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Objective:To investigate the predictive value of lymph node size for ipsilateral central lymph node metastasis (ICLNM) of papillary thyroid microcarcinoma (PTMC) in CT examination.Methods:The CT data of 229 patients with single PTMC admitted to the Department of Oncology, Hangzhou First People’s Hospital, Affiliated to Zhejiang University School of Medicine from Jan. 2018 to Jun. 2019 were retrospectively analyzed. All cases were confirmed by surgery and pathology. The ipsilateral central lymph nodes were divided into <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group according to their maximun diameters, and the distribution difference of positive and negative ICLNM among the three groups were observed and analyzed by χ 2 test. Results:In 229 PTMCs, the proportion of positive and negative ICLNM were 29.69% (68/229) and 70.31% (108/155) , respectively. Positive ICLNM in <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group accounted for 11.43% (16/140) , 64.29% (36/56) and 81.82% (27/33) , respectively. When 0.2 cm and 0.4 cm were used as the threshold to determine positive ICLNM, the values of χ 2 and P between groups were 87.663 and <0.001. The sensitivity and specificity of diagnosing lymph node metastasis were 79.75% (63/79) and 82.67% (124/150) , 34.18% (27/79) and 96% (144/150) , respectively. The proportions of high enhancement, calcification and cystic degeneration were 3.2% (5/155) , 0.7% (1/155) and 0 (0/155) , respectively. Conclusions:In CT examination of patients with PTMC, the diameter of lymph nodes less than 0.2 cm highly indicates negative ICLNM. The proportion of positive ICLNM increased with increasing lymph node diameter, and the diameter of lymph nodes less than 0.4 cm highly indicates positive ICLNM.
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Objective To investigate the diagnostic value of CT signs of ipsilateral central lymph node metastasis (ICLNM) in single papillary thyroid carcinoma (PTC) by multivariate regression analysis.Methods The CT data of 302 single PTC with diameter ＞1.0 cm confirmed by operation and pathology were retrospectively analyzed.The optimal thresholds of lymph node metastasis diameter were obtained by receiver operating characteristic (ROC) curve analysis.And multivariate regression analysis was used to analyze the relation between lymph node size,degree of enhancement,calcification or cystic degeneration,central turbidity,positive lateral cervical lymph nodes and the ICLNM positivity.Results In 302 PTC,the proportion of ICLNM positive and negative was 63.6％ (192/302) and 36.4％ (110/302),respectively.According to the ROC curve,with the increase of lymph node diameter,the sensitivity of diagnosing lymph node metastasis decreased and the specificity increased.When the threshold was 0.4 cm,Youden index was the largest (0.358),and the sensitivity and specificity was 50.5％ and 80.3％,respectively.Multivariate analysis showed that the diameter≥0.4 cm,high enhancement,central turbidity and lateral cervical lymph nodes positivity were the independent risk factors of ICLNM,and the OR values were 4.189[95％ CI (2.037-8.617)],3.875 [(95％ CI (1.561-9.617)],4.054[(95％CI (2.230-7.371)] and 8.735 [(95％ CI (1.093-69.831)],respectively.Calcification or cystic degeneration was not statistically significant in ICLNM.Conclusions The diameter ≥0.4 cm,high enhancement,central turbidity and lateral cervical lymph nodes positivity are the independent risk factors of ICLNM.Although calcification or cystic degeneration is not the independent risk factor,it has high accuracy for ICLNM positivity.The accurate identification of these signs can help surgeons to take a more thorough surgical treatment and has great significance to reduce postoperative recurrence.
