Identification of benign and malignant thyroid nodules by in vivo iodine concentration measurement using single-source dual energy CT: A retrospective diagnostic accuracy study.
This study proposed to determine whether in vivo iodine concentration measurement by single-source dual energy (SSDE) CT can improve differentiation between benign and malignant thyroid nodules. In total, 53 patients presenting with thyroid nodules underwent SSDE CT scanning. Iodine concentrations were measured for each nodule and normal thyroid tissue using the GSI-viewer image analysis software. A total of 26 thyroid nodules were malignant in 26 patients and confirmed by surgery; 33 nodules from 27 patients were benign, with 10 confirmed by surgery and others after follow-up. Iodine concentrations with plain CT were significantly lower in malignant than benign nodules (0.47 ± 0.20 vs 1.17 ± 0.38 mg/mL, P = 0.00). Receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.93; with a cutoff of 0.67, iodine concentration showed 92.3% sensitivity and 88.5% specificity in diagnosing malignancy. Iodine concentration obtained by enhanced and plain CT were significantly higher in malignant than benign nodules (9.05 ± 3.35 vs 3.46 ± 2.24 mg/mL, P = 0.00). ROC curve analysis showed an AUC of 0.93; with a cutoff value of 3.37, iodine concentration displayed 78% sensitivity, 95% specificity in diagnosing malignancy. Combining unenhanced with enhanced iodine concentrations, the diagnostic equation was: Y = -8.641 × unenhanced iodine concentration + 0.663 × iodine concentration. ROC curve showed an AUC of 0.98 (95% CI, 0.94, 1.00). With Y ≥ -2 considered malignancy, diagnostic sensitivity and specificity were 96%, 96.3%, respectively. This study concluded that SSDE CT can detect the differences in iodine uptake and blood supply between benign and malignant thyroid lesions.
aKey laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology bKey laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute cKLMI, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
Shun-Yu
SY
Gao
Xiao-Yan
XY
Zhang
Wei
W
Wei
Xiao-Ting
XT
Li
Yan-Ling
YL
Li
Min
M
Xu
Ying-Shi
YS
Sun
Xiao-Peng
XP
Zhang
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007455:Iodine / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000378:metabolism; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000737:chemistry / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D007455:Iodine
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