Skip to main content
SpringerLink
Log in

Clinical value of dual-energy CT for predicting occult metastasis in central neck lymph nodes of papillary thyroid carcinoma

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To predict the probability of occult lymph node metastasis (OLNM) in the central cervical by analyzing the dual-energy computed tomography (DECT) parameters derived from papillary thyroid carcinoma (PTC).

Methods

Data were retrospectively collected from patients with pathologically confirmed PTC who underwent arterial and venous phases of enhanced DECT with concurrent central neck lymph node dissection (CLND). Three clinical features, three shape-related features, and twenty-six DECT-derived parameters were measured. The univariate and multivariate analyses were applied to select the relevant parameters and develop the nomogram.

Results

A total 140 cases with negative diagnosis of cervical central lymph node metastases by preoperative evaluation were included, among which 88 patients with metastasis (OLNM +) and 52 patients without metastasis (OLNM −) were finally confirmed by pathology. (1) Anteroposterior/transverse diameter ratio (A/T) derived from the PTC focus had significant difference between the OLNM + and OLNM − groups (p < 0.05). (2) In the arterial phase, iodine concentration (ICarterial), normalized iodine concentration (NICarterial), effective atomic number (Zeff-arterial), electron density (EDarterial), and slope of energy curve (karterial) from PTC focus showed significant difference (all p < 0.05) between the two groups. In the venous phase, only the CT value under the 40 keV (HU40keVvenous) had differences (p < 0.05). (3) The nomogram was produced to predict the probability of OLNM, and the AUC, sensitivity, and specificity in the training and test cohort were 0.830, 75.0%, 76.9%, and 0.829, 65.9%, 84.6%, respectively.

Conclusions

DECT parameters combined with shape-related feature derived from PTC might be used as predictors of OLNM in the central neck.

Clinical relevance statement

Preoperative imaging evaluation combining shape-related features and dual-energy CT parameters could serve as a reference to discern occult lymph node metastasis in central neck during the surgically planning of papillary thyroid carcinoma.

Key Points

• Papillary thyroid carcinoma (PTC) patients may have occult lymph node metastasis (OLNM) in the central neck, which is extremely difficult to find by preoperative imaging examination.

• Dual-energy CT quantitative evaluation has higher accuracy than conventional CT and can predicting OLNM in the central neck of PTC.

• Dual-energy CT quantitative parameters and morphology of PTC can serve as a useful tool in predicting OLNM in the central neck, and as a guide for personalized treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

A/T:

Anteroposterior/transverse

AD:

Anteroposterior diameter

AJCC:

American Joint Commission of Cancer

CLND:

Central lymph node dissection

CLNM:

Central lymph node metastasis

CT:

Computed tomography

DECT:

Dual-energy CT

ED:

Electron cloud density

ICA:

Internal carotid artery

NCDB:

National Cancer Database

NIC:

Normalized IC

OLNM:

Occult lymph node metastasis

PTC:

Papillary thyroid carcinoma

ROC:

Receiver operating characteristic curve

ROI:

Region of interest

SEER:

Surveillance, Epidemiology, and End Results

TD:

Transverse diameter

US:

Ultrasound

References

  1. Kowalska A, Walczyk A, Kowalik A et al (2016) Increase in papillary thyroid cancer incidence is accompanied by changes in the frequency of the BRAF V600E mutation: a single-institution study. Thyroid 26:543–551. https://doi.org/10.1089/thy.2015.0352

    Article  CAS  PubMed  Google Scholar 

  2. Lee YK, Hong N, Shin DY et al (2019) The relationship of comorbidities to mortality and cause of death in patients with differentiated thyroid carcinoma. Sci Rep 9:11435. https://doi.org/10.1038/s41598-019-47898-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Xu Y, Xu L, Wang J (2018) Clinical predictors of lymph node metastasis and survival rate in papillary thyroid microcarcinoma: analysis of 3607 patients at a single institution. J Surg Res 221:128–134. https://doi.org/10.1016/j.jss.2017.08.007

