Dual‐energy CT iodine quantification for characterizing focal thyroid lesions

Lee, Do Hyung; Lee, Young Hen; Seo, Hyung Suk; Lee, Ki Yeol; Suh, Sang Il; Ryoo, Inseon; You, Sung Hyun; Kim, Byungjun; Yang, Kyung Sook

doi:10.1002/hed.25524

Cited by 22 publications

(17 citation statements)

References 34 publications

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“…After these quantitative parameters were analysed by ROC curves, APλHU demonstrated the highest efficacy with an AUC value of 0.829. These results of quantitative parameters in the current study are consistent with those in previous studies [ 16 , 17 ], which can be used to diagnose thyroid lesions with good diagnostic efficiency. Our findings also revealed that the APNIC value of TMC was lower than that of benign micro-nodule.…”

Section: Discussionsupporting

confidence: 93%

Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from malignant thyroid micro-nodules

Song

Zhang

et al. 2023

Cancer Imaging

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Purpose To analyse the predictive effect of a nomogram combining dual-layer spectral computed tomography (DSCT) quantitative parameters with typical radiological features in distinguishing benign micro-nodule from thyroid microcarcinoma (TMC). Methods Data from 342 instances with thyroid micro-nodules (≤1 cm) who underwent DSCT (benign group: n = 170; malignant group: n = 172) were reviewed. Typical radiological features including micro-calcification and enhanced blurring, and DSCT quantitative parameters including attenuation on virtual monoenergetic images (40 keV, 70 keV and 100 keV), the slope of the spectral HU curve (λHU), normalized iodine concentration (NIC), and normalized effective atomic number (NZeff) in the arterial phase (AP) and venous phase (VP), were measured and compared between the benign and malignant groups. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of significant quantitative DSCT parameters or the models combining DSCT parameters respectively and typical radiological features based on multivariate logistic regression (LR) analysis. A nomogram was developed using predictors with the highest diagnostic performance in the above model, as determined by multivariate LR analysis. Results The DSCT parameter APλHU showed the greatest diagnostic efficiency in identifying patients with TMC, with an area under the ROC curve (AUC) of 0.829, a sensitivity and specificity of 0.738 and 0.753, respectively. Then, APλHU was combined with the two radiological features to construct the DSCT-Radiological nomogram, which had an AUC of 0.858, a sensitivity of 0.791 and a specificity of 0.800. The calibration curve of the nomogram demonstrated that the prediction result was in good agreement with the actual observation. The decision curve revealed that the nomogram can result in a greater net benefit than the all/none-intervention strategy for all threshold probabilities. Conclusion As a valid and visual noninvasive prediction tool, the DSCT-Radiological nomogram incorporating DSCT quantitative parameters and radiological features shows favourable predictive efficiency for identifying benign and malignant thyroid micro-nodules.

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Section: Discussionsupporting

confidence: 93%

Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from malignant thyroid micro-nodules

Song

Zhang

et al. 2023

Cancer Imaging

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“…Dual-source CT achieves the separation of iodine from the surrounding soft tissues and acquires information about the lesion [24]. Previous research has revealed a U-shaped association between iodine consumption and thyroid problems, as well as abnormal modifications in iodine metabolism in thyroid lesions [15][16][17][18][19][20][21][22][23][24][25][26][27]. DS-DECT detects the iodine content of thyroid nodules, and the iodine content in benign nodules exceeds that of malignant nodules, indicating that thyroid lesions have implications for follicular cells and the decreased iodine metabolism in the lesion area.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Effectiveness of Dual Source Dual Energy Computed Tomography for Benign and Malignant Thyroid Nodules

Zhu

Kanglin

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To evaluate the diagnostic effectiveness of dual source dual energy computed tomography (DS-DECT) for benign and malignant thyroid nodules. Methods. Between January 2019 and December 2021, 60 patients with surgically and pathologically verified thyroid nodules treated at our institution were recruited. DS-DECT was administered to all patients. The iodine content of lesioned and normal tissues, the normalized iodine concentration (NIC) and standardized CT values of benign and malignant nodules, the consistency of examination results and pathological findings, and diagnostic effectiveness were all investigated. Results. The diagnosis accuracy was the same as that of surgical pathology, producing a 100% accuracy for the 60 patients with thyroid nodules (42 were benign and 18 were malignant). The iodine content of lesioned solid tissue differed significantly from that of normal tissue, as did the iodine content of malignant and benign nodules ( P < 0.05 ). In the arterial phase, no significant difference was found in NIC and standardized CT values between benign and malignant nodules ( P > 0.05 ). The optimal critical NIC for differentiating benign and malignant nodules in the venous phase was 0.74 and the standardized CT value was 0.79 HU according to the receiver operating characteristics (ROC) curve. Malignant nodules were diagnosed when the NIC was <0.74 and the standardized CT value was <0.79 HU, with AUC values of 0.89 and 0.93, respectively, where the sensitivity and specificity of the differential diagnosis of NIC were 90.48% (38/42) and 88.89% (16/18), respectively, and those of the differential diagnosis of standardized CT value were 92.86% (39/ 42) and 94.44% (17/18), respectively. The diagnosis accuracy of DS-DECT was 100%, and the diagnostic results of morphological characteristics and pathological testing were consistent. The sensitivity and specificity of the NIC values and standardized CT values in the venous phase differential diagnosis of benign and malignant nodules were compatible with the morphological differential diagnosis. Conclusion. DS-DECT is highly accurate in determining the benignity and malignancy of thyroid nodules and has a strong potential for clinical promotion to allow for prompt treatment.

