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5、ers（Basel），2021，13（1）：155.DOI：10.3390/cancers13010155.（收稿日期：2022-05-24，修回日期：2022-07-08）引用本文：王桂东，李雪菲，李劲浩，等.基于直方图检查的CT强化扫描在鉴别诊断甲状腺良恶性结节中的价值J.安徽医药，2023，27（8）：1601-1604.DOI：10.3969/j.issn.1009-6469.2023.08.024.基于直方图检查的CT强化扫描在鉴别诊断甲状腺良恶性结节中的价值王桂东，李雪菲，李劲浩，杨扬，孟凯龙作者单位：邯郸市第一医院CT/MR室，河北 邯郸056002通信作者：孟凯龙，男，主任医师
6、，研究方向为呼吸、颈部及心血管系统影像诊断，Email：IPS摘要：目的 探讨基于直方图检查的CT强化扫描用于甲状腺良恶性肿瘤鉴别诊断临床效能。方法 回顾性分析邯郸市第一医院2017年1月至2020年6月收治具有明确病理组织学诊断结果甲状腺良恶性结节病人264例278个病灶临床资料，根据结节性质分为良性组（130个）和恶性组（148个）；比较两组平扫和强化扫描CT直方图相关指标，描绘ROC曲线评价平扫及强化扫描CT直方图相关指标用于甲状腺良恶性结节鉴别诊断临床效能。结果 恶性组CT平扫直方图均值，第10、50及90百分位数均显著高于良性组（P0.05）；恶性组CT强化扫描直方图均值，第1、10
7、、50及90百分位数均显著高于良性组（P0.05）；恶性组CT强化扫描直方图方差显著低于良性组（P0.05）；ROC曲线分析结果显示，CT平扫及强化扫描直方图指标中用于甲状腺良恶性结节鉴别诊断中，CT强化扫描直方图第10百分位数的AUC最高（0.70），灵敏度和特异度分别为75.26%，63.75%（P0.05）。结论 基于直方图检查的CT强化扫描用于甲状腺良恶性结节鉴别诊断具有良好价值，其中CT强化扫描直方图第10百分位数可作为重要预测指标加以关注。关键词：甲状腺结节；CT；直方图；鉴别诊断Clinical value of CT enhanced scan based on histogr
8、am in differential diagnosis of benign and malignant thyroid nodulesWANG Guidong,LI Xuefei,LI Jinhao,YANG Yang,MENG KailongAuthor Affiliation:CT and MR Room,The First Hospital of Handan,Handan,Hebei 056002,ChinaAbstract：Objective To investigate the clinical value of CT enhanced scan based on histogr
9、am in differential diagnosis of benign and malignant thyroid nodules.Methods Clinical data of 264 patients for 278 lesions with benign and malignant thyroid nodules with definite histopathological diagnosis in the the First Hospital of Handan from January 2017 to June 2020 were retrospectively chose
10、n.All patients were assigned into 2 groups including benign group(130 lesions)and malignant group(148 lesions)according to nodules nature.The levels of plain scan and enhanced CT histograms were compared between 2 groups.ROC curve was used to evaluate the clinical value of histogram related indexes
11、of plain scan and enhanced CT in differential diagnosis of benign and malignant thyroid nodules.Results The mean value of CT plain histogram,10th,50th and 90th percentile in malignant group were significantly higher than those in benign group(P0.05).The contrast-enhanced CT histogram mean,1st,10th,5
12、0th and 90th percentile levels in malignant 临床医学1601网络首发时间：2023-07-06 13:12:17网络首发地址：https:/ 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Aug，27（8）group were significantly higher than tnose in benign group(P0.05).The variance of contrast-enhanced CT histogram in malignant group was significan
13、tly lower than that in benign group(P0.05).ROC curve analysis showed that CT plain scan and enhanced scan histogram index were used in the differential diagnosis of benign and malignant thyroid nodule,AUC(0.70)was the highest in the 10th percentile of CT enhanced histograms,and the sensitivity and s
14、pecificity were 75.26%and 63.75%respectively(P0.75判定为信度良好；P0.05为差异有统计学意义。2结果2.1勾画ROI的ICC分析两名医师勾画ROI的ICC=0.91 95%CI：（0.87，0.96），提示勾画ROI一致性良好。2.2两组平扫CT直方图相关指标水平比较恶性组CT平扫直方图均值，第10、50及90百分位数均显高于良性组（P0.05），见表1。2.3两组强化扫描 CT 直方图相关指标水平比较恶性组CT强化扫描直方图均值，第1、10、50及90百分位数均高于良性组（P0.05）；恶性组CT强化扫描直方图方差低于良性组（P0.05），
15、见表2。典型CT平扫、强化扫描见图1，2。2.4平扫和强化扫描CT直方图相关指标用于甲状腺良恶性结节鉴别诊断价值ROC曲线分析ROC曲线分析结果显示，CT平扫及强化扫描直方图指标中用于甲状腺良恶性结节鉴别诊断中，CT强化扫描直方图第10百分位数的AUC最高（0.70），灵敏度和特异度分别为75.26%，63.75%（P0.05）。见表3。表1甲状腺良恶性结节264例平扫CT直方图相关指标水平比较/x s组别良性组恶性组t值P值病灶数量130148均值133.8415.95140.9417.673.520.001方差105.9643.60107.7047.220.320.750偏度0.370.1
16、30.350.101.420.156峰度0.370.060.390.161.410.160第1百分位数110.8422.95114.9927.671.370.173第10百分位数120.0517.10126.2924.452.490.014第50百分位数134.7215.14140.5917.103.040.003第90百分位数149.9216.15156.1023.242.600.010第99百分位数164.6324.96169.5930.301.500.1361602安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Aug，27（8）3讨论近年来随着多种影像学检查方式普及和体检观念深入人心，甲状腺结节检出率及检出人数均不断提高5。目前临床对于甲状腺良恶性结节治疗方案存在较大差异，故早期准确识别恶性结节对于指导甲状腺结节治疗方案制定及改善临床预后意义重大6。甲状腺组织含碘量较周围组织更为丰富，而CT检查已被证实可清晰准确显示甲状腺内结构改变、周围组织侵犯或淋巴结转移等，同时其对于钙化灶更为敏感，已成为甲状腺术前定位定性主要检查