    Article  PubMed  Google Scholar 

  4. Meler-Claramonte C, Avilés-Jurado FX, Vilaseca I et al (2022) Semaphorin-3F/neuropilin-2 transcriptional expression as a predictive biomarker of occult lymph node metastases in HNSCC. Cancers (Basel) 14:2259. https://doi.org/10.3390/cancers14092259

    Article  CAS  PubMed  Google Scholar 

  5. Lee J, Song Y, Soh EY (2014) Central lymph node metastasis is an important prognostic factor in patients with papillary thyroid microcarcinoma. J Korean Med Sci 29:48–52. https://doi.org/10.3346/jkms.2014.29.1.48

    Article  PubMed  Google Scholar 

  6. Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133. https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wu Z, Han L, Li W et al (2021) Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy? Cancer Med 10:1614–1622. https://doi.org/10.1002/cam4.3743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Amin MB, Greene FL, Edge SB et al (2017) The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67:93–99. https://doi.org/10.3322/caac.21388

    Article  PubMed  Google Scholar 

  9. Chen H, Pang Y, Wu J et al (2020) Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging 47:1820–1832. https://doi.org/10.1007/s00259-020-04769-z

    Article  PubMed  Google Scholar 

  10. Fu H, Orcid Id, Wu J et al (2022) 68Ga fibroblast activation protein inhibitor PET/CT in the detection of metastatic thyroid cancer: comparison with 18F-FDG PET/CT. Radiology 304:397–405. https://doi.org/10.1148/radiol.212430

    Article  PubMed  Google Scholar 

  11. Cho SJ, Suh CH, Baek JH, Chung SR, Choi YJ, Lee JH (2019) Diagnostic performance of CT in detection of metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis. Eur Radiol 29:4635–4647. https://doi.org/10.1007/s00330-019-06036-8

    Article  PubMed  Google Scholar 

  12. Pulickal GG, Singh D, Lohan R, Chawla A (2019) Dual-source dual-energy CT in submandibular sialolithiasis: reliability and radiation burden. AJR Am J Roentgenol 213:1291–1296. https://doi.org/10.2214/AJR.19.21299

    Article  PubMed  Google Scholar 

  13. Wang P, Tang Z, Xiao Z et al (2021) Dual-energy CT in predicting Ki-67 expression in laryngeal squamous cell carcinoma. Eur J Radiol 140:109774. https://doi.org/10.1016/j.ejrad.2021.109774

    Article  PubMed  Google Scholar 

  14. Kim C, Kim W, Park SJ et al (2020) Application of dual-energy spectral computed tomography to thoracic oncology imaging. Korean J Radiol 21:838–850. https://doi.org/10.3348/kjr.2019.0711

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li M, Zheng X, Li J et al (2012) Dual-energy computed tomography imaging of thyroid nodule specimens: comparison with pathologic findings. Invest Radiol 47:58–64. https://doi.org/10.1097/RLI.0b013e318229fef3

    Article  PubMed  Google Scholar 

  16. Gao SY, Zhang XY, Wei W et al (2016) Identification of benign and malignant thyroid nodules by in vivo iodine concentration measurement using single-source dual energy CT: a retrospective diagnostic accuracy study. Medicine (Baltimore) 95:e4816. https://doi.org/10.1097/MD.0000000000004816

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Liu X, Ouyang D, Li H et al (2015) Papillary thyroid cancer: dual-energy spectral CT quantitative parameters for preoperative diagnosis of metastasis to the cervical lymph nodes. Radiology 275:167–176. https://doi.org/10.1148/radiol.14140481

    Article  PubMed  Google Scholar 

  18. Zhou Y, Su GY, Hu H et al (2022) Radiomics from primary tumor on dual-energy CT derived iodine maps can predict cervical lymph node metastasis in papillary thyroid cancer. Acad Radiol 29:S222–S231. https://doi.org/10.1016/j.acra.2021.06.014

