MRI detection of cervical metastasis from differentiated thyroid carcinoma
MRI detection of cervical metastasis from differentiated thyroid carcinoma
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DOI：
10.1097/00005537-200111000-00006
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发表时间：
2001-11-01
期刊：
影响因子：
2.6
通讯作者：
Cohen, JI
中科院分区：
文献类型：
--
作者：
Gross, ND;Weissman, JL;Cohen, JI
背景：随着血清甲状腺球蛋白作为高分化甲状腺癌(WDTC)全甲状腺切除术后复发的标志物的出现，临床医生越来越面临临床检查正常的甲状腺球蛋白阳性患者的复发部位的诊断难题。这种甲状腺球蛋白的高蛋白含量可能使其可以通过磁共振(MR)成像进行特异性检测。目标。目的：探讨磁共振成像对颈淋巴转移癌的诊断价值。研究设计：回顾性队列研究。方法：研究方法。两位独立的头颈部放射科医生对26例甲状腺癌患者(12例原发疾病，14例复发)的34例头颈部MR扫描进行了盲法复查，所有患者随后都接受了手术切除被认为有影像风险的淋巴结。结果。MRI的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确度分别为95%、51%、84%、78%和83%。两位放射科医生的符合率为69%。在MR扫描检测上颈静脉、下颈静脉或气管旁结节是否存在疾病的能力方面没有总体差异。然而，对于乳头状癌(PPV86%，准确率85%)，它比滤泡性癌或滤泡型乳头状癌(PPV63%，准确率67%)更有用。结论。磁共振成像是一种敏感和准确的技术，用于检测颈淋巴转移的WDTC，特别是乳头状癌。然而，这种方式的较低的特异性排除了它作为筛查工具的使用。
Background: With the advent of the use of serum thyroglobulin as a marker for the recurrence of well-differentiated thyroid cancer (WDTC) after total thyroidectomy, clinicians are increasingly faced with the diagnostic dilemma of detecting the site of recurrence in thyroglobulin-positive patients with normal clinical examinations. The high protein content of this thyroglobulin may make it specifically detectable by magnetic resonance (MR) imaging. Objective. To determine the ability of MR imaging to detect the presence of metastatic WDTC in cervical lymph nodes. Study Design: Retrospective cohort. Methods. Blinded review by two independent head and neck radiologists of 34 head and neck MR scans obtained from 26 patients with thyroid cancer (12 with primary disease and 14 with recurrent disease) all of whom subsequently underwent surgical removal of the lymph nodes considered at risk by imaging. Results. The average overall percent sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MR imaging were 95%, 51%, 84%,78%, and 83%, respectively. The concordance between the two radiologists was 69%. There was no overall difference in the ability of the MR scan to detect the presence of disease in the upper jugular, lower jugular, or paratracheal nodal stations. However, it was more useful for papillary carcinoma (PPV 86%, accuracy 85%) than for follicular carcinoma or the follicular variant of papillary carcinoma (PPV 63%, accuracy 67%). Conclusion. MR imaging is a sensitive and accurate technique for the detection of WDTC, particularly papillary carcinoma, metastatic to cervical lymph nodes. However, the lower specificity of this modality precludes its use as a screening tool.