{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:29:34Z","timestamp":1788827374523,"version":"build-2803163510"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the capability of dual-layer detector spectral CT (DLCT) quantitative parameters in conjunction with clinical variables to detect malignant\u2002lesions\u2002in cytologically indeterminate thyroid nodules (TNs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Data from 107 patients with cytologically indeterminate TNs who underwent DLCT scans were retrospectively reviewed and randomly divided into training and validation sets (7:3 ratio). DLCT quantitative parameters (iodine concentration (IC), NIC<jats:sub>P<\/jats:sub> (IC nodule\/IC thyroid parenchyma), NIC<jats:sub>A<\/jats:sub> (IC nodule\/IC ipsilateral carotid artery), attenuation on the slope of spectral HU curve and effective atomic number), along with clinical variables, were compared between benign and malignant cohorts through univariate analysis. Multivariable logistic regression analysis was employed to identify independent predictors which were used to construct the clinical model, DLCT model, and combined model. A nomogram was formulated based on optimal performing model, and its performance was assessed using receiver operating characteristic curve, calibration curve, and decision curve analysis. The nomogram was subsequently tested in the validation set.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Independent predictors associated with malignant TNs with indeterminate cytology included NIC<jats:sub>P<\/jats:sub> in the arterial phase, Hashimoto\u2019s Thyroiditis (HT), and BRAF V600E (all <jats:italic>p<\/jats:italic> &amp;lt; 0.05). The DLCT-clinical nomogram, incorporating the aforementioned variables, exhibited superior performance than the clinical model or DLCT model in both training set (AUC: 0.875 vs 0.792 vs 0.824) and validation set (AUC: 0.874 vs 0.792 vs 0.779). The DLCT-clinical nomogram demonstrated satisfactory calibration and clinical utility in both training set and validation set.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The DLCT-clinical nomogram emerges as an effective tool to detect malignant\u2002lesions\u2002in cytologically indeterminate TNs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1357419","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T04:54:16Z","timestamp":1716872056000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Detection of malignant lesions in cytologically indeterminate thyroid nodules using a dual-layer spectral detector CT-clinical nomogram"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaofang","family":"Ren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuhua","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojiao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayi","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongwen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youjia","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuoyue","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0898","article-title":"The diagnosis and management of thyroid nodules: A review","volume":"319","author":"Durante","year":"2018","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"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","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0305","article-title":"Impact of the multi-gene thyroSeq next-generation sequencing assay on cancer diagnosis in thyroid nodules with atypia of undetermined significance\/follicular lesion of undetermined significance cytology","volume":"25","author":"Nikiforov","year":"2015","journal-title":"Thyroid"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0500","article-title":"The 2017 bethesda system for reporting thyroid cytopathology","volume":"27","author":"Cibas","year":"2017","journal-title":"Thyroid"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26085","article-title":"The role of [18F]-2-fluoro-2-deoxy-d-glucose-positron emission tomography in thyroid nodules with indeterminate fine-needle aspiration biopsy: systematic review and meta-analysis of the literature","volume":"117","author":"Vriens","year":"2011","journal-title":"Cancer"},{"key":"B6","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1089\/thy.2016.0379","article-title":"Examining the role of preoperative positron emission tomography\/computerized tomography in combination with ultrasonography in discriminating benign from Malignant cytologically indeterminate thyroid nodules","volume":"27","author":"Merten","year":"2017","journal-title":"Thyroid"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-020-00783-w","article-title":"Developing a tool that could reliably refute total thyroidectomy for solitary Bethesda IV thyroid nodules","volume":"73","author":"Bakkar","year":"2021","journal-title":"Updates Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1530\/EJE-15-1199","article-title":"Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET\/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology","volume":"174","author":"Piccardo","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003580","article-title":"The american association of endocrine surgeons guidelines for the definitive surgical management of thyroid disease in adults","volume":"271","author":"Patel","year":"2020","journal-title":"Ann Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-012-2385-6","article-title":"Quantitative evaluation of contrast-enhanced ultrasound after intravenous administration of a microbubble contrast agent for differentiation of benign and Malignant thyroid nodules: assessment of diagnostic accuracy","volume":"22","author":"Nemec","year":"2012","journal-title":"Eur Radiol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.14140481","article-title":"Papillary thyroid cancer: dual-energy spectral CT quantitative parameters for preoperative diagnosis of metastasis to the cervical lymph nodes","volume":"275","author":"Liu","year":"2015","journal-title":"Radiology"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-021-07703-5","article-title":"Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing-a single-center retrospective study in a large cohort","volume":"31","author":"Sparano","year":"2021","journal-title":"Eur Radiol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02239-y","article-title":"Indeterminate thyroid nodules. The role of 18F-FDG PET\/CT in the \u201cera\u201d of ultrasonography risk stratification systems and new thyroid cytology classifications","volume":"69","author":"Piccardo","year":"2020","journal-title":"Endocrine"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-006-0517-6","article-title":"Material differentiation