双源CT双能量扫描对于甲状腺结节良恶性鉴别诊断的应用价值
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摘要
第一部分CT增强扫描对于甲状腺结节良恶性的鉴别诊断中的应用价值
目的：探讨CT增强扫描对于甲状腺结节良恶性鉴别诊断中的应用价值
方法：自2011年5月至2012年1月在河北医科大学第四医院行甲状腺CT增强扫描的64例甲状腺结节的病人纳入本研究。本研究中，所有病例均经手术或穿刺活检取得病理证实。其中男性19例，女性45例，年龄范围27-86岁，平均年龄48岁，共84个甲状腺结节，结节大小范围0.5-8.8cm，平均3.3cm。本研究中，恶性结节35例，其中包括25例甲状腺乳头状癌，灶性乳头状癌7例，2例滤泡状癌，1例髓样癌，良性结节49例，其中包括36例结节性甲状腺肿，其中19例伴腺瘤样增生，11例甲状腺腺瘤，以及2例桥本氏甲状腺炎。
使用德国第二代双源CT（SOMATOM Definition Flash），首先应用双能量模式（管电压分别为80KV和140KV,层厚5mm）进行平扫，而后利用高压注射器以3ml/S的速度经肘静脉注入造影剂碘海醇(300mg/ml)，注射量1.5-2.0mg/kg，注入对比剂后30s及60s进行双能增强扫描，分别观察甲状腺结节的形态，边界、有无囊性变、内部有无钙化及细颗粒状钙化，强化特点，有无颈部淋巴结肿大等征象。
采用SPSS13.0统计软件进行统计学分析。计数资料的比较采用x2检验，如果1个或多个格子的理论频数T<5，改用Fisher’s Exact Test，P<0.05为差异有统计学意义。以病理结果为金标准计算甲状腺结节的形态，边界，细颗粒状钙化，强化特点等征象诊断甲状腺恶性病变的灵敏度、特异度和准确度。
结果：甲状腺恶性结节多表现为形态不规则，边界不清，内可见细颗粒状钙化，增强扫描后可见“强化残圈征”或“蟹足状强化”。以上的特征性表现在甲状腺良恶性结节之间差异均有统计学差异（p<0.05）。增强CT可以成为鉴别甲状腺良恶性结节的有用方法（p<0.05）,诊断的灵敏度、特异度和准确度分别为82.9%，83.7%，83.3%。
结论：增强CT是诊断甲状腺结节良恶性的有效和可靠的检查方法,掌握各种甲状腺病变的CT表现特点能有效的提高诊断的准确性，为临床制定治疗方案提供重要依据。
第二部分双能量扫描中碘图对于甲状腺结节良恶性鉴别诊断中的应用价值
目的：探讨双能CT扫描中碘图对于甲状腺结节良恶性的鉴别诊断中的应用价值
方法：除8例完全囊性变的结节因病变囊壁较薄，无法准确选择结节实性成分作为感兴趣区，未入组本研究外，其它同第一部分。将平扫的两组双能量数据传入西门子双源CT的工作站上的Dual—Energy软件中，选择“Thyroid”模式，得到碘图，测量平扫时甲状腺结节实性成分以及病灶周围正常正常甲状腺组织的碘含量。
结果：在平扫时甲状腺良恶性结节内实性成分之间的碘含量差异有统计学意义（p<0.05），良性结节的碘含量明显高于恶性结节。良恶性结节结节周边正常甲状腺组织的碘含量差异无统计学意义(p>0.05)。利用SPSS软件中受试者工作特征曲线（receiver operator characteristic,ROC曲线）法选取碘含量最佳灵敏度及特异度时的临界值，界值为0.20mg/ml时，灵敏度为65.7%，特异度为97.6%；界值为0.35mg/ml时，灵敏度为71.4%，特异度为90.2%。
结论：双能量CT的碘图能够成为鉴别甲状腺结节良恶性的有用工具。
第三部分双能量扫描中能谱分析对于甲状腺结节良恶性的鉴别诊断中的应用价值
目的：探讨双能CT扫描中能谱分析对于甲状腺结节良恶性的鉴别诊断中的应用价值
方法：除8例完全囊性变的结节因病变囊壁较薄，无法准确选择结节实性成分作为感兴趣区，未入组本研究外，其它同第一部分。将平扫的两组双能量数据传入西门子双源CT的工作站上的Dual—Energy软件中，选择“Monoenergetic”模式进行能谱分析，得到不同Kev（40Kev-190Kev区间）下的图像，产生病变的能谱曲线。
结果：良性结节的能谱曲线均表现为“下降型”，恶性结节的能谱曲线既可以表现为“上升型”（57.1%），又可以表现为“下降型”（42.9%），曲线类型在甲状腺良恶性结节之间具有统计学意义（p<0.05）。能谱分析诊断甲状腺结节的灵敏度、特异度和准确度分别57.1%，100.0%，80.3%。
碘含量测定利用SPSS软件中ROC曲线法与能谱分析软件诊断甲状腺结节的良恶性，均具有较高的诊断的特异度，明显高于常规增强CT的诊断特异度。
结论：双能量CT的能谱分析软件可以成为鉴别甲状腺结节良恶性的有用工具。
Part One The clinical utility of CT enhancement scanningin the differentiation of benign and malignant thyroid nodule
Objective: To discuss the clinical utility of CT enhancement scanningin the differentiation of benign and malignant thyroid nodule.