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Objective To investigate diagnostic value of CT signs in papillary thyroid carcinoma (PTC) by comparing CT signs of PTC with different sizes.Methods CT signs of 406 PTC from 396 patients confirmed by histology were analyzed retrospectively.Based on the largest tumor diameter,PTC were divided into 1.1-2.0 cm group,2.1-3.0 cm group and＞3.0 cm group.Distribution of irregular shape,cookie bite sign,enhanced narrow/ fuzzy and microcalcification in each group was analyzed.Results There were 318 pieces in 1.1-2.0 cm group,60 pieces in 2.1-3.0 cm group and 28 pieces in ＞3.0 cm group,respectively.The rate of irregular shape was 89.6％(285/318),75.0％(45/60) and 64.3％(18/28) in each group,the rate of cookie bite sign was 83.6％(266/318),71.7％(43/60) and 64.3％ (18/28),and enhanced narrow/fuzzy was 84％(267/318),78.3％ (47/60) and 67.9％ (19/28) in each group,and microcalcification was 35.5％ (113/318),40.0％ (24/60) and 59.3％ (16/27) in each group.The rate of irregular shape (x2=20.092,P=0.000)and cookie bite sign (x2=9.695,P=0.008)had statistical difference among the three groups,while the rate of enhanced narrow/fuzzy(x2=5.175,P=0.075)and microcalcification (x2=5.277,P=0.071) had no statistical difference among each group.Furthermore,irregular shape and cookie bite sign were compared between groups.Rate of irregular shape in 1.1-2.0 cm group and 2.1-3.0 cm (x2=9.746,P=0.002)group,1.1-2.0 cm group and ＞ 3.0 cm group (x2=15.180,P=0.000) was statistically different.Rate of cookie bite sign in 1.1-2.0 cm group and ＞3.0 cm(x2=6.560,P=-0.010)was statistically different.There was no statistical difference between other groups.Conclusions Although irregular shape,cookie bite sign,enhanced narrow/fuzzy and microcalcification are important CT signs in diagnosing PTC,distribution of different signs varies with tumor sizes.Correct identification of these differences will help to improve the accuracy of preoperative diagnosis,and reduce occurrence of misdiagnosis.
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Objective Based on contrasting CT signs distributed in PTC greater than 1.0 cm in diameter and nodular goiters(NG),multiple logistic regression analysis is adopted to make a statistics of what diagnostic value that CT signs have for PTC.Methods Retrospective analysis of CT findings of 288 PTC with diameter ＞1.0 cm in 277 cases confirmed by histology,including nodular form,cookie bite symptom,microcalcifications and en hanced narrowing/blurring was performed,and compared with CT signs of 276 NG in 231 cases with diameter＞1.0 cm.Analysis of various CT signs were performed by multivariate Logistic regression method,and the sensitivity,specificity of positive CT signs and their combinations in PTC diagnosis were calculated.Results Multivariate Logistic regression analysis showed that irregular nodules,cookie bite symptom,microcalcifications and enhanced arrowing/hlurring were often observed in PTC,with OR values of 17.249(95％ CI 8.954-33.227),23.697 (95％ CI 11.653-48.188),4.536 (95％ CI 2.031-10.132),4.672 (95％ CI 8.954-8.999),respectively.The sensitivity,specificity of single CT sign diagnosing PTC were 31.3％-82.3％ and 83.3％-93.1％,respectively.The sensitivity,specificity of two CT signs combinations diagnosing PTC were 24.0％-70.5％ and 96.7％-100％,respectively.The sensitivity,and specificity of three or four CT signs combinations diagnosing PTC were 19.1％-61.5％ and 99.6％ -100％,respectively.Conclusions Although the nodule form,cookie bite symptom,microcalcifications and enhanced narrowing/blurring are the important signs for diagnosing PTC,the OR values of various signs had great difference.The accurate identification of these differences and various CT signs combinations can further improve the specificity of diagnosing PTC,thus reducing misdiagnosis.
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Objective To investigate the diagnostic value of hyperenhancement sign on ultrasound,CT and their combination in diagnosis of thyroid benign and malignant nodules.Methods The contrast-enhanced ultrasound and enhanced CT datas of 172 thyroid nodules in 144 cases confirmed by operation and pathology were retrospectively analyzed,including 97 benign nodules and 75 malignant nodules.According to the degree of enhancement,these nodules were divided into iso-or low-enhancement and hyperenhancement.The distributions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules,adenomatoid lesions and nodular goiters were analyzed,followed byx2 test for statistical analysis.Results In 172 thyroid nodules,the proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules were 53.6％(52/97) and 20.0％(15/75)(x2＝20.090,P＜0.05),34.0％ (33/97) and 4.0％ (3/75) (x2＝23.033,P＜0.05),31.0％ (30/97) and 0％ (0/75) (x2＝28.096,P＜0.05),respectively.Their sensitivity and specificity of diagnosing benign nodules were 53.6％ (52/97) and 80.0％ (60/75),34.0％ (33/97) and 96％ (72/75),30.9％ (30/97) and 100％ (75/75),respectively.The proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in adenomatoid lesions and nodular goiters were 96.9％(31/32) and 32.3％(21/65)0x2＝35.946,P＜0.05),65.6％(21/32) and 18.5％(12/65)(x2＝21.250,P＜0.05),65.6％(21/32) and 13.8％ (9/65)(x2＝26.912,P＜0.05).Their sensitivity and specificity of diagnosing adenomatoid lesions were 96.9％(31/32) and 67.7％(44/65),65.6％(21/32) and 81.5％(53/65),65.6％(21/32) and 87.2％(56/65).Conclusions Ultrasound hyperenhancement,CT hyperenhancement for diagnosing thyroid benign nodules are of significant value.Especially for adenomatoid nodules,ultrasound hyperenhancement has a higher sensitivity,while CT hyperenhancement has a higher specificity.Their combination can further improve the diagnostic specificity,thus reducing the unnecessary surgical trauma.
