CAJ | 학술논문

目的：探讨双源CT双能量碘浓度相关定量参数值鉴别甲状腺结节良恶性的应用价值。方法回顾性分析接受双源CT双能量平扫、动脉期及静脉期扫描的甲状腺结节患者78例[112个结节，其中良性结节43例（64个）、恶性结节35例（48个）]，经双能量软件处理得到碘图，测量平扫、动脉期、静脉期碘图正常甲状腺碘浓度(IC甲状腺)、甲状腺内结节碘浓度(IC病灶)、同时相颈动脉碘浓度(IC 颈动脉)内碘浓度值，计算正常甲状腺与甲状腺结节内碘浓度差异值(ICD)、碘浓度差异值比(ICDNR)、标准化碘浓度比(NIC)，良恶性结节间各参数比较采用两独立样本t检验或t'检验，将3期参数绘制ROC曲线，分析ICD、ICDNR、NIC、IC 病灶的诊断效能。结果平扫期恶性结节ICDNR、ICD、IC 病灶分别为1.04±0.95、(2.20±1.82)mg/ml、(-0.04±1.65)mg/ml ，良性结节分别为0.04±0.41、(0.35±0.97)mg/ml、(2.19±0.55)mg/ml，恶性结节的ICDNR、ICD均大于良性结节(t'值分别为6.63、6.39，P值均<0.05)，而恶性结节IC 病灶小于良性结节(t=10.13，P<0.05)。动脉期恶性结节ICDNR、ICD、IC 病灶分别为0.39±0.29、(2.23±1.77) mg/ml、(3.81±1.50) mg/ml，良性结节分别为0.49±0.22、(2.97±1.91) mg/ml、(3.17±1.64) mg/ml，恶性结节ICDNR、ICD小于良性结节(t'=2.08，t=2.12；P值均<0.05)，恶性结节IC病灶大于良性结节(t=2.12，P<0.05)。静脉期恶性结节和良性结节NIC分别为0.45±0.21、0.58±0.37，恶性结节小于良性结节，差异有统计学意义（t'=2.35，P<0.05）。平扫期ICDNR的曲线下面积（AUC）最大，为0.892，敏感度为83.3%，特异度为90.5%。结论双源CT双能量碘图定量参数值对甲状腺结节良恶性鉴别诊断有较大价值，可提高诊断准确率。
목적：탐토쌍원CT쌍능량전농도상관정량삼수치감별갑상선결절량악성적응용개치。방법회고성분석접수쌍원CT쌍능량평소、동맥기급정맥기소묘적갑상선결절환자78례[112개결절，기중량성결절43례（64개）、악성결절35례（48개）]，경쌍능량연건처리득도전도，측량평소、동맥기、정맥기전도정상갑상선전농도(IC갑상선)、갑상선내결절전농도(IC병조)、동시상경동맥전농도(IC 경동맥)내전농도치，계산정상갑상선여갑상선결절내전농도차이치(ICD)、전농도차이치비(ICDNR)、표준화전농도비(NIC)，량악성결절간각삼수비교채용량독립양본t검험혹t'검험，장3기삼수회제ROC곡선，분석ICD、ICDNR、NIC、IC 병조적진단효능。결과평소기악성결절ICDNR、ICD、IC 병조분별위1.04±0.95、(2.20±1.82)mg/ml、(-0.04±1.65)mg/ml ，량성결절분별위0.04±0.41、(0.35±0.97)mg/ml、(2.19±0.55)mg/ml，악성결절적ICDNR、ICD균대우량성결절(t'치분별위6.63、6.39，P치균<0.05)，이악성결절IC 병조소우량성결절(t=10.13，P<0.05)。동맥기악성결절ICDNR、ICD、IC 병조분별위0.39±0.29、(2.23±1.77) mg/ml、(3.81±1.50) mg/ml，량성결절분별위0.49±0.22、(2.97±1.91) mg/ml、(3.17±1.64) mg/ml，악성결절ICDNR、ICD소우량성결절(t'=2.08，t=2.12；P치균<0.05)，악성결절IC병조대우량성결절(t=2.12，P<0.05)。정맥기악성결절화량성결절NIC분별위0.45±0.21、0.58±0.37，악성결절소우량성결절，차이유통계학의의（t'=2.35，P<0.05）。평소기ICDNR적곡선하면적（AUC）최대，위0.892，민감도위83.3%，특이도위90.5%。결론쌍원CT쌍능량전도정량삼수치대갑상선결절량악성감별진단유교대개치，가제고진단준학솔。
Objective To investigate the application of quantitative parameters associated with iodine concentration derived from iodine overlay image by dual-source dual-energy computed tomographic (CT) in differentiating benign and malignant thyroid nodules. Methods Seventy-eight patients (total 112 nodules, including 64 benign and 48 malignant nodules) with thyroid nodules who underwent plain scan (PS), arterial phase (AP) and venous phase (VP) enhanced scan by DSCT (80 kVp/ Sn140 kVp) were analyzed retrospectively. Iodine overlay images were obtained by the dual energy post-processing software. The mean iodine concentrations in the normal thyroid parenchyma (ICThy), the lesion (ICLes), and the carotid artery(ICCar) of PS, AP and VP were measured from iodine overlay images. The iodine concentration difference (ICD), the iodine concentration difference-to-normal parenchyma ratio (ICDNR) and the normalized iodine concentration ratio (NIC) were calculated. The two-sample t test was performed to compare quantitative parameters between the benign and malignant nodules. ROC curve with quantitative parameters of three phases was used to analyze the diagnostic efficiency of ICD, ICDNR, NIC and ICles. Results During <br> PS, mean ICDNR, ICD and ICLes of malignant nodules were respectively 1.04 ± 0.95, (2.20 ± 1.82) mg/ml, (-0.04 ± 1.65) mg/ml, ICDNR, ICD and ICLes of benign nodules were respectively 0.04 ± 0.41, (0.35 ± 0.97) mg/ml, (2.19 ± 0.55) mg/ml. ICDNR and ICD of malignant nodules were higher than benign nodules (t'=6.63, 6.39, P<0.05), while ICles of malignant nodules were lower than benign nodules (t=10.13, P<0.05). During AP , mean ICDNR, ICD, ICLes of malignant nodules were 0.39 ± 0.29, (2.23 ± 1.77) mg/ml, (3.81 ± 1.50) mg/ml, and benign nodules were 0.49 ± 0.22, (2.97 ± 1.91) mg/ml, (3.17 ± 1.64) mg/ml, respectively. ICDNR, ICD of malignant nodules were lower than benign nodules (t'=2.08, t=2.12;P<0.05),while ICles of malignant nodules were higher than benign nodules (t=2.12, P< 0.05). During VP, mean NIC of the malignant and benign nodules were 0.45 ± 0.21, 0.58 ± 0.37, respectively. NIC of malignant nodules were lower than benign nodules (t'=2.35, P< 0.05). AUC of ICDNR during PS was 0.892, the sensitivity was 83.3% and the specificity were 90.5%. Conclusion Quantitative parameters associated with iodine concentration by dual-source dual-energy CT may increase the efficiency and accuracy in differentiating benign and malignant thyroid nodules.