Methods:64cases with thyroid nodule accepted the thyroid enhancedCT examination were selected. All the cases were confirmed bypathohistology,operation or puncture biopsy.
All64cases including19female and45male,whose mean age is48years. There are totally84nodules of these patients,diameters from0.5cm to8.8cm, which mean diameters is3.3cm.84thyroid nodules were divided intotwo groups,35malignant nodules (which included25papillary carcinoma,7focus papillary carcinoma,2follicular carcinoma,1medullary carcinoma) and49benign nodules (which included36nodular goiter, of the total19case withadenomatoid hyperplasia,11adenomas,2hashimoto's thyroiditis).
Firstly, all patients were performed routine non-enhanced scan(tubevoltage80KV and140KV,slice thickness is5mm)using DSCT with dualenergy mode, then underwent the enhanced scanning with dual energy modeafter injection of iodinated contrast material (iohexol,300mg/ml,1.5-2ml/kg,injective rate3ml/s,at30s,60s).To observe the shape, boundary appearance,cystic change;calcifications, micro-calcificatio，enhanced characteristics，andthe character of lymph node of cervical part.
The SPSS for Windows version13.0software package was used forstatistical data analysis. The x2test was performed to numeration datacompare.If one or more of the expected count were less than5，Fisher’s ExactTest was used.P<0.05was considered with statistically significance.The pathology diagnosis was considered as the gold standard， thesensitivity,specificity and accuracy of all signs (including the shape,boundary appearance, cystic change; micro-calcification， enhancedcharacteristics) that was diagnosised thyroid cancer with CT enhancedscanning were calculated.
Results: Malignant nodules were more often showed irregular shape,obscure boundary, contained micro-calcification， showed no completeenhanced ring around the tumor or crab-foot shaped enhancement. Differencesof the CT characteristics between the benign and malignant nodules of thethyroid gland showed statistical significance (P<0.05). Enhanced CT can beone implemental method for differentiate malignant thyroid nodules frombenign ones(x2=36.668,p=0.000,P<0.05).The sensitivity, specificity, accuracyof enhanced CT in the diagnosis of thyroid lesions were82.9%，83.7%，83.3%respectively.
Conclusion: Enhanced CT is an efficient and reliable imaging methodfor detection and differential diagnosis of thyroid nodules. Mastering theenhanced CT features of various thyroid nodules can improve the accuracy ofdiagnosis.
Part Two The clinical utility of iodine-enhanced image ofdual-energy computed tomography(CT) in evaluating the benignand malignant thyroid nodule
Objective: To investigate the clinical utility of iodine-enhanced image ofdual-energy computed tomography(CT)in evaluating the benign and malignantthyroid nodule.
Methods: Excepted8complete cystic change nodules,because ofnodules capsule wall was thin，impossible accurate choose nodules true component as region of interest，not enter this study,other the same to part One.Transfer the two groups dual energy data into Dual-Energy software of theworkstation,Choose “Thyroid” mode to obtained the iodine-enhancedimages.Iodine content of thyroid nodule as well as normal thyroid gland thatsurrounding lesion in nonenhanced weighted images were measured.
Results: Iodine content between the benign and malignant thyroidnodules in nonenhanced weighted images showed statistical significance(P<0.05). Iodine content of benign thyroid nodules is more than that ofmalignant thyroid nodules.Iodine content of normal thyroid gland thatsurrounding lesion did not showed statistical significance (P>0.05).To utilizereceiver operator characteristic curve(ROCcurve)in SPSS software to selectcritical value of optimum sensitivity and specificity，when critical value is0.20mg/ml， sensitivity is65.7%,specificity is97.6%,critical value is0.35mg/ml，sensitivity is71.4%，specificity is90.2%.
Conclusion: Iodine-enhanced images with DECT in nonenhancedweighted images may be a implemental tool for differential diagnosis ofbenign and malignant nodules of the thyroid gland.
Part Three The clinical utility of dual-energy energy spectrumanalyzing technology in evaluating the benign and malignantthyroid nodules
Objective: To investigate the clinical utility of dual-energy computedtomography(CT) energy spectrum analyzing technology in evaluating thebenign and malignant thyroid nodules.
Methods: Excepted8complete cystic change nodules,because ofnodules capsule wall was thin,impossible accurate choose nodules truecomponent as region of interest，not enter this study,other the same to part One. Transfer the two groups dual energy data of nonenhanced weighted imagesinto Dual-Energy software of the workstation,choose“Monoenergetic”mode toobtained images under different Kev(40Kev-190Kev), then make energyspectrum analysis, bring about energy spcetrum curve of different lesion.
Results: Energy spectrum curve of benign thyroid nodules mainlyrepresent as “descent model”. Energy spcetrum curve of malignantthyroid nodules represent as either“rise model”(57.1%)or “descent model”(42.9%).Curve model between the benign and malignant thyroid nodules innonenhanced weighted images showed statistical significance (P<0.05).Thesensitivity,specificity,accuracy of curve model in the diagnosis of thyroidlesions were57.1%，100.0%，80.3%respectively.
To utilize receiver operator characteristic curve(ROCcurve)in SPSSsoftware and energy spectrum analyzing technology, both have higherdiagnostic specificity,have an advantage compared routine CT enhancedscanning.
