PDF(Pubmed)
Abstract：
UNASSIGNED: Thyroid nodules (TNs) cytologically defined as category Bethesda III and IV pose a major diagnostic challenge before surgery, demanding new methods to reduce unnecessary diagnostic thyroid lobectomies for patients with benign TNs. This study aimed to assess whether a model combining dual-energy computed tomography (DECT) quantitative parameters with morphologic features could reliably differentiate between benign and malignant lesions in Bethesda III and IV TNs.
UNASSIGNED: Data from 77 patients scheduled for thyroid surgery for Bethesda III and IV TNs (malignant =48; benign =29) who underwent DECT scans were reviewed. DECT quantitative parameters including normalized iodine concentration (NIC), attenuation on the slope of spectral Hounsfield unit (HU) curve, and normalized effective atomic number (Zeff) were measured in the arterial phase (AP) and venous phase (VP). DECT quantitative parameters and morphologic features were compared between the malignant and benign cohorts. The receiver operating characteristic curve was performed to compare the performances of significant DECT quantitative parameters, morphologic features, or the models combining the DECT parameters, respectively, with morphologic features. A nomogram was constructed from the optimal performance model, and the performance was evaluated via the calibration curve and decision curve analysis.
UNASSIGNED: The areas under the receiver operating characteristic curve with 95% confidence interval (CI) of the NIC in the AP (AP-NIC), slope of spectral HU curve in the AP, and NZeff in the AP were 0.749 (95% CI: 0.641-0.857), 0.654 (95% CI: 0.530-0.778), and 0.722 (95% CI: 0.602-0.842), respectively. The model combining AP-NIC with enhanced blurring showed the highest diagnostic performance, with an area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of 0.808, 0.854, and 0.655, respectively; it was then used to construct a nomogram. The calibration curve showed that the discrepancy between the prediction of the nomogram and actual observations was less than 5%. The decision curve analysis indicated the nomogram had a positive net benefit in threshold risk ranges of 14% to 58% or 60% to 91% for malignant Bethesda III and IV TNs.
UNASSIGNED: The model combining AP-NIC with enhanced blurring could reliably differentiate between benign and malignant lesions in Bethesda III and IV TNs.
UNASSIGNED: Data from 77 patients scheduled for thyroid surgery for Bethesda III and IV TNs (malignant =48; benign =29) who underwent DECT scans were reviewed. DECT quantitative parameters including normalized iodine concentration (NIC), attenuation on the slope of spectral Hounsfield unit (HU) curve, and normalized effective atomic number (Zeff) were measured in the arterial phase (AP) and venous phase (VP). DECT quantitative parameters and morphologic features were compared between the malignant and benign cohorts. The receiver operating characteristic curve was performed to compare the performances of significant DECT quantitative parameters, morphologic features, or the models combining the DECT parameters, respectively, with morphologic features. A nomogram was constructed from the optimal performance model, and the performance was evaluated via the calibration curve and decision curve analysis.
UNASSIGNED: The areas under the receiver operating characteristic curve with 95% confidence interval (CI) of the NIC in the AP (AP-NIC), slope of spectral HU curve in the AP, and NZeff in the AP were 0.749 (95% CI: 0.641-0.857), 0.654 (95% CI: 0.530-0.778), and 0.722 (95% CI: 0.602-0.842), respectively. The model combining AP-NIC with enhanced blurring showed the highest diagnostic performance, with an area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of 0.808, 0.854, and 0.655, respectively; it was then used to construct a nomogram. The calibration curve showed that the discrepancy between the prediction of the nomogram and actual observations was less than 5%. The decision curve analysis indicated the nomogram had a positive net benefit in threshold risk ranges of 14% to 58% or 60% to 91% for malignant Bethesda III and IV TNs.
UNASSIGNED: The model combining AP-NIC with enhanced blurring could reliably differentiate between benign and malignant lesions in Bethesda III and IV TNs.
摘要：
■在细胞学上定义为BethesdaIII和IV类的甲状腺结节（TNs）在手术前构成了重大的诊断挑战，需要新的方法来减少良性TNs患者不必要的诊断性甲状腺切除术。这项研究旨在评估将双能量计算机断层扫描（DECT）定量参数与形态学特征相结合的模型是否可以可靠地区分BethesdaIII和IVTNs的良性和恶性病变。
■评估了77例因BethesdaIII和IVTNs（恶性=48；良性=29）进行DECT扫描而进行甲状腺手术的患者的数据。DECT定量参数，包括归一化碘浓度（NIC），光谱亨氏单位(HU)曲线斜率上的衰减，在动脉期（AP）和静脉期（VP）测量归一化有效原子序数（Zeff）。在恶性和良性队列之间比较了DECT的定量参数和形态学特征。进行了接收器工作特性曲线，以比较重要的DECT定量参数的性能，形态学特征，或组合DECT参数的模型，分别,具有形态学特征。从最佳性能模型构建了一个列线图，并通过校准曲线和决策曲线分析评估性能。
■在AP（AP-NIC）中具有NIC95％置信区间（CI）的接收器工作特性曲线下的区域，AP中光谱HU曲线的斜率，AP中的NZeff为0.749（95％CI：0.641-0.857），0.654（95%CI：0.530-0.778），和0.722（95%CI：0.602-0.842），分别。将AP-NIC与增强的模糊相结合的模型显示出最高的诊断性能，接收器工作特性曲线下的面积（AUC），灵敏度,特异性分别为0.808、0.854和0.655；然后将其用于构建列线图。校准曲线表明，列线图的预测与实际观测值之间的差异小于5％。决策曲线分析表明，对于恶性BethesdaIII和IVTNs，列线图在阈值风险范围为14％至58％或60％至91％的正净收益。
■结合AP-NIC和增强模糊的模型可以可靠地区分BethesdaIII和IVTNs的良性和恶性病变。
■评估了77例因BethesdaIII和IVTNs（恶性=48；良性=29）进行DECT扫描而进行甲状腺手术的患者的数据。DECT定量参数，包括归一化碘浓度（NIC），光谱亨氏单位(HU)曲线斜率上的衰减，在动脉期（AP）和静脉期（VP）测量归一化有效原子序数（Zeff）。在恶性和良性队列之间比较了DECT的定量参数和形态学特征。进行了接收器工作特性曲线，以比较重要的DECT定量参数的性能，形态学特征，或组合DECT参数的模型，分别,具有形态学特征。从最佳性能模型构建了一个列线图，并通过校准曲线和决策曲线分析评估性能。
■在AP（AP-NIC）中具有NIC95％置信区间（CI）的接收器工作特性曲线下的区域，AP中光谱HU曲线的斜率，AP中的NZeff为0.749（95％CI：0.641-0.857），0.654（95%CI：0.530-0.778），和0.722（95%CI：0.602-0.842），分别。将AP-NIC与增强的模糊相结合的模型显示出最高的诊断性能，接收器工作特性曲线下的面积（AUC），灵敏度,特异性分别为0.808、0.854和0.655；然后将其用于构建列线图。校准曲线表明，列线图的预测与实际观测值之间的差异小于5％。决策曲线分析表明，对于恶性BethesdaIII和IVTNs，列线图在阈值风险范围为14％至58％或60％至91％的正净收益。
■结合AP-NIC和增强模糊的模型可以可靠地区分BethesdaIII和IVTNs的良性和恶性病变。
