多模态超声联合CT对甲状腺癌合并桥本甲状腺炎患者颈部淋巴结转移的预测价值

Predictive value of multimodal ultrasound combined with CT for cervical lymph node metastasis in thyroid cancer patients with Hashimoto thyroiditis

摘要:

目的 探讨多模态超声联合CT对甲状腺癌合并桥本甲状腺炎患者颈部淋巴结转移的预测价值。方法 回顾性分析2019年1月—2024年1月在南京医科大学附属南京医院进行手术的80例甲状腺癌合并桥本甲状腺炎患者的临床资料，经临床及影像学评估，根据颈部淋巴结是否发生转移分为未转移组51例，转移组29例。比较两组患者的多模态超声和CT检查结果（对比剂灌注方向、造影强度分布、病灶增强水平及增强早期被膜连续性等）；采用受试者工作特征（ROC）曲线评估其在颈部淋巴结转移中的预测价值。结果 未转移组的年龄高于转移组（P <0.05），未转移组的癌灶最大径低于转移组（P <0.05）；两组的性别构成、体质量指数和病灶数量构成比较，差异均无统计学意义（P >0.05）。两组的形态、位置、钙化类型、实性成分回声、对比剂灌注方向、造影强度分布，差异均无统计学意义（P >0.05）；未转移组中病灶等/高增强、存在连续被膜的占比高于转移组（P <0.05）。未转移组的静脉期CT值、净增CT值、标准化CT值和Emean均低于转移组（P <0.05）。两组动脉期CT值、净增CT值和标准化CT值比较，差异均无统计学意义（P >0.05）。两组平扫期CT值比较，差异无统计学意义（P >0.05）。这些指标与多模态超声联合使用，对甲状腺癌合并桥本甲状腺炎患者颈部淋巴结转移诊断的敏感性为93.1%（95% CI：0.772，0.992），特异性为94.1%（95% CI：0.938，0.988），曲线下面积为0.970（95% CI：0.937，1.000）。结论 多模态超声联合CT对于预测甲状腺癌合并桥本甲状腺炎患者颈部淋巴结转移具有重要价值，能够提供更准确的诊断信息，有助于临床医生进行疾病分期和治疗规划。此外，年龄、癌灶最大径、病灶增强水平和增强早期被膜连续性等因素对预测颈部淋巴结转移具有重要意义。

Abstract:

Objective To explore the predictive value of multimodal ultrasound combined with computed tomography (CT) in detecting cervical lymph node metastasis in thyroid cancer patients with Hashimoto thyroiditis.Methods This study retrospectively analyzed the clinical data of 80 patients with thyroid cancer complicated by Hashimoto thyroiditis who underwent surgery at Nanjing Hospital affiliated with Nanjing Medical University from January 2019 to January 2024. After clinical and imaging assessments, patients were divided into a non-metastatic group of 51 and a metastatic group of 29 based on whether cervical lymph node metastasis occurred. By comparing the results of multimodal ultrasound and CT scans between the two groups, including indicators such as contrast agent perfusion direction, contrast intensity distribution, lesion enhancement level, and early enhancement capsular continuity, the ROC curve was used to evaluate its diagnostic value in cervical lymph node metastasis.Results Comparisons between the non-metastatic and metastatic groups regarding age, gender, body mass index, maximum diameter of cancer lesions, and number of lesions were made using t-tests and chi-square tests. Significant differences (P <0.05) were found in age and maximum diameter of lesions; the non-metastatic group was older and had smaller maximum lesion diameters than the metastatic group. Comparisons of morphology, location, type of calcification, echogenicity of solid components, contrast agent perfusion direction, contrast intensity distribution, lesion enhancement level, and early enhancement capsular continuity between groups were analyzed using chi-square tests. Significant differences (P <0.05) were observed in lesion enhancement level and early enhancement capsular continuity, with higher proportions of equal/high enhancement and continuous capsules in the non-metastatic group. Comparisons of venous phase CT values, net enhancement CT values, normalized CT values, and Emean between the groups were conducted using t-tests, showing statistically significant differences (P <0.05), with the non-metastatic group having lower values. When combined with multimodal ultrasound, these indicators achieved high diagnostic sensitivity 93.1% (95% CI: 0.772, 0.992) and specificity 94.1% (95% CI: 0.938, 0.988) for detecting cervical lymph node metastasis in patients with thyroid cancer and Hashimoto thyroiditis, with an area under the curve of 0.970 (95% CI: 0.937, 1.000).Conclusions Multimodal ultrasound combined with CT is valuable for predicting cervical lymph node metastasis in patients with thyroid cancer and concurrent Hashimoto thyroiditis, providing accurate diagnostic information that aids clinicians in disease staging and treatment planning. Furthermore, factors such as age, maximum lesion diameter, lesion enhancement level, and early enhancement capsular continuity play significant roles in predicting cervical lymph node metastasis.