Conclusion: Energy spectrum analyzing with DECT may be aimplemental tool for differential diagnosis of benign and malignant nodules ofthe thyroid gland.
目的：探讨CT增强扫描对于甲状腺结节良恶性鉴别诊断中的应用价值
方法：自2011年5月至2012年1月在河北医科大学第四医院行甲状腺CT增强扫描的64例甲状腺结节的病人纳入本研究。本研究中，所有病例均经手术或穿刺活检取得病理证实。其中男性19例，女性45例，年龄范围27-86岁，平均年龄48岁，共84个甲状腺结节，结节大小范围0.5-8.8cm，平均3.3cm。本研究中，恶性结节35例，其中包括25例甲状腺乳头状癌，灶性乳头状癌7例，2例滤泡状癌，1例髓样癌，良性结节49例，其中包括36例结节性甲状腺肿，其中19例伴腺瘤样增生，11例甲状腺腺瘤，以及2例桥本氏甲状腺炎。
使用德国第二代双源CT（SOMATOM Definition Flash），首先应用双能量模式（管电压分别为80KV和140KV,层厚5mm）进行平扫，而后利用高压注射器以3ml/S的速度经肘静脉注入造影剂碘海醇(300mg/ml)，注射量1.5-2.0mg/kg，注入对比剂后30s及60s进行双能增强扫描，分别观察甲状腺结节的形态，边界、有无囊性变、内部有无钙化及细颗粒状钙化，强化特点，有无颈部淋巴结肿大等征象。
采用SPSS13.0统计软件进行统计学分析。计数资料的比较采用x2检验，如果1个或多个格子的理论频数T<5，改用Fisher’s Exact Test，P<0.05为差异有统计学意义。以病理结果为金标准计算甲状腺结节的形态，边界，细颗粒状钙化，强化特点等征象诊断甲状腺恶性病变的灵敏度、特异度和准确度。
结果：甲状腺恶性结节多表现为形态不规则，边界不清，内可见细颗粒状钙化，增强扫描后可见“强化残圈征”或“蟹足状强化”。以上的特征性表现在甲状腺良恶性结节之间差异均有统计学差异（p<0.05）。增强CT可以成为鉴别甲状腺良恶性结节的有用方法（p<0.05）,诊断的灵敏度、特异度和准确度分别为82.9%，83.7%，83.3%。
结论：增强CT是诊断甲状腺结节良恶性的有效和可靠的检查方法,掌握各种甲状腺病变的CT表现特点能有效的提高诊断的准确性，为临床制定治疗方案提供重要依据。
第二部分双能量扫描中碘图对于甲状腺结节良恶性鉴别诊断中的应用价值
目的：探讨双能CT扫描中碘图对于甲状腺结节良恶性的鉴别诊断中的应用价值
方法：除8例完全囊性变的结节因病变囊壁较薄，无法准确选择结节实性成分作为感兴趣区，未入组本研究外，其它同第一部分。将平扫的两组双能量数据传入西门子双源CT的工作站上的Dual—Energy软件中，选择“Thyroid”模式，得到碘图，测量平扫时甲状腺结节实性成分以及病灶周围正常正常甲状腺组织的碘含量。
结果：在平扫时甲状腺良恶性结节内实性成分之间的碘含量差异有统计学意义（p<0.05），良性结节的碘含量明显高于恶性结节。良恶性结节结节周边正常甲状腺组织的碘含量差异无统计学意义(p>0.05)。利用SPSS软件中受试者工作特征曲线（receiver operator characteristic,ROC曲线）法选取碘含量最佳灵敏度及特异度时的临界值，界值为0.20mg/ml时，灵敏度为65.7%，特异度为97.6%；界值为0.35mg/ml时，灵敏度为71.4%，特异度为90.2%。
结论：双能量CT的碘图能够成为鉴别甲状腺结节良恶性的有用工具。
第三部分双能量扫描中能谱分析对于甲状腺结节良恶性的鉴别诊断中的应用价值
目的：探讨双能CT扫描中能谱分析对于甲状腺结节良恶性的鉴别诊断中的应用价值
方法：除8例完全囊性变的结节因病变囊壁较薄，无法准确选择结节实性成分作为感兴趣区，未入组本研究外，其它同第一部分。将平扫的两组双能量数据传入西门子双源CT的工作站上的Dual—Energy软件中，选择“Monoenergetic”模式进行能谱分析，得到不同Kev（40Kev-190Kev区间）下的图像，产生病变的能谱曲线。
结果：良性结节的能谱曲线均表现为“下降型”，恶性结节的能谱曲线既可以表现为“上升型”（57.1%），又可以表现为“下降型”（42.9%），曲线类型在甲状腺良恶性结节之间具有统计学意义（p<0.05）。能谱分析诊断甲状腺结节的灵敏度、特异度和准确度分别57.1%，100.0%，80.3%。
碘含量测定利用SPSS软件中ROC曲线法与能谱分析软件诊断甲状腺结节的良恶性，均具有较高的诊断的特异度，明显高于常规增强CT的诊断特异度。
结论：双能量CT的能谱分析软件可以成为鉴别甲状腺结节良恶性的有用工具。
Part One The clinical utility of CT enhancement scanningin the differentiation of benign and malignant thyroid nodule
Objective: To discuss the clinical utility of CT enhancement scanningin the differentiation of benign and malignant thyroid nodule.
