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Quantitative analysis of dual-phase enhanced CT in cervical lymph node metastasis of papillary thyroid carcinoma: a comparative study along with pathological manifestations

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Abstract

Purpose

This study aimed to investigate the diagnostic value of dual-phase enhanced computed tomography (CT) in the cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) by analyzing the dual-phase enhanced Hounsfield units (HUs) of lymph node and sternocleidomastoid muscle, and the ratio and difference.

Methods

The CT arterial-phase and venous-phase imaging data of 143 metastasis-positive lymph nodes (MPLNs) in 88 cases and 172 metastasis-negative lymph nodes (MNLNs) in 128 cases with PTC were retrospectively analyzed. All lymph nodes were confirmed by surgical pathology. The arterial-phase HU of lymph nodes (ANHU), venous-phase HU of lymph nodes (VNHU), arterial-phase HU of the sternocleidomastoid muscle (AMHU) and venous-phase HU of the sternocleidomastoid muscle (VMHU) were measured, and their difference and ratio (ANHU-AMHU, ANHU/AMHU, VNHU-VMHU, VNHU/VMHU) were calculated. The cutoff values and corresponding diagnostic efficacy for diagnosing LNM in PTC were sought by performing the receiver operating characteristic curves. The maximum pathological diameter (MPD) measured on pathological sections of lymph nodes was compared with the maximum transverse diameter (MTD) and maximum sagittal diameter (MSD) and their average values on CT images.

Results

The ANHU, and VNHU of MPLNs and MNLNs were 111.89 ± 33.26 and 66.12 (56.81–76.86) (P < 0.001), and 99.07 ± 23.27 and 75.47 ± 13.95 (P < 0.001), respectively. The area under the curve, sensitivity, and specificity of the arterial-phase three parameters (ANHU, ANHU-AMHU, ANHU/AMHU) for diagnosing LNM were (0.877–0.880), (0.755–0.769), and (0.901–0.913), respectively, and the venous-phase three parameters (VNHU, VNHU-VMHU, VNHU/VMHU) were (0.801–0.817), (0.650–0.678), and (0.826–0.901), respectively. Compared with MPD, MTD (Z = −2.686, P = 0.007) and MSD (Z = −3.539, P < 0.001) were significantly different, while (MTD + MSD)/2 was not statistically different (Z = –0.038b, P = 0.969).

Conclusion

In the differential diagnosis of cervical LNM of PTC by dual-phase enhanced CT angiography, the arterial phase had higher diagnostic efficacy.

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Funding

This work was supported by Zhejiang Provincial Medical and Health Technology Project [grant. 2021RC024].

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Author notes

  1. These authors contributed equally: Chang Shao, Yanyan Shu

Authors and Affiliations

  1. Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University school of Medicine, Hangzhou, Zhejiang, China

    Chang Shao & Yingqi Gao

  2. Department of Radiology, the First People’s Hospital of XiaoShan District, Hangzhou, Zhejiang, China

    Yanyan Shu

  3. Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University school of Medicine, Hangzhou, Zhejiang, China

    Peiying Wei, Jiying Zhu & Zhijiang Han

  4. The Fourth Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China

    Min Tian

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  1. Chang Shao
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by C.S., Y.S., P.W. and Z.H. The first draft of the paper was written by C.S. and all authors commented on previous versions of the paper. All authors read and approved the final paper. C.S. and Y.S. contributed equally to this study.

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Correspondence to Zhijiang Han.

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The authors declare no competing interests.

Ethics approval

The study was performed in accordance with the ethical guidelines of the Helsinki Declaration. It was approved by the ethics committee of the Affiliated Hangzhou First People’s Hospital (IRB-2019-200). The written informed consent for participation was waived due to the retrospective nature of the study and the use of anonymized patient data.

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Shao, C., Shu, Y., Wei, P. et al. Quantitative analysis of dual-phase enhanced CT in cervical lymph node metastasis of papillary thyroid carcinoma: a comparative study along with pathological manifestations. Endocrine 82, 108–116 (2023). https://doi.org/10.1007/s12020-023-03386-8

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  • DOI: https://doi.org/10.1007/s12020-023-03386-8

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