This study was approved by the Institutional Review Board, and the requirement for written informed consent from patients was waived. A population database consisting of 92 patients with incidental thyroid nodules who underwent unenhanced and contrast-enhanced gemstone spectral CT scans between August 2016 and December 2017 was queried to identify patients suffering from thyroid papillary carcinoma or nodular goiter confirmed by postoperative histopathology. Thyroid adenomas and medullary carcinoma were excluded due to obviously cystic change and collarbone artifacts on lesions. A total of 81 patients were ultimately eligible for inclusion. The following 26 patients were excluded: (1) disease recurrence, (2) nodular goiter with complete cystic change, (3) previous treatment, (4) with thyroiditis, (5) lesions <1.0 cm [20 (link)], and (6) poor image quality. Finally, 55 GS patients were included in this study (Figure 1).
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