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“…Numerous applications of DECT have been described in head and neck imaging. 10,[13][14][15][16][17][18][19][20][21] Previously published studies of dual-energy parathyroid CT have primarily focused on the potential for radiation dose reduction using virtual noncontrast images to eliminate the standard noncontrast phase 22,23 and on describing quantitative dual-energy characteristics of parathyroid adenomas, thyroid parenchyma, and lymph nodes on postcontrast phases. 24,25 The authors are aware of 1 previous study that evaluated dual-energy noncontrast parathyroid CT images obtained on a dual-source system using 90-keV, 150-keV, and mixed images (dual-energy composition factor, 0.8), but 40-keV VMI were not specifically evaluated in this previous investigation.…”

Section: Discussionmentioning

confidence: 99%

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

Bunch

Pavlina

Lipford

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In parathyroid CT, a noncontrast phase aids discrimination of parathyroid lesions (not iodinecontaining) from thyroid tissue (iodine-containing). When thyroid iodine is pathologically diminished, this differentiation is difficult with standard CT. Because the attenuation of an element is maximal near its K-edge (iodine ¼ 33.2 keV), we hypothesized that dual-energy CT 40-keV virtual monoenergetic images will accentuate thyroid iodine relative to standard images, improving the differentiation of thyroid from parathyroid lesions. Our purpose was to test this hypothesis through quantitative assessment of Hounsfield unit attenuation and contrast-to-noise on dual-energy CT standard (70-keV) and 40-keV noncontrast images. MATERIALS AND METHODS:For this retrospective study including 20 dual-energy parathyroid CTs, we used an ROI-based analysis to assess the attenuation of thyroid tissue, parathyroid lesions, and sternocleidomastoid muscle as well as corresponding contrast-to-noise on standard and 40-keV noncontrast images. Wilcoxon signed rank tests were performed to compare differences between 70 and 40 keV.RESULTS: Absolute and percentage increases in attenuation at 40 keV were significantly greater for thyroid gland than for parathyroid lesions and sternocleidomastoid muscle (P , .001 for all). Significant increases in the contrast-to-noise of thyroid relative to parathyroid lesions (median increase, 0.8; P , .001) and relative to sternocleidomastoid muscle (median increase, 1.3; P , .001) were observed at 40 keV relative to 70 keV.CONCLUSIONS: Forty-kiloelectron volt virtual monoenergetic images facilitate discrimination of parathyroid lesions from thyroid tissue by significantly increasing thyroid attenuation and associated contrast-to-noise. These findings are particularly relevant for parathyroid lesions that exhibit isoattenuation to the thyroid on parathyroid CT arterial and venous phases and could, therefore, be missed without the noncontrast phase.ABBREVIATIONS: CNR ¼ contrast-to-noise ratio; DECT ¼ dual-energy CT; IQR ¼ interquartile range; VMI ¼ virtual monoenergetic images P arathyroid 4D-CT is a powerful tool for localizing abnormal parathyroid tissue in the setting of primary hyperparathyroidism. 1 Localization of a single adenoma facilitates minimally invasive parathyroidectomy and its associated benefits, 2,3 whereas localization of multigland disease aids bilateral neck exploration. The optimal number of CT phases is undetermined, but the most commonly used protocol involves 3 CT acquisitions of the neck and upper chest, including noncontrast, arterial, and venous phases. 4 Parathyroid lesions, exophytic thyroid nodules, and lymph nodes may appear morphologically identical on CT. 5 Although the

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Dual‐energy CT iodine quantification for characterizing focal thyroid lesions

Cited by 22 publications

References 34 publications

Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from malignant thyroid micro-nodules

Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from malignant thyroid micro-nodules

Diagnostic Effectiveness of Dual Source Dual Energy Computed Tomography for Benign and Malignant Thyroid Nodules

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

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