摘要
目的探讨双能量CT检查在术前预测甲状腺乳头状癌(PTC)患者BRAF^(V600E)突变的应用价值。方法回顾2017年5月至2021年10月丽水市中心医院经手术病理检查证实的213例PTC患者,术前均接受双能量CT增强检查。对所有患者的手术病理标本进行了BRAF^(V600E)突变分析,并根据结果将患者分为BRAF^(V600E)突变型和BRAF^(V600E)野生型。使用多因素logistic回归分析筛选出BRAF^(V600E)突变的独立预测因子并构建联合模型。采用ROC曲线评估不同定量参数及联合模型的诊断效能,计算AUC、灵敏度、特异度、阳性预测值、阴性预测值和准确度。结果BRAF^(V600E)突变型病灶最大径小于BRAF^(V600E)野生型(P<0.05),而动脉期碘浓度(IC)、标准化碘浓度(NIC)、标准化有效原子序数(nZeff)和能谱曲线斜率(λ_(Hu))及静脉期NIC和λ_(Hu)均高于BRAF^(V600E)野生型(均P<0.05)。多因素logistic回归分析显示,最大径、静脉期NIC及动脉期NIC、nZeff和λ_(Hu)是BRAF^(V600E)突变的独立预测因子,其中动脉期NIC诊断效能最高。联合上述参数构建的预测模型AUC、灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为0.877、0.865、0.800、0.901、0.738、0.844。结论双能量CT检查对识别PTC患者术前BRAF^(V600E)突变具有潜在的应用价值,可以在一定程度上指导个体化治疗。
Objective To explore the application value of preoperative dual-energy CT for predicting BRAF^(V600E) mutation in patients with papillary thyroid carcinoma(PTC).Methods Clinical data of 213 patients with PTC admitted in Lishui Central Hospital From May 2017 to October 2021 were retrospectively analyzed.The BRAF^(V600E) gene mutation analysis of breast cancer was performed on surgical specimens and patients were divided into the BRAF^(V600E) gene mutation group and BRAF^(V600E) wild group according to the results.Univariate and multivariate analyses were used to screen the independent predictors of BRAF^(V600E) mutation,based on which a prediction model was constructed.The diagnostic efficacy of different dualenergy CT parameters and the prediction model was evaluated with receiver operating characteristic(ROC)curve.Results The tumor size in the BRAF^(V600E) gene mutation group was significantly smaller than that in the wild group(P<0.05),while the iodine concentration(IC),normalized iodine concentration(NIC),normalized effective atomic number(nZeff),and the slope of the spectral Hounsfield unit curve(λ_(Hu))in the arterial phase,as well as the NIC andλ_(Hu) in the venous phase were significantly higher than those in the BRAF^(V600E) wild group(all P<0.05).Multivariate analysis showed that tumor size,NIC in the arterial and GGCCAAAAATTTAATCAGTGGAvenous phase,nZeff andλ_(Hu) in the venous phase were independent predictors of BRAF^(V600E) gene mutation,and NIC in the arterial phase had the highest diagnostic efficiency.The area under ROC curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the prediction model were 0.877,0.865,0.800,0.901,0.738 and 0.844,respectively.Conclusion Dual-energy CT parameters have potential application value in identifying BRAF^(V600E) genemutation in patients with PTC,and may be used for individualized treatment to a certain extent.
作者
吴天斌
林桂涵
陈春妙
程枫
毛卫波
纪建松
WU Tianbin;LIN Guihan;CHEN Chunmiao;CHENG Feng;MAO Weibo;JI Jiansong(Department of Radiology,Zhejiang Key Laboratory of Image Diagnosis and Interventional Minimally Invasive Research,Lishui Central Hospital,Lishui 323000,China;不详)
出处
《浙江医学》
CAS
2023年第8期824-829,I0004,共7页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2022KY1424、2022KY1425)。