Methods:64cases with thyroid nodule accepted the thyroid enhancedCT examination were selected. All the cases were confirmed bypathohistology,operation or puncture biopsy.
All64cases including19female and45male,whose mean age is48years. There are totally84nodules of these patients,diameters from0.5cm to8.8cm, which mean diameters is3.3cm.84thyroid nodules were divided intotwo groups,35malignant nodules (which included25papillary carcinoma,7focus papillary carcinoma,2follicular carcinoma,1medullary carcinoma) and49benign nodules (which included36nodular goiter, of the total19case withadenomatoid hyperplasia,11adenomas,2hashimoto's thyroiditis).
Firstly, all patients were performed routine non-enhanced scan(tubevoltage80KV and140KV,slice thickness is5mm)using DSCT with dualenergy mode, then underwent the enhanced scanning with dual energy modeafter injection of iodinated contrast material (iohexol,300mg/ml,1.5-2ml/kg,injective rate3ml/s,at30s,60s).To observe the shape, boundary appearance,cystic change;calcifications, micro-calcificatio，enhanced characteristics，andthe character of lymph node of cervical part.
The SPSS for Windows version13.0software package was used forstatistical data analysis. The x2test was performed to numeration datacompare.If one or more of the expected count were less than5，Fisher’s ExactTest was used.P<0.05was considered with statistically significance.The pathology diagnosis was considered as the gold standard， thesensitivity,specificity and accuracy of all signs (including the shape,boundary appearance, cystic change; micro-calcification， enhancedcharacteristics) that was diagnosised thyroid cancer with CT enhancedscanning were calculated.
Results: Malignant nodules were more often showed irregular shape,obscure boundary, contained micro-calcification， showed no completeenhanced ring around the tumor or crab-foot shaped enhancement. Differencesof the CT characteristics between the benign and malignant nodules of thethyroid gland showed statistical significance (P<0.05). Enhanced CT can beone implemental method for differentiate malignant thyroid nodules frombenign ones(x2=36.668,p=0.000,P<0.05).The sensitivity, specificity, accuracyof enhanced CT in the diagnosis of thyroid lesions were82.9%，83.7%，83.3%respectively.
Conclusion: Enhanced CT is an efficient and reliable imaging methodfor detection and differential diagnosis of thyroid nodules. Mastering theenhanced CT features of various thyroid nodules can improve the accuracy ofdiagnosis.
Part Two The clinical utility of iodine-enhanced image ofdual-energy computed tomography(CT) in evaluating the benignand malignant thyroid nodule
Objective: To investigate the clinical utility of iodine-enhanced image ofdual-energy computed tomography(CT)in evaluating the benign and malignantthyroid nodule.
Methods: Excepted8complete cystic change nodules,because ofnodules capsule wall was thin，impossible accurate choose nodules true component as region of interest，not enter this study,other the same to part One.Transfer the two groups dual energy data into Dual-Energy software of theworkstation,Choose “Thyroid” mode to obtained the iodine-enhancedimages.Iodine content of thyroid nodule as well as normal thyroid gland thatsurrounding lesion in nonenhanced weighted images were measured.
Results: Iodine content between the benign and malignant thyroidnodules in nonenhanced weighted images showed statistical significance(P<0.05). Iodine content of benign thyroid nodules is more than that ofmalignant thyroid nodules.Iodine content of normal thyroid gland thatsurrounding lesion did not showed statistical significance (P>0.05).To utilizereceiver operator characteristic curve(ROCcurve)in SPSS software to selectcritical value of optimum sensitivity and specificity，when critical value is0.20mg/ml， sensitivity is65.7%,specificity is97.6%,critical value is0.35mg/ml，sensitivity is71.4%，specificity is90.2%.
Conclusion: Iodine-enhanced images with DECT in nonenhancedweighted images may be a implemental tool for differential diagnosis ofbenign and malignant nodules of the thyroid gland.
Part Three The clinical utility of dual-energy energy spectrumanalyzing technology in evaluating the benign and malignantthyroid nodules
Objective: To investigate the clinical utility of dual-energy computedtomography(CT) energy spectrum analyzing technology in evaluating thebenign and malignant thyroid nodules.
Methods: Excepted8complete cystic change nodules,because ofnodules capsule wall was thin,impossible accurate choose nodules truecomponent as region of interest，not enter this study,other the same to part One. Transfer the two groups dual energy data of nonenhanced weighted imagesinto Dual-Energy software of the workstation,choose“Monoenergetic”mode toobtained images under different Kev(40Kev-190Kev), then make energyspectrum analysis, bring about energy spcetrum curve of different lesion.
Results: Energy spectrum curve of benign thyroid nodules mainlyrepresent as “descent model”. Energy spcetrum curve of malignantthyroid nodules represent as either“rise model”(57.1%)or “descent model”(42.9%).Curve model between the benign and malignant thyroid nodules innonenhanced weighted images showed statistical significance (P<0.05).Thesensitivity,specificity,accuracy of curve model in the diagnosis of thyroidlesions were57.1%，100.0%，80.3%respectively.
To utilize receiver operator characteristic curve(ROCcurve)in SPSSsoftware and energy spectrum analyzing technology, both have higherdiagnostic specificity,have an advantage compared routine CT enhancedscanning.