    Article  PubMed  Google Scholar 

  19. Malhi HS, Grant EG (2021) Ultrasound of thyroid nodules and the Thyroid Imaging Reporting and Data System. Neuroimaging Clin N Am 31:285–300. https://doi.org/10.1016/j.nic.2021.04.001

    Article  PubMed  Google Scholar 

  20. Lee DY, Hwang SM, An JH et al (2017) Predicting extrathyroidal extension in patients with papillary thyroid microcarcinoma according to a BRAF mutation. Clin Exp Otorhinolaryngol 10:174–180. https://doi.org/10.21053/ceo.2015.01655

    Article  PubMed  Google Scholar 

  21. Niederer-Wüst SM, Jochum W, Förbs D et al (2015) Impact of clinical risk scores and BRAF V600E mutation status on outcome in papillary thyroid cancer. Surgery 157:119–125. https://doi.org/10.1016/j.surg.2014.07.015

    Article  PubMed  Google Scholar 

  22. Feng JW, Hong LZ, Wang F et al (2021) A nomogram based on clinical and ultrasound characteristics to predict central lymph node metastasis of papillary thyroid carcinoma. Front Endocrinol 12:666315. https://doi.org/10.3389/fendo.2021.666315

    Article  Google Scholar 

  23. Li J, Sun P, Huang T et al (2022) Preoperative prediction of central lymph node metastasis in cN0T1/T2 papillary thyroid carcinoma: a nomogram based on clinical and ultrasound characteristics. Eur J Surg Oncol 48:1272–1279. https://doi.org/10.1016/j.ejso.2022.04.001

    Article  PubMed  Google Scholar 

  24. Papapostolou KD, Evangelopoulou CC, Ioannidis IA et al (2020) Taller-than-wide thyroid nodules with microcalcifications are at high risk of malignancy. In Vivo 34:2101–2105. https://doi.org/10.21873/invivo.12014

    Article  PubMed  PubMed Central  Google Scholar 

  25. Shin JH, Baek JH, Chung J et al (2016) Ultrasonography diagnosis and imaging-based management of thyroid nodules: Revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol 17:370–395. https://doi.org/10.3348/kjr.2016.17.3.370

    Article  PubMed  PubMed Central  Google Scholar 

  26. D’Cruz AK, Vaish R, Kapre N et al (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521–529. https://doi.org/10.1056/NEJMoa1506007

    Article  CAS  PubMed  Google Scholar 

  27. Sparano A, Weinstein G, Chalian A, Yodul M, Weber R (2004) Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg 131:472–476. https://doi.org/10.1016/j.otohns.2004.04.008

    Article  PubMed  Google Scholar 

  28. Onishi S, Fujioka C, Kaichi Y et al (2020) Utility of dual-energy CT for predicting the vascularity of meningiomas. Eur J Radiol 123:108790. https://doi.org/10.1016/j.ejrad.2019.108790

    Article  PubMed  Google Scholar 

  29. Chen M, Li X, Wei Y, Qi L, Sun YS (2020) Spectral CT imaging parameters and Ki-67 labeling index in lung adenocarcinoma. Chin J Cancer Res 32:96–104. https://doi.org/10.21147/j.issn.1000-9604.2020.01.11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Goo HW, Goo JM (2017) Dual-energy CT: new horizon in medical imaging. Korean J Radiol 18:555–569. https://doi.org/10.3348/kjr.2017.18.4.555

    Article  PubMed  PubMed Central  Google Scholar 

  31. Jang JY, Orcid Id, Kim DS et al (2019) Preoperative serum VEGF-C but not VEGF-A level is correlated with lateral neck metastasis in papillary thyroid carcinoma. Head Neck 41:2602–2609. https://doi.org/10.1002/hed.25729

    Article  PubMed  Google Scholar 

  32. Tian X, Song Q, Xie F et al (2020) Papillary thyroid carcinoma: an ultrasound-based nomogram improves the prediction of lymph node metastases in the central compartment. Eur Radiol 30:5881–5893. https://doi.org/10.1007/s00330-020-06906-6

