Enhancement on CT for preoperative diagnosis of metastatic lymph nodes in thyroid cancer: a comparison across experience levels.

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Pub Date : 2025-01-01 Epub Date: 2024-07-09 DOI:10.1007/s00330-024-10919-w

Yun Hwa Roh, Sae Rom Chung, Su Jeong Yang, Jung Hwan Baek, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee

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Abstract

Objectives: To investigate the diagnostic performance and interobserver agreement of quantitative CT parameters indicating strong lymph node (LN) enhancement in differentiated thyroid cancer (DTC), comparing them with qualitative analysis by radiologists of varying experience.

Materials and methods: This study included 463 LNs from 399 patients with DTC. Three radiologists independently analyzed strong LN enhancement on CT. Qualitative analysis of strong enhancement was defined as LN cortex showing greater enhancement than adjacent muscles on the arterial phase. Quantitative analysis included the mean attenuation value (MAV) of LN on arterial phase (LN_A) and venous phase (LN_V), LN_A normalized to the common carotid artery (NAV_CCA), internal jugular vein (NAV_IJV), and sternocleidomastoid muscle (NAV_SCM), attenuation difference [AD; (LN_A - MAV_SCM)], and relative washout ratio [((LN_A - LN_V)/LN_A) × 100]. The interobserver agreement and diagnostic performance of the quantitative and qualitative analyses were evaluated.

Results: Interobserver agreement was excellent for all quantitative CT parameters (ICC, 0.83-0.94) and substantial for qualitative assessment (κ = 0.61). All CT parameters except for LN_V showed good diagnostic performance for metastatic LNs (AUC, 0.81-0.85). NAV_CCA (0.85, 95% CI: 0.8-0.9) and AD (0.85, 95% CI: 0.81-0.89) had the highest AUCs. All quantitative parameters except for NAV_IJV had significantly higher AUCs than qualitative assessments by inexperienced radiologists, with no significant difference from assessments by an experienced radiologist.

Conclusion: Quantitative assessment of LN enhancement on arterial phase CT showed higher interobserver agreement and AUC values than qualitative analysis by inexperienced radiologists, supporting the need for a standardized quantitative CT parameter-based model for determining strong LN enhancement.

Clinical relevance statement: When assessing strong LN enhancement in DTC, quantitative CT parameters indicating strong enhancement can improve interobserver agreement, regardless of experience level. Therefore, the development of a standardized diagnostic model based on quantitative CT parameters might be necessary.

Key points: Accurate preoperative assessment of LN metastasis in thyroid cancer is crucial. Quantitative CT parameters indicating strong LN enhancement demonstrated excellent interobserver agreement and good diagnostic performance. Quantitative assessment of contrast enhancement offers a more objective model for the identification of metastatic LNs.

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用于甲状腺癌术前诊断转移性淋巴结的 CT 增强：不同经验水平的比较。

目的研究显示分化型甲状腺癌（DTC）淋巴结（LN）强强化的定量 CT 参数的诊断性能和观察者之间的一致性，并将其与具有不同经验的放射科医生的定性分析进行比较：这项研究包括 399 名 DTC 患者的 463 个淋巴结。三名放射科医生独立分析了 CT 上的 LN 强强化。强强化的定性分析定义为 LN 皮质在动脉期比邻近肌肉显示出更强的强化。定量分析包括 LN 在动脉期（LNA）和静脉期（LNV）的平均衰减值（MAV）、LNA 与颈总动脉（NAVCCA）、颈内静脉（NAVIJV）和胸锁乳突肌（NAVSCM）的归一化值、衰减差[AD；（LNA - MAVSCM）]和相对冲洗比[（（LNA - LNV）/LNA）×100]。对定量和定性分析的观察者间一致性和诊断性能进行了评估：所有定量 CT 参数的观察者间一致性都很好（ICC，0.83-0.94），定性评估的观察者间一致性也很好（κ = 0.61）。除 LNV 外，所有 CT 参数对转移性 LN 均显示出良好的诊断性能（AUC，0.81-0.85）。NAVCCA（0.85，95% CI：0.8-0.9）和AD（0.85，95% CI：0.81-0.89）的AUC最高。除NAVIJV外，所有定量参数的AUC都明显高于经验不足的放射科医生的定性评估，与经验丰富的放射科医生的评估没有明显差异：结论：动脉期 CT 上 LN 强化的定量评估结果显示，观察者之间的一致性和 AUC 值均高于经验不足的放射科医生进行的定性分析，这证明需要一个基于 CT 参数的标准化定量模型来确定 LN 强化：临床相关性声明：在评估 DTC 的 LN 强强化时，无论经验水平如何，显示强强化的定量 CT 参数都能提高观察者之间的一致性。因此，可能有必要开发基于定量 CT 参数的标准化诊断模型：要点：术前准确评估甲状腺癌的 LN 转移至关重要。显示LN强强化的定量CT参数显示出极佳的观察者间一致性和良好的诊断性能。对比度增强的定量评估为识别转移性LN提供了更客观的模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.