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Objective To assess the value of CT in identification and diagnosis of benign and malignant calcified thyroid nodules.Methods Retrospective analysis was performed on the CT data of 313 surgically and pathologically confirmed cases with 378 calcified nodules.Based on the size,morphology,and number,calcification was divided into microcalcification (d≤2 mm and axis displayed in only one cross-section),coarse calcification (d＞2 mm or displayed in two or more cross-sections),annular calcification (arc or annular),and multiple microcalcifications (solitary multiple microcalcification without a soft tissue lump);a distribution of microcalcification,coarse calcification,and annular calcification as well as a clearer enhanced periphery or internal calcification than nonenhanced data in benign and malignant thyroid nodules were observed.Results The 378 nodules consisted of 259 benign nodules (68.5％) (all were nodular goiters) and 119 malignant nodules (31.5％) (including 111 papillary thyroid carcinomas,4 follicular carcinomas,3 medullary thyroid carcinomas and 1 lymphoma).Microcalcification was more common in malignant nodules (MNs) than in benign nodules (BNs),with a rate of 43.6％ vs 12.4％,respectively (P≤0.05),and its sensitivity,specificity,positive predicted value,and negative predicted value were 42.9％,87.6％,61.4％ and 76.9％,respectively.Coarse calcification,annular calcification,and clearer enhanced periphery or internal calcification than nonenhanced data were more common in BNs than in MNs,with rates of 52.9％ vs 20.2％ (P≤0.05),66.0％ vs 42.0％ (P≤0.05) and 43.2％ vs 19.3％ (P≤0.05),respectively,whose sensitivity,specificity,positive predicted value and negative predicted value were 66.0％ vs 22.4％ vs 43.2％,58.0％ vs 86.6％ vs 80.7％,77.4％ vs 78.4％ vs 83％,and 43.9％ vs 33.9％ vs 39.8％,respectively.Two multiple microcalcifications without a soft tissue lump were MNs (papillary thyroid carcinoma).Conclusions Microcalcification and multiple calcifications are conducive to the diagnosis of MNs,whereas coarse calcification,annular calcification,and clearer enhanced periphery or internal calcification than nonenhanced data benefit the diagnosis of BNs,but the low specificity and high false positive rate suggest that the judgment of BNs or MNs should not depend on coarse calcification alone.
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Objective To investigate the combination of multiple CT signs in diagnosis and differential diagnosis of nodular goiters (NGs).Methods The CT images of 242 pathologically confirmed lesions (＞ 10 mm in diameter) from 188 patients with nodular goiters were retrospectively reviewed.The CT signs,including regular shape,cystic degeneration,clearer enhancement margin,strong enhancement of nodular goiters were compared with those of 236 pathologically confirmed lesions (＞ 10 mm in diameter)from 225 patients with papillary thyroid carcinomas (PTCs).The sensitivity,specificity and accuracy of different CT signs or their combination in diagnosis and differential diagnosis of NGs were analyzed.Results Regular shape was present in 208 of 242 NGs (86.0％) and in 35 of 236 PTCs (14.8％) (x2 =241.804,P =0.000).Cystic degeneration was present in 143 of 242 NGs (59.1％) and 7 of 236 PTCs (3.0％)(x2 =174.783,P =0.000).Clearer enhancement margin was present in 192 of 242 NGs (79.3 ％) and in 51 of 236 PTCs (21.6％) (x2 =159.318,P =0.000).Strong enhancement was present in 41 of 242 NGs(16.9％) and in 3 of 236 PTCs (1.3％) (x2 =35.108,P =0.000).Regular shape showed the highest sensitivity and accuracy for diagnosis of NGs (86.0％ and 85.6％),while strong enhancement showed the highest specificity (98.7％).The combination of regular shape and clearer enhancement margin showed the highest sensitivity and accuracy of 67.4％ and 80.5％,respectively.The combination of strong enhancement with any of other signs showed the highest specificity of 100.0％.The combination of regular shape,cystic degeneration and clearer enhancement margin showed the highest sensitivity,specificity and accuracy of 45.5％,99.6％ and 72.2％ respectively.The combing of 4 signs showed a sensitivity,specificity,and accuracy of 2.9％,100.0％ and 50.8％.Conclusion CT scan is effective for diagnosis of NGs,and the combination of different CT signs can significantly improve the specificity and reduce the incidence of misdiagnosis to avoid unnecessary surgery.