Conclusion: Energy spectrum analyzing with DECT may be aimplemental tool for differential diagnosis of benign and malignant nodules ofthe thyroid gland.
引文
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1Remy-Jardin M, Faivre JB, Pontana F, et al. Thoracic applications of dualenergy.Radiol Clin N Am2010(48):193-205
2Petersilka M,Bruder H,Krauss B,et al.Technical principles of dual sourceCT.Eur J Radiol2008,68:362-368
3Kang MJ,Park CM,Lee CH,et a1.Dual-energy CT:clinical applications invarious pulmonary diseases.Radiographies,2010,30:685-698
4薛华丹，刘炜，孙昊，等.第二代双源CT双能扫描模式对胰腺癌的影像诊断价值初探.中国医学科学院学报，2010,32(6):640-644
5林晓珠，沈云，陈克敏, CT能谱成像的基本原理与临床应用研究进展.中华放射学杂志，2011,45(8):798-800
6谭红娜，顾雅佳，彭卫军，等.甲状腺乳头状癌的CT表现与病理对照分析.中华放射学杂志，2009,43:799-804
7李铭，郑向鹏，李剑颖，等.甲状腺结节的能谱CT研究.中华放射学杂志，2011,45:780-783
1Remy-Jardin M, Faivre JB, Pontana F, et al. Thoracic applications of dualenergy.Radiol Clin N Am2010(48):193-205
2章跃武，吴渭贤，余新春，等.双能CT对孤立性肺结节的诊断价值.放射学实践，2011,26(2):176-178
3薛华丹，刘炜，孙昊，等.第二代双源CT双能扫描模式对胰腺癌的影像诊断价值初探.中国医学科学院学报，2010,32(6):640-644
4林晓珠，沈云，陈克敏，等.CT能谱成像的基本原理与临床应用研究进展.中华放射学杂志，2011,45(8):798-800
5Musturay K,Aykut A.Dual-energy CT revisited with muhidetectorCT:review of principles and clinical applications.Dian Interv Radiol,2010,Inpress
6Kang MJ,Park CM,Lee CH,et a1.Dual-energy CT:clinical applications invarious pulmonary diseases.Radiographies,2010,30:685-698
7张晓鹏.探索的精神与乐趣—CT能谱成像临床应用研究中的思考.中华放射学杂志，2011,45(8):708-712
8辛小燕，朱斌，陈君坤，等. CT能谱成像在胸腔渗出液与漏出液定性鉴别中的作用.中华放射学杂志，2011,45(8):723-726
9刘金刚，刘亚，李丽新，等. CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志，2011,45(8):731-735
10林晓珠，陈克敏，吴志远，等. CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与黏液性囊性肿瘤中的价值.中华放射学杂志，2011,45(8):713-717
11李铭，郑向鹏，李剑颖，等.甲状腺结节的能谱CT研究.中华放射学杂志，2011,45:780-781
12庞丽芳，张欢，宋立涛，等.宝石CT能谱成像在胃癌诊断中的研究应用.外科理论及实践，2011,16(3):243-247
1Cooper DS,Doherty GM,Haugen BR,et al.Revised management guidelinesfor patients with thyroid nodules and differentiated thyroid cancer.Thyroid,2009,19(11):1167-1214
2Dean DS,Gharib H.Epidemiology of thyroid nodules.Best Pract Res ClinEndocrinol Metab,2008,22(6):901-911
3张彬.甲状腺结节治疗的规范化.中国耳鼻喉头颈外科，2008,15(6):317-318
4Iyer NG,Shaha AR.Management of thyroid nodules and surgery fordifferentiated thyroid cancer.Clin Oncol (R Coll Radiol),2010,22(6):405-412
5Davies L, Welch HG.Increasing incidence of thyroid cancer in the UnitedStates,1973-2002.JAMA,2006,295(18):2164-2167
6中华医学会内分泌学会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南—甲状腺结节.中华内科杂志，2008,47(10):867-868
7侯传国，朱理玮.甲状腺单发结节355例临床诊治分析.天津医科大学学报，2009,15(3):413-415
8张仑，李树玲．甲状腺结节的诊断和处理原则．临床外科杂志，2007,12(4):588-589
9冯学明．甲状腺癌的影像学研究进展．国际放射医学核医学杂志，2006，30(5):275-280
10PapiniE,Guglielmi R,Bianchini A,et al. Risk of malignancy in nonpalpablethyroid nodules: predictive value of ultrasound and color-Doppler features.Clin Endocrinol Metab,2002,87(5):1941-1946
11Frates MC,Benson CB,Charboneau JW,et al.Management of thyroidnodules detected at US: Society of Radiologists in Ultrasound consensusconference statement. Radiology2005;237(3):794-800
12汪玲珑,乔海燕,卓玉水.甲状腺癌高频超声的临床诊断.超声影像学,2009,24(6):674-675
13傅先水,张武,王金瑞,等.甲状腺超声诊断常见误区.中华医学超声杂志(电子版),2008,5(1):153
14葛琛瑾,舒政,等.甲状腺良恶性肿瘤的螺旋CT鉴别诊断.实用放射学杂志，2008,24(9):459-461
15Khoo ML,Asa SL,Witterick IJ,et a1.Thyroid calcification and itsassociation with thyroid carcinoma.Head Neck,2002,24(7):651-655
