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

期刊论文
发表日期：

2024年7月9日

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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

摘要

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.