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Objective To assess the value of computed tomgraphy (CT)in differential diagnosis between medullar thyroid carcinoma (MTC)and papillary thyroid carcinoma (PTC).Methods CT findings of 20 lesions in 16 MTC patients and 35 lesions in 35 PTC patients were retrospectively analyzed.All patients were confirmed by pathology exam.We investigated the shape,location,bitten cookie sign,calification and lymph node metastasis between the two groups of patients to summarize the sensitivity and specificity of regular shape for MTC or lesions located in lower thyroid lobe,bitten cookie sign,lymph node metastasis for PTC.Results Regular shape was more common in MTC patients than in PTC patients (X2=5.815,P=0.016),with sensitivity and specificity of 55％ and 77.1％ respectively.Lesions were located at lower thyroid(X2=10.732,P=0.001),bitten cookie sign(X2=18.832,P=0.000)and lymph node metastasis (X2=4.377,P=0.036)was significantly more common in PTC patients than in MTC patients,with sensitivity and specificity of 40％ (14/35)and 100％ (16/16),80％ (28/35)and 80％ (16/20),and 68.6％(24/35)and 62.5％(10/16)respectively.Calcification was not significantly different between MTC and PTC patients (X2=0.550,P=0.458).Conclusions CT plays an important role in differential diagnosis between MTC and PTC.Regular shape is helpful for the diagnosis of MTC.Leisions located at lower thyroid,with bitten cookie sign and lymph node metastasis are conductive to the diagnosis of PTC.
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Objective To assess the value of CT hyperenhancement sign in diagnosis and differential diagnosis of benign and malignant thyroid nodules.Methods CT findings of 2926 nodules in 1676 patients were retrospectively analyzed,among which 2174 nodules were benign and 752 nodules were malignant.All the patients had pathological diagnosis.The degrees of enhancement were divided into hyperenhancement and iso/hypoenhancement.The distribution of hyperenhancement in benign and malignant nodules were summarized.The sensitivity,specificity,positive and negative predictive value and accuracy of hyperenhancement for benign nodules and adenomatoid nodules were observed.Results Hyperenhancement was more common in benign nodules than in malignant nodules (10.3％ vs 0.7％,x2 =70.259,P ＜ 0.05),and its sensitivity,specificity,positive and negative predictive value and accuracy was 9.8％,99.5％,98.2％,27.6％ and 32.8％,respectively.Hyperenhancement was more common in adenomatoid nodules than in nonadenomatoid benign nodules (67.4％ vs 6.1％,x2 =525.025,P ＜ 0.05),and its sensitivity,specificity,positive and negative predictive value and accuracy was 67.4％,93.9％,41.6％,97.8％ and 92.3％,respectively.Conclusion Hyperenhancement sign is an important sign which can effectively differentiate benign nodules from malignant nodules,and adenomatoid nodules from nonadenomatoid benign nodules,and it is helpful for diagnosis of benign nodules and adenomatoid nodules.
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Objective To evaluate the value of annular calcification in CT in the diagnosis and differential diagnosis for benign and malignant thyroid nodules.Methods CT findings of 67 nodules in 67 patients pathologically diagnosed with annular calcifications were retrospectively analyzed to identify 49 benign nodules and 18 malignant nodules.The interior or boundaries of annular calcification before and after contrast-enhancement were compared,and the degree of enhancements of both interior annular calcification and thyroid tissues were observed.After contrast-enhancement,the numbers of lesions showing clearer boundaries and higher degree of enhancement were summarized.Statistic analysis was conducted by using x2 test.Results Among 67 nodules with annular calcifications,clearer boundaries after contrast-enhancement were observed in 61.2％ (30/49) benign nodules and 16.7％ (3/18) malignant nodules,showing significant statistical difference (x2 =10.457,P ＜ 0.05).The sensitivity and specificity of clearer edge after contrast-enhancement for benign nodules were 61.2％ (30/49) and 83.3％ (15/18) respectively.Higher degree of enhancement were observed in 16.3％ (8/49) in benign nodules and 0(0/18) malignant nodules,showing no significant statistical difference (x2 =3.337,P ＞ 0.05).The sensitivity and specificity of higher degree of enhancement for benign nodules were 16.3％ (8/49) and 100.0％ (18/18) respectively.The combination of clearer boundaries and higher degree of enhancement after contrast-enhancement was observed in 77.6％ (38/49) benign nodules and 16.7％ (3/18) malignant nodules,showing significant statistical difference (x2 =20.549,P ＜ 0.05).Meanwhile,the sensitivity and specificity of such combination for benign nodules were 77.6％ (38/49) and 83.3％ (15/18) respectively.Conclusions CT is important in the diagnosis of thyroid nodules with annular calcification.Clearer boundary after contrast-enhancement and its combination with higher degree of enhancement are helpful for the diagnosis of benign nodules.Boundaries that similar to or more obscure than that of plain scan indicate malignant nodules.