    Article  PubMed  Google Scholar 

  33. Cheng SM, Ling W, Zhu J, Xu JR, Wu LM, Gong HX (2018) Dual energy spectral CT imaging in the assessment of gastric cancer and cell proliferation: a preliminary study. Sci Rep 48:17619. https://doi.org/10.1038/s41598-018-35712-w

    Article  CAS  Google Scholar 

  34. Hua CH, Shapira N, Merchant TE, Klahr P, Yagil Y (2018) Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual-layer dual-energy computed tomography system. Med Phys 45:2486–2497. https://doi.org/10.1002/mp.12903

    Article  CAS  PubMed  Google Scholar 

  35. Rajiah P, Sundaram M, Subhas N (2019) Dual-energy CT in musculoskeletal imaging: what is the role beyond gout? AJR Am J Roentgenol 213:493–505. https://doi.org/10.2214/AJR.19.21095

    Article  PubMed  Google Scholar 

  36. Agostini A, Orcid Id, Borgheresi A et al (2019) Dual-energy CT: theoretical principles and clinical applications. Radiol Med 124:1281–1295. https://doi.org/10.1007/s11547-019-01107-8

    Article  PubMed  Google Scholar 

  37. Yang M, Zhu XR, Park PC et al (2012) Comprehensive analysis of proton range uncertainties related to patient stopping-power-ratio estimation using the stoichiometric calibration. Phys Med Biol 57:4095–4115. https://doi.org/10.1088/0031-9155/57/13/4095

    Article  PubMed  PubMed Central  Google Scholar 

  38. van Abbema JK, van Goethem MJ, Greuter MJ, van der Schaaf A, Brandenburg S, van der Graaf ER (2015) Relative electron density determination using a physics based parameterization of photon interactions in medical DECT. Phys Med Biol 60:3825–3846. https://doi.org/10.1088/0031-9155/60/9/3825

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Yingqian Ge, an employee of Siemens Healthineers, for her kind help in the statistical analysis.

Funding

The Joint Program of Yunnan Provincial Science and Technology Department and Kunming Medical University 2019FE001 (-213). The Joint Program of Yunnan Provincial Science and Technology Department and Kunming Medical University 202001AY070001-201. National Natural Science Foundation of China (81960310). The China Foundation for International Exchange 2021 SKY Imaging Research Found Z-2014–07-2101.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, China

    Wen Zhao, Shasha Shen, Jie Jiang, Xiaojie Xie, Xingyue Hu, Xiaonan Tang & Dan Han

  2. Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China

    Tengfei Ke

  3. Department of Pathology, the First Affiliated Hospital of Kunming Medical University, Kunming, China

    Yingxia Wang

  4. GE Healthcare, Wuhan, China

    Jun Chen

Authors
  1. Wen Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shasha Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tengfei Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jie Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yingxia Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaojie Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xingyue Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiaonan Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dan Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Tengfei Ke or Dan Han.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dan Han.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and Biometry

Jun Chen kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

This was a retrospective study and no informed consent was required.

Ethical approval

Therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki (Revised in 2013). This study was approved by the ethics committee of the First Affiliated Hospital of Kunming Medical University (2018-L-48) and the Yunnan Cancer Hospital (KYLX202160). All methods were carried out in accordance with relevant guidelines and regulations.

Study subjects or cohorts overlap

Patients with suspected thyroid cancer on DECT scans performed at the First Affiliated Hospital of Kunming Medical University and Yunnan Cancer Hospital between January 2016 and December 2021 were collected retrospectively. Finally, 140 patients with PTC were included in this study.

Methodology

• retrospective

• observational

• performed at one institution

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Wen Zhao and Shasha Shen are co-first authors.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 337 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, W., Shen, S., Ke, T. et al. Clinical value of dual-energy CT for predicting occult metastasis in central neck lymph nodes of papillary thyroid carcinoma. Eur Radiol 34, 16–25 (2024). https://doi.org/10.1007/s00330-023-10004-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-023-10004-8

Keywords

Search

Navigation