16罗德红，石木兰，罗斗强.甲状腺癌的CT诊断.中华放射学杂志,1998,32(11):758-760
17Silverman PM, Newman GE, Korobkin M, et al. Computed tomography inthe evaluation of thyroid disease.American Journal of Roentgenology,1984,142:897-902
18谢榜昆，关玉宝，袁小平，等.甲状腺癌的CT表现与病理相关性研究.癌症，2003,22:192-197
19黄昌辉，马丽华，李洁.甲状腺肿瘤的螺旋CT诊断价值.中国医学影像技术，2001,17(10):968-969
20罗德红，石木兰，李复.甲状腺癌淋巴结转移的CT表现.中华放射学杂志，2002,36(1):36-39
21兰宝森.中华影像医学头颈部卷.北京:人民卫生出版社，2002,306-318
22兰勇，龙晚生等.甲状腺单发结节的CT诊断及鉴别诊断．放射学实践，2009,24(2):144
23卢绍辉，李恒国，梁久平.结节性甲状腺肿与甲状腺癌的CT鉴别诊断.暨南大学学报（医学版），2009,30(4):445-448
24WeberAL, Randol ph G, Aks FG. The thyroid and parathyroidglands. CTand MR imaging and correlation with pathology and clinical findings.Radiol Clin North Am,2008,38(5):1105-1129
25关玉宝，谢榜昆，袁小平，等.甲状腺癌的MRI诊断.癌症，2003,22,739-744
26Cases JA, Surks MI. The changing role of scintigraphy in theevaluation ofthyroid nodules. Semin Nucl Med,2000,30:81-87
27Fletcher JG,Takahashi N,Hamnan R,et a1.Dual-energy and dual-sourceCT:is there a role in the abdomen and pelvis?Radiol Clin NorthAm,2009,47:41-57
28Yeh BM,Shepherd JA,Wang ZJ,et a1.Dual-energy and low-kVp CT inthe abdomen.AJR,2009,193:47-54
29Zhang LJ,Zhao YE,Wu SY,et al.Pulmonary embolism detection withdual-energy CT:experimental study of dual-source CT in rabbits.Radiology,2009,252:61-70
30张龙江，卢光明，黄伟，等.双源CT双能量肺灌注成像的初步观察.中华放射学杂志，2008,42:1183-1186
31Zhang LJ,Chai X,Wu SY,et al.Detection of pulmonary embolism by dualenergy CT:correlation with perfusion scintigraphy and pathohistologicalfindings in rabbits.Eur Radiol,2009,19:2844-2854
32彭晋，张龙江，周长圣，等.单次对比增强双源CT双能量心脏成像的初步应用研究.国际医学放射学杂志，2009,32:313-316
33Zhang LJ,Wu SY,Niu JB,et al.Dual energy CT angiography for theevaluation of intracranial neurysms:image quality,radiation dose,andcomparison with3D rotational digital subtraction angiography. AJR,2010,194:23-30
34彭晋，张龙江，吴新生，等.双源CT双能量上腹部虚拟平扫临床应用价值的初步探讨.临床放射学杂志，2009,28:1680-1684
35Scheffel H,Stolzmann P,Frauenfelde TR,et al.Dual-energy contrastenhanced computed tomography for the detection of urinary stonedisease.Invest Radiol,2007,42:823-829
36Graser A,Johnson TR,Bader M,et al.Dual energy CT characterization ofurinary calculi:initial in vitro and clinical experience.Invest Radiol,2008,43:112-119
37Choil HK,Al-Arfaj AM,Eftekhari A,et al.Dual energy computedtomography in tophaceous gout.Ann Rheum Dis,2009,68:1609-1612
38Petersilka M,Bruder H,Krauss B,et al.Technical principles of dual sourceCT.Eur J Radiol2008,68:362-368
39Remy-Jardin M, Faivre JB, Pontana F, et al. Thoracic applications of dualenergy.Radiol Clin N Am2010(48):193-205
40Kang MJ,Park CM,Lee CH,et a1.Dual-energy CT:clinical applications invarious pulmonary diseases.Radiographies,2010,30:685-698
41薛华丹，刘炜，孙昊，等.第二代双源CT双能扫描模式对胰腺癌的影像诊断价值初探.中国医学科学院学报，2010,32(6):640-644
42Chae EJ,Song JW,Sec JB,el a1.Clinical utility of dual-energy CT in tlIeevaluation of solitary pulmonary L: initial experience.Radiology,2008,249:67l-681
43Thieme SF,Johnson TRC,Reiser MF.Dual-energy lung perfusioncomputed tomography:a novel pulmonary functional imaging method.Semin ultrasound CT MRI2010(31):301-308
44林晓珠，沈云，陈克敏，CT能谱成像的基本原理与临床应用研究进展.中华放射学杂志，2011,45(8):798-800
45李铭，郑向鹏，李剑颖，等.甲状腺结节的能谱CT研究.中华放射学杂志，2011,45:780-783
46Musturay K,Aykut A.Dual-energy CT revisited with muhidetector CT:review of principles and clinical applications.Dian Interv Radiol,2010,Inpress
