Preoperative assessment of cervical lymph node metastases in patients with papillary thyroid carcinoma: Incremental diagnostic value of dual-energy CT combined with ultrasound

Abstract

Purpose To determine whether dual-energy CT (DECT) has incremental diagnostic value when combined with ultrasound (US) in the diagnosis of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). Methods This was a single-center retrospective cohort study of patients diagnosed with PTC between October 2019 and August 2020. US features of LNs to include hyperechogenicity, round shape, microcalcification, cystic component, and homogeneous/peripheral vascularity were considered suggestive of metastasis. The HU of arterial phase (HUarterial) and DECT-derived CT images [contrast media (CM) and areas under the 100 keV monoenergetic curve (AUC100keV)] were measured. Effective atomic numbers (Zeff), iodine concentration (mg/mL), and slope of the HU curve (λHU) were also obtained. The values for metastatic and benign LNs were compared using Student’s t-test with false-discovery correction. Logistic regression with areas under the receiver operating characteristic curves (AUCs) were performed for predicting metastatic LNs. Results A total of 102 patients were included (49 metastatic and 53 benign LNs; mean age, 46±15 years). Metastatic LNs showed significantly higher values for HUarterial, CM, Zeff, λHU, AUC100keV, and iodine concentration (all, P = 0.001). In logistic regression, the HUarterial demonstrated the highest AUC (0.824; 95% confidence interval [CI], 0.751–0.897), followed by CM HU (0.762; 95% CI, 0.679–0.846). Combination of DECT parameters with US features improved the AUC from 0.890 to 0.941. Conclusion Compared to US features alone, combination with DECT-derived quantitative parameters improved diagnostic performance in predicting metastatic cervical LNs in patients with PTC.

Dual-Energy Computed Tomography in Detecting and Predicting Lymph Node Metastasis in Malignant Tumor Patients: A Comprehensive Review

“…The study revealed that combined DECT parameters (AUC = 0.942) significantly surpassed US morphological parameters (AUC = 0.771, p < 0.001) in diagnostic accuracy, with a sensitivity, specificity, and accuracy of 92.9%, 86.2%, and 90.9%, respectively. Similarly, the retrospective assessment by Yoon et al [38] of 102 patients (49 with LN metastases and 53 without) indicated that integrating DECT parameters with US features elevated the diagnostic AUC from 0.890 to 0.941.…”

“…In the realm of thyroid disease, US remains the preferred preoperative imaging modality. However, its operator dependency and limited capacity to visualize deep-seated LNs may compromise the accurate diagnosis of cervical nodal metastasis in PTC patients [2,38]. Li et al [2] compared the diagnostic performance of DECT and US in detecting lateral cervical nodal metastasis in PTC.…”

Diagnosis of benign and malignant thyroid nodules by a dual-layer spectral detector CT-based nomogram

“…Therefore, quantification of IC is difficult in areas with mixed tissue types. However, in DLCT, IC can be measured based on iodine uptake per unit volume by iodine-based material decomposition imaging, which is a more realistic representation of IC values (20,21).Tang et al (22) demonstrated through simulation experiments that quantitative IC values derived from DECT are highly consistent with actual iodine deposition in the tissue, suggesting that they represent the true distribution of iodine in the tumor tissue. Following efforts to minimize individual circulation-induced variability, NIC has been shown to be an important marker in a wide range of clinical cancer studies (22)(23)(24)(25).…”