为了探索双能量计算机断层扫描(CT)中动脉增强分数(AEF)对于诊断乳头状甲状腺癌(PTC)颈淋巴结(LN)转移的附加价值，共招募了92名PTC患者的273个颈部LN（153个非转移性和120个转移性）。评估了LN的定性图像特征。分别计算了单能量CT（SECT）衍生的AEF(AEFS)和双能量CT（DECT）衍生的AEF（AEFD）。使用Pearson相关系数确定AEFD与AEFS之间的相关性。使用前向变量选择方法进行多变量Logistic回归分析，构建了三个模型（常规特征、常规特征+AEFS和常规特征+AEFD）。使用受试者工作特征曲线（ROC曲线）分析评估了诊断性能。 选择异常增强、钙化和囊变构建模型1，并且该模型具有中等诊断性能，ROC曲线下面积（AUC）为0.675。转移性LN显示出显著较高的AEFD(1.14 vs 0.48; p < 0.001)和AEFS(1.08 vs 0.38; p < 0.001)，相较于非转移性LN。AEFD与AEFS的相关性良好(r = 0.802; p < 0.001)，并且具有与AEFS相当的性能(AUC, 0.867 vs 0.852; p = 0.628)。将CT图像特征与AEFS（模型2）和AEFD（模型3）结合，可显著改善诊断性能（AUC, 0.865 vs 0.675; AUC, 0.883 vs 0.675; 均p < 0.001）。 AEFD与AEFS的相关性良好，并且具有与AEFS相当的性能。将定性CT图像特征与AEFS和AEFD结合，进一步提高了PTC颈LN转移的诊断能力。 动脉增强分数（AEF）值，特别是来源于双能量计算机断层扫描的AEF，可以帮助诊断乳头状甲状腺癌患者的颈淋巴结转移，补充常规CT图像特征，以改善临床决策的准确性。 · 在乳头状甲状腺癌患者颈淋巴结中，转移性淋巴结显示出双能量计算机断层扫描（DECT）和单能量CT（SECT）衍生的动脉增强分数（AEF）明显高于非转移性淋巴结。 · 双能量CT衍生的AEF（AEFD）与AEFS显著相关，并展现出与AEFS相当的性能。 · 将定性CT图像特征与AEFS和AEFD结合，可以进一步提高鉴别能力。 ©2023. 作者独家许可，欧洲放射学会。

To explore the added value of arterial enhancement fraction (AEF) derived from dual-energy computed tomography CT (DECT) to conventional image features for diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC).A total of 273 cervical LNs (153 non-metastatic and 120 metastatic) were recruited from 92 patients with PTC. Qualitative image features of LNs were assessed. Both single-energy CT (SECT)-derived AEF (AEFS) and DECT-derived AEF (AEFD) were calculated. Correlation between AEFD and AEFS was determined using Pearson's correlation coefficient. Multivariate logistic regression analysis with the forward variable selection method was used to build three models (conventional features, conventional features + AEFS, and conventional features + AEFD). Diagnostic performances were evaluated using receiver operating characteristic (ROC) curve analyses.Abnormal enhancement, calcification, and cystic change were chosen to build model 1 and the model provided moderate diagnostic performance with an area under the ROC curve (AUC) of 0.675. Metastatic LNs demonstrated both significantly higher AEFD (1.14 vs 0.48; p < 0.001) and AEFS (1.08 vs 0.38; p < 0.001) than non-metastatic LNs. AEFD correlated well with AEFS (r = 0.802; p < 0.001), and exhibited comparable performance with AEFS (AUC, 0.867 vs 0.852; p = 0.628). Combining CT image features with AEFS (model 2) and AEFD (model 3) could significantly improve diagnostic performances (AUC, 0.865 vs 0.675; AUC, 0.883 vs 0.675; both p < 0.001).AEFD correlated well with AEFS, and exhibited comparable performance with AEFS. Integrating qualitative CT image features with both AEFS and AEFD could further improve the ability in diagnosing cervical LN metastasis in PTC.Arterial enhancement fraction (AEF) values, especially AEF derived from dual-energy computed tomography, can help to diagnose cervical lymph node metastasis in patients with papillary thyroid cancer, and complement conventional CT image features for improved clinical decision making.• Metastatic cervical lymph nodes (LNs) demonstrated significantly higher arterial enhancement fraction (AEF) derived from dual-energy computed tomography (DECT) and single-energy CT (SECT)-derived AEF (AEFS) than non-metastatic LNs in patients with papillary thyroid cancer. • DECT-derived AEF (AEFD) correlated significantly with AEFS, and exhibited comparable performance with AEFS. • Integrating qualitative CT images features with both AEFS and AEFD could further improve the differential ability.© 2023. The Author(s), under exclusive licence to European Society of Radiology.