47Remy-Jardin M,Faivre JB,Pontana F,et a1.Thoracic applications ofdualenergy.RadiolClin North Am,2010,48:193-205
48Kang MJ,Park CM,Lee CH,et a1.Dual-energy CT:clinical applications invarious pulmonary diseases.Radiographies,2010,30:685-698
49辛小燕，朱斌，陈君坤，等. CT能谱成像在胸腔渗出液与漏出液定性鉴别中的作用.中华放射学杂志，2011,45(8):723-726
50刘金刚，刘亚，李丽新、等. CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志，2011,45(8):731-735
51林晓珠，陈克敏，吴志远，等. CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与黏液性囊性肿瘤中的价值.中华放射学杂，2011,45(8):713-717
2Won Jin Moon, So Lyong Lung, Jeong Hyun Lee, et al. Benign andmalignant thyroid nodules: US differtiation muticenter retrospectivestudy.Radiology,2008,247(3):762-765
3FratesMC, Benson CB, Charboneau JW, et al. Management of thyroidnodules detected at US: Society of Radiologists in Ultrasound consensusconference statement. Radiology2005,237(3):794-800
4兰勇，龙晚生，易兰，等.甲状腺单发结节的CT诊断及鉴别诊断．放射学实践，2009,24(2):142-144
5罗德红，石木兰，李复.甲状腺癌淋巴结转移的CT表现.中华放射学杂志，2002,36(1):36-39
6兰宝森.中华影像医学头颈部卷.北京：人民卫生出版社，2002.306-318
7韩志江，陈文辉，舒艳艳，等.结节性甲状腺肿和甲状腺癌的CT鉴别诊断.中国临床医学影像杂志，2011,22(6):415-417
8王友良，任刚，张传好，等.螺旋CT对甲状腺单发结节良恶性鉴别的价值.实用肿瘤杂志，2009,22(2):129-131
9韩本谊，顾立军，赵亚娥，等.甲状腺癌多排螺旋CT诊断及鉴别诊断.中国医学影像学杂志，2011,19(10):749-752
1Remy-Jardin M, Faivre JB, Pontana F, et al. Thoracic applications of dualenergy.Radiol Clin N Am2010(48):193-205
2Petersilka M,Bruder H,Krauss B,et al.Technical principles of dual sourceCT.Eur J Radiol2008,68:362-368
3Kang MJ,Park CM,Lee CH,et a1.Dual-energy CT:clinical applications invarious pulmonary diseases.Radiographies,2010,30:685-698
4薛华丹，刘炜，孙昊，等.第二代双源CT双能扫描模式对胰腺癌的影像诊断价值初探.中国医学科学院学报，2010,32(6):640-644
5林晓珠，沈云，陈克敏, CT能谱成像的基本原理与临床应用研究进展.中华放射学杂志，2011,45(8):798-800
6谭红娜，顾雅佳，彭卫军，等.甲状腺乳头状癌的CT表现与病理对照分析.中华放射学杂志，2009,43:799-804
7李铭，郑向鹏，李剑颖，等.甲状腺结节的能谱CT研究.中华放射学杂志，2011,45:780-783
1Remy-Jardin M, Faivre JB, Pontana F, et al. Thoracic applications of dualenergy.Radiol Clin N Am2010(48):193-205
2章跃武，吴渭贤，余新春，等.双能CT对孤立性肺结节的诊断价值.放射学实践，2011,26(2):176-178
3薛华丹，刘炜，孙昊，等.第二代双源CT双能扫描模式对胰腺癌的影像诊断价值初探.中国医学科学院学报，2010,32(6):640-644
4林晓珠，沈云，陈克敏，等.CT能谱成像的基本原理与临床应用研究进展.中华放射学杂志，2011,45(8):798-800
5Musturay K,Aykut A.Dual-energy CT revisited with muhidetectorCT:review of principles and clinical applications.Dian Interv Radiol,2010,Inpress
6Kang MJ,Park CM,Lee CH,et a1.Dual-energy CT:clinical applications invarious pulmonary diseases.Radiographies,2010,30:685-698
7张晓鹏.探索的精神与乐趣—CT能谱成像临床应用研究中的思考.中华放射学杂志，2011,45(8):708-712
8辛小燕，朱斌，陈君坤，等. CT能谱成像在胸腔渗出液与漏出液定性鉴别中的作用.中华放射学杂志，2011,45(8):723-726
9刘金刚，刘亚，李丽新，等. CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志，2011,45(8):731-735
10林晓珠，陈克敏，吴志远，等. CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与黏液性囊性肿瘤中的价值.中华放射学杂志，2011,45(8):713-717
11李铭，郑向鹏，李剑颖，等.甲状腺结节的能谱CT研究.中华放射学杂志，2011,45:780-781
12庞丽芳，张欢，宋立涛，等.宝石CT能谱成像在胃癌诊断中的研究应用.外科理论及实践，2011,16(3):243-247
1Cooper DS,Doherty GM,Haugen BR,et al.Revised management guidelinesfor patients with thyroid nodules and differentiated thyroid cancer.Thyroid,2009,19(11):1167-1214
2Dean DS,Gharib H.Epidemiology of thyroid nodules.Best Pract Res ClinEndocrinol Metab,2008,22(6):901-911
3张彬.甲状腺结节治疗的规范化.中国耳鼻喉头颈外科，2008,15(6):317-318
4Iyer NG,Shaha AR.Management of thyroid nodules and surgery fordifferentiated thyroid cancer.Clin Oncol (R Coll Radiol),2010,22(6):405-412
5Davies L, Welch HG.Increasing incidence of thyroid cancer in the UnitedStates,1973-2002.JAMA,2006,295(18):2164-2167
