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Added value of arterial enhancement fraction derived from dual-energy computed tomography for preoperative diagnosis of cervical lymph node metastasis in papillary thyroid cancer: initial results

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Abstract

Objectives

To explore the added value of arterial enhancement fraction (AEF) derived from dual-energy computed tomography CT (DECT) to conventional image features for diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC).

Methods

A total of 273 cervical LNs (153 non-metastatic and 120 metastatic) were recruited from 92 patients with PTC. Qualitative image features of LNs were assessed. Both single-energy CT (SECT)–derived AEF (AEFS) and DECT-derived AEF (AEFD) were calculated. Correlation between AEFD and AEFS was determined using Pearson’s correlation coefficient. Multivariate logistic regression analysis with the forward variable selection method was used to build three models (conventional features, conventional features + AEFS, and conventional features + AEFD). Diagnostic performances were evaluated using receiver operating characteristic (ROC) curve analyses.

Results

Abnormal enhancement, calcification, and cystic change were chosen to build model 1 and the model provided moderate diagnostic performance with an area under the ROC curve (AUC) of 0.675. Metastatic LNs demonstrated both significantly higher AEFD (1.14 vs 0.48; p < 0.001) and AEFS (1.08 vs 0.38; p < 0.001) than non-metastatic LNs. AEFD correlated well with AEFS (r = 0.802; p < 0.001), and exhibited comparable performance with AEFS (AUC, 0.867 vs 0.852; p = 0.628). Combining CT image features with AEFS (model 2) and AEFD (model 3) could significantly improve diagnostic performances (AUC, 0.865 vs 0.675; AUC, 0.883 vs 0.675; both p < 0.001).

Conclusions

AEFD correlated well with AEFS, and exhibited comparable performance with AEFS. Integrating qualitative CT image features with both AEFS and AEFD could further improve the ability in diagnosing cervical LN metastasis in PTC.

Clinical relevance statement

Arterial enhancement fraction (AEF) values, especially AEF derived from dual-energy computed tomography, can help to diagnose cervical lymph node metastasis in patients with papillary thyroid cancer, and complement conventional CT image features for improved clinical decision making.

Key Points

• Metastatic cervical lymph nodes (LNs) demonstrated significantly higher arterial enhancement fraction (AEF) derived from dual-energy computed tomography (DECT) and single-energy CT (SECT)–derived AEF (AEFS) than non-metastatic LNs in patients with papillary thyroid cancer.

• DECT-derived AEF (AEFD) correlated significantly with AEFS, and exhibited comparable performance with AEFS.

• Integrating qualitative CT images features with both AEFS and AEFD could further improve the differential ability.

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Abbreviations

AEF:

Arterial enhancement fraction

AEFD :

DECT-derived AEF

AEFS :

SECT-derived AEF

AUC:

Area under the curve

CI:

Confidence interval

CT:

Computed tomography

CTDIvol:

CT dose index

DECT:

Dual-energy CT

DLP:

Dose-length product

HU:

Hounsfield unit

ICC:

Intraclass correlation coefficient

ID:

Iodine density

IQR:

Interquartile range

LN:

Lymph node

PTC:

Papillary thyroid cancer

ROC:

Receiver operating characteristic

ROI:

Region of interest

SECT:

Single-energy CT

US:

Ultrasonography

VIF:

Variance inflation factor

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Acknowledgements

We thank LetPub (http://www.letpub.com) for its linguistic assistance.

Funding

This study received funding by the Natural Science Foundation of China (82171928), Natural Science Foundation of Jiangsu Province (BK20201494), and Basic (Natural) Science Foundation of Education Department of Jiangsu Province (22KJB320005).

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Author notes

  1. Yan Zhou and Yong-Kang Xu contribute equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China

    Yan Zhou, Yong-Kang Xu, Di Geng, Jing-Wei Wang, Guo-Yi Su, Xiao-Quan Xu & Fei-Yun Wu

  2. Section of Clinical Research, Philips Healthcare Ltd, Shanghai, China

    Xing-Biao Chen

  3. Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Yan Si & Mei-Ping Shen

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  1. Yan Zhou
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Corresponding authors

Correspondence to Xiao-Quan Xu or Fei-Yun Wu.

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Guarantor

The scientific guarantor of this publication is Fei-Yun Wu.

Conflict of interest

Xing-Biao Chen is an employee of Philips Healthcare. The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

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• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Zhou, Y., Xu, YK., Geng, D. et al. Added value of arterial enhancement fraction derived from dual-energy computed tomography for preoperative diagnosis of cervical lymph node metastasis in papillary thyroid cancer: initial results. Eur Radiol 34, 1292–1301 (2024). https://doi.org/10.1007/s00330-023-10109-0

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