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Objective To analyze CT characteristics of patients with primary parathyroid hyperplasia ( PPH) , parathyroid adenoma ( PA) , atypical parathyroid adenoma ( APA) , and parathyroid carcinoma ( PC) and to evaluate the value of CT in the diagnosis and differential diagnosis of primary hyperparathyroidism ( PHPT ) . Methods CT scan of 134 pathologically proved PHPT patients with complete clinical and laboratory data were retrorespectively analyzed .The similarities and differences of CT features in patients with PPH , PA, APA and PC were studied.Results Among 140 lesions in the 134 patients, 130 cases had solitary parathyroid mass and 4 cases had 10 parathyroid masses , including 22 lesions in 17 patients with PPH, with the diameter ranging from 0.6 cm to 2.8 cm(1.2 ±0.6)cm, 106 lesions in 105 patients with PA, with the diameter ranging from 0.3 cm to 3.2 cm (1.1 ±0.6)cm, 10 lesions in 10 patients with APA, with the diameter ranging from 0.9 cm to 3.3 cm(2.6 ± 0.6)cm, and 2 lesions in 2 patients with PC, with the diameter ranging from 2.1 cm to 3.0 cm(2.6 ±0.6)cm. 124 lesions were located in tracheo-esophageal groove or at the side of trachea on CT .The boundaries between the parathyroid and thyroid gland were low density .3 lesions did not appear .9 lesions were located at the area over the manubrium sterni among 13 lesions which were ectopic.CT images showed round (29.9%,41/137), oval (38.0%,52/137), triangular(19.7%, 27/137), and cylindrical(12.4%,17/137) tumors in 137 lesions.The density of lesions were 30-66 Hu(45.0 ±12.3)Hu on non-enhanced CT scan, and 59-209 Hu(121.8 ±32.7)Hu on enhanced scan .Different pathological lesions had no statistical difference on location ( left upper , left lower , right upper, right lower, ectopic)(χ2 =15.839), linear low density sign(χ2 =1.896), shape(χ2 =10.945), non-enhanced CT(χ2 =0.915) or enhancement CT(χ2 =6.165)(P>0.05).Different pathological lesions had statistical significance on sizes(χ2 =18.395, P<0.05).The diameter of APA-PC was bigger than that in PH-PA.99 lesions exhibited homogeneous enhancement , and 38 lesions exhibited heterogeneous enhancement .The necrosis rate of APA-PC was more than that of PH-PA(χ2 =7.929, P<0.05).Conclusions The lesions origi-nate from parathyroid if they are located in tracheo-esophageal groove or at the side of trachea with hyperparathy-roidism.Multiple lesions help in PH diagnosis .Large size and necrosis in lesions imply APA or PC .The location (left upper, left lower, right upper, right lower, ectopic), shape, density and the degree of enhancement of the lesions have not specificity for diagnosis of PHPT .
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Objective To evaluate the imaging feature of microcarcinoma of thyroid with CT.Methods CT findings of 50 lesions in 47 patients with microcarcinoma of thyroid ( dimeter,0.5 to 1.0 cm) were retrospectively analyzed.All of the patients had pathological diagnosis.Results Of the 50 lesions,38 lesions showed homogeneous low density on non-enhanced CT and various degree of enhancement on postcontrast CT. Thirty-three lesions showed discontinuous edge of the thyroids on non-enhanced CT. The boundary of 30 lesions became unclear on post-contrast CT relative to non-enhanced CT and the extension of low density of lesions decreased. Theshape of 31 lesions were irregular. Fifteen lesions showed calcifications,with granular calcifications in 13 lesions.Ten lesions were complicated with thyroiditis.Conclusions Irregular shape,discontinuous edge of the thyroids,the shrinkage of low density of lesions on post-contrast CT relative to non-enhanced CT,granular calcifications and multiple small lymph node around lesions indicate the diagnosis of microcarcinoma of the thyroid.It should be noted that thyroiditis can cover up microcarcinoma of thyroid.