI-RADS):the impact of Quantitative Strain Elastography for better stratification of cancer risks.Med Ultrason,2015,17:327-332.
[6]成建明,詹松华,周俊,等.甲状腺微小乳头状癌的CT诊断价值分析.医学影像学杂志,2017,27:1447-1450.
[7]骆洪浩,彭玉兰,赵海娜.不同类型的钙化对甲状腺良恶性肿瘤的诊断价值.中国医学计算机成像杂志,2016,22:162-166.
[8]瞿佳丽,朱妙平,韩志江.各种CT征象联合应用在甲状腺微小乳头状癌诊断中的价值,2015,24:151-155.
[9]李鹏.CT在乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断中的价值分析.中国CT和MRI杂志,2015,13:30-32.
[10]朱妙平,周秀艳,韩志江.不同CT征象及其联合应用在甲状腺乳头状癌诊断中的价值.中国临床医学影像杂志,2014,25:840-843.
[11]周健,赖旭峰,韩志江,等.多种CT征象对甲状腺良、恶性结节的预测价值.中华全科医师杂志,2018,17:44-49.
[12]王永胜,蔡剑波,何俊林,等.1-MSCT动态增强在甲状腺乳头状微小癌诊断中的应用价值.医学前沿,2015,5:40-42.
[13]Choi SY,Shin JH.Prevalence and prediction for malignancy of additional thyroid nodules coexisting with proven papillary throid microcarcinoma.0tolaryngol Head Neck Surg,2013,139:53-59.