{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:25:38Z","timestamp":1787729138571,"version":"build-2784847793"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T00:00:00Z","timestamp":1639353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Reyon Pharmaceuticals, Co., Ltd."}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To determine whether dual-energy CT (DECT) has incremental diagnostic value when combined with ultrasound (US) in the diagnosis of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a single-center retrospective cohort study of patients diagnosed with PTC between October 2019 and August 2020. US features of LNs to include hyperechogenicity, round shape, microcalcification, cystic component, and homogeneous\/peripheral vascularity were considered suggestive of metastasis. The HU of arterial phase (HU<jats:sub>arterial<\/jats:sub>) and DECT-derived CT images [contrast media (CM) and areas under the 100 keV monoenergetic curve (AUC<jats:sub>100keV<\/jats:sub>)] were measured. Effective atomic numbers (Z<jats:sub>eff<\/jats:sub>), iodine concentration (mg\/mL), and slope of the HU curve (\u03bb<jats:sub>HU<\/jats:sub>) were also obtained. The values for metastatic and benign LNs were compared using Student\u2019s <jats:italic>t<\/jats:italic>-test with false-discovery correction. Logistic regression with areas under the receiver operating characteristic curves (AUCs) were performed for predicting metastatic LNs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 102 patients were included (49 metastatic and 53 benign LNs; mean age, 46\u00b115 years). Metastatic LNs showed significantly higher values for HU<jats:sub>arterial<\/jats:sub>, CM, Z<jats:sub>eff<\/jats:sub>, \u03bb<jats:sub>HU<\/jats:sub>, AUC<jats:sub>100keV<\/jats:sub>, and iodine concentration (all, <jats:italic>P<\/jats:italic> = 0.001). In logistic regression, the HU<jats:sub>arterial<\/jats:sub> demonstrated the highest AUC (0.824; 95% confidence interval [CI], 0.751\u20130.897), followed by CM HU (0.762; 95% CI, 0.679\u20130.846). Combination of DECT parameters with US features improved the AUC from 0.890 to 0.941.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Compared to US features alone, combination with DECT-derived quantitative parameters improved diagnostic performance in predicting metastatic cervical LNs in patients with PTC.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0261233","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T18:24:56Z","timestamp":1639419896000},"page":"e0261233","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Preoperative assessment of cervical lymph node metastases in patients with papillary thyroid carcinoma: Incremental diagnostic value of dual-energy CT combined with 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