6中华医学会内分泌学会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南—甲状腺结节.中华内科杂志，2008,47(10):867-868
7侯传国，朱理玮.甲状腺单发结节355例临床诊治分析.天津医科大学学报，2009,15(3):413-415
8张仑，李树玲．甲状腺结节的诊断和处理原则．临床外科杂志，2007,12(4):588-589
9冯学明．甲状腺癌的影像学研究进展．国际放射医学核医学杂志，2006，30(5):275-280
10PapiniE,Guglielmi R,Bianchini A,et al. Risk of malignancy in nonpalpablethyroid nodules: predictive value of ultrasound and color-Doppler features.Clin Endocrinol Metab,2002,87(5):1941-1946
11Frates MC,Benson CB,Charboneau JW,et al.Management of thyroidnodules detected at US: Society of Radiologists in Ultrasound consensusconference statement. Radiology2005;237(3):794-800
12汪玲珑,乔海燕,卓玉水.甲状腺癌高频超声的临床诊断.超声影像学,2009,24(6):674-675
13傅先水,张武,王金瑞,等.甲状腺超声诊断常见误区.中华医学超声杂志(电子版),2008,5(1):153
14葛琛瑾,舒政,等.甲状腺良恶性肿瘤的螺旋CT鉴别诊断.实用放射学杂志，2008,24(9):459-461
15Khoo ML,Asa SL,Witterick IJ,et a1.Thyroid calcification and itsassociation with thyroid carcinoma.Head Neck,2002,24(7):651-655
16罗德红，石木兰，罗斗强.甲状腺癌的CT诊断.中华放射学杂志,1998,32(11):758-760
17Silverman PM, Newman GE, Korobkin M, et al. Computed tomography inthe evaluation of thyroid disease.American Journal of Roentgenology,1984,142:897-902
18谢榜昆，关玉宝，袁小平，等.甲状腺癌的CT表现与病理相关性研究.癌症，2003,22:192-197
19黄昌辉，马丽华，李洁.甲状腺肿瘤的螺旋CT诊断价值.中国医学影像技术，2001,17(10):968-969
20罗德红，石木兰，李复.甲状腺癌淋巴结转移的CT表现.中华放射学杂志，2002,36(1):36-39
21兰宝森.中华影像医学头颈部卷.北京:人民卫生出版社，2002,306-318
22兰勇，龙晚生等.甲状腺单发结节的CT诊断及鉴别诊断．放射学实践，2009,24(2):144
23卢绍辉，李恒国，梁久平.结节性甲状腺肿与甲状腺癌的CT鉴别诊断.暨南大学学报（医学版），2009,30(4):445-448
24WeberAL, Randol ph G, Aks FG. The thyroid and parathyroidglands. CTand MR imaging and correlation with pathology and clinical findings.Radiol Clin North Am,2008,38(5):1105-1129
25关玉宝，谢榜昆，袁小平，等.甲状腺癌的MRI诊断.癌症，2003,22,739-744
26Cases JA, Surks MI. The changing role of scintigraphy in theevaluation ofthyroid nodules. Semin Nucl Med,2000,30:81-87
27Fletcher JG,Takahashi N,Hamnan R,et a1.Dual-energy and dual-sourceCT:is there a role in the abdomen and pelvis?Radiol Clin NorthAm,2009,47:41-57
28Yeh BM,Shepherd JA,Wang ZJ,et a1.Dual-energy and low-kVp CT inthe abdomen.AJR,2009,193:47-54
29Zhang LJ,Zhao YE,Wu SY,et al.Pulmonary embolism detection withdual-energy CT:experimental study of dual-source CT in rabbits.Radiology,2009,252:61-70
30张龙江，卢光明，黄伟，等.双源CT双能量肺灌注成像的初步观察.中华放射学杂志，2008,42:1183-1186
31Zhang LJ,Chai X,Wu SY,et al.Detection of pulmonary embolism by dualenergy CT:correlation with perfusion scintigraphy and pathohistologicalfindings in rabbits.Eur Radiol,2009,19:2844-2854
32彭晋，张龙江，周长圣，等.单次对比增强双源CT双能量心脏成像的初步应用研究.国际医学放射学杂志，2009,32:313-316
33Zhang LJ,Wu SY,Niu JB,et al.Dual energy CT angiography for theevaluation of intracranial neurysms:image quality,radiation dose,andcomparison with3D rotational digital subtraction angiography. AJR,2010,194:23-30
34彭晋，张龙江，吴新生，等.双源CT双能量上腹部虚拟平扫临床应用价值的初步探讨.临床放射学杂志，2009,28:1680-1684
35Scheffel H,Stolzmann P,Frauenfelde TR,et al.Dual-energy contrastenhanced computed tomography for the detection of urinary stonedisease.Invest Radiol,2007,42:823-829
36Graser A,Johnson TR,Bader M,et al.Dual energy CT characterization ofurinary calculi:initial in vitro and clinical experience.Invest Radiol,2008,43:112-119
37Choil HK,Al-Arfaj AM,Eftekhari A,et al.Dual energy computedtomography in tophaceous gout.Ann Rheum Dis,2009,68:1609-1612
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