by dual energy CT: initial experience","volume":"17","author":"Johnson","year":"2007","journal-title":"Eur Radiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2020.0996","article-title":"Clinical applications of dual-energy CT","volume":"22","author":"Hamid","year":"2021","journal-title":"Korean J Radiol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1080\/14737140.2019.1626234","article-title":"An update on advanced dual-energy CT for head and neck cancer imaging","volume":"19","author":"Forghani","year":"2019","journal-title":"Expert Rev Anticancer Ther"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2019.1574404","article-title":"Differentiation between Malignant and benign rectal tumors by dual-energy computed tomography - a feasibility study","volume":"58","author":"Al-Najami","year":"2019","journal-title":"Acta Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-021-08159-3","article-title":"Dual-energy CT in differentiating benign sinonasal lesions from Malignant ones: comparison with simulated single-energy CT, conventional MRI, and DWI","volume":"32","author":"Wang","year":"2022","journal-title":"Eur Radiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40644-023-00525-2","article-title":"Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from Malignant thyroid micro-nodules","volume":"23","author":"Song","year":"2023","journal-title":"Cancer Imaging"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.20.23516","article-title":"Preoperative prediction of cervical nodal metastasis in papillary thyroid carcinoma: value of quantitative dual-energy CT parameters and qualitative morphologic features","volume":"216","author":"Wu","year":"2021","journal-title":"AJR Am J Roentgenol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.967988","article-title":"Association of Hashimoto\u2019s thyroiditis and anti-thyroid antibodies with oral lichen planus: A cross-sectional study","volume":"13","author":"Zhang","year":"2022","journal-title":"Front Immunol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24098452","article-title":"Oxidative stress linking obesity and cancer: is obesity a \u2018Radical trigger\u2019 to cancer","volume":"24","author":"Jovanovi\u0107","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.824226","article-title":"Point of care measurement of body mass index and thyroid nodule Malignancy risk assessment","volume":"13","author":"Ahmadi","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa250","article-title":"Does obesity cause thyroid cancer? A mendelian randomization study","volume":"105","author":"Fussey","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814564537","article-title":"Modifiable risk factors and thyroid cancer","volume":"152","author":"Stansifer","year":"2015","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5898","article-title":"Value of BRAF V600E in high-risk thyroid nodules with benign cytology results","volume":"39","author":"Chen","year":"2018","journal-title":"AJNR Am J Neuroradiol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2019.03.034","article-title":"BRAF V600E mutation and microRNAs are helpful in distinguishing papillary thyroid Malignant lesions: Tissues and fine needle aspiration cytology cases","volume":"223","author":"Zarkesh","year":"2019","journal-title":"Life Sci"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1067390","article-title":"Influence of Hashimoto thyroiditis on diagnosis and treatment of thyroid nodules","volume":"13","author":"Mao","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.surg.2019.02.024","article-title":"Immune cell infiltrate-associated dysregulation of DNA repair machinery may predispose to papillary thyroid carcinogenesis","volume":"167","author":"Nicolson","year":"2020","journal-title":"Surgery"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1210\/er.2017-00133","article-title":"Diagnostic utility of molecular and imaging biomarkers in cytological indeterminate thyroid nodules","volume":"39","author":"de Koster","year":"2018","journal-title":"Endocr Rev"},{"key":"B31","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1186\/s12935-021-02405-w","article-title":"Epigenetic modification and BRAF gene mutation in thyroid carcinoma","volume":"21","author":"Huang","year":"2021","journal-title":"Cancer Cell Int"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102649","article-title":"Hashimoto\u2019s thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential Malignant transformation","volume":"19","author":"Ralli","year":"2020","journal-title":"Autoimmun Rev"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-018-9474-z","article-title":"The increasing prevalence of chronic lymphocytic thyroiditis in papillary microcarcinoma","volume":"19","author":"Vita","year":"2018","journal-title":"Rev Endocr Metab Disord"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1210\/endo.142.8.8344","article-title":"Differential regulation of the human sodium\/iodide symporter gene promoter in papillary thyroid carcinoma cell lines and normal thyroid cells","volume":"142","author":"Kogai","year":"2001","journal-title":"Endocrinology"},{"key":"B35","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/s0304-3835(00)00565-6","article-title":"Detection of mRNA of sodium iodide symporter in benign and Malignant human thyroid tissues","volume":"160","author":"Liou","year":"2000","journal-title":"Cancer Lett"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1111\/cyt.12828","article-title":"Impact of image analysis and artificial intelligence in thyroid pathology, with particular reference to cytological aspects","volume":"31","author":"Girolami","year":"2020","journal-title":"Cytopathology"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1111\/cyt.13279","article-title":"Delphi expert consensus for whole slide imaging in thyroid cytopathology","volume":"34","author":"Marletta","year":"2023","journal-title":"Cytopathology"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S429681","article-title":"Comparison of diagnostic values of ACR TI-RADS versus C-TIRADS scoring and classification systems for the elderly thyroid cancers","volume":"16","author":"Huang","year":"2023","journal-title":"Int J Gen Med"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1357419\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T04:54:18Z","timestamp":1716872058000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1357419\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,28]]},"references-count":38,"alternative-id":["10.3389\/fonc.2024.1357419"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1357419","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,28]]},"article-number":"1357419"}}