ACR TI-RADS分类在诊断甲状腺结节中的应用价值探究  

The Applicational Value of ACR TI-RADS Stratification in Diagnosing Thyroid Nodules

作　　者：刘红[1] 胡正明[1] 罗海愉 张威威[1] 白小鹤 刘俐[1] 陈芸[1] Liu Hong;Hu Zhengming;Luo Haiyu;Zhang Weiwei;Bai Xiaohe;Liu Li;Chen Yun(Department of Ultrasound,Shenzhen Hospital of Peking University,Shenzhen,Guangdong 518036,China)

机构地区：[1]北京大学深圳医院超声影像科,广东省深圳市518036

出　　处：《中国超声医学杂志》2018年第8期673-675,共3页Chinese Journal of Ultrasound in Medicine

基　　金：深圳市"三名工程"赞助项目(No.SZSM201512026);深圳市科技计划项目(No.ZDSYS201504301045406);广东省自然科学基金(No.2015A030313889)

摘　　要：目的探讨美国放射学会(ACR)2017年发布的甲状腺影像报告和数据系统(TI-RADS)在诊断甲状腺良恶性结节中的应用价值。方法回顾性分析661例共693个甲状腺结节的超声影像学资料及病理结果,参照ACR发布的TI-RADS指南,对每个结节赋分并分类。以病理结果为金标准,以结节总得分构建受试者工作特征曲线(ROC曲线),获得最佳诊断界值并评估其诊断效能。结果 (1)ROC曲线下面积为0.89(95%可信区间:0.864～0.916),依据ROC曲线最佳诊断界值为6分,且以>6分作为TI-RADS诊断恶性的标准时,其敏感度、特异度及约登指数分别为92.0%、72.1%、0.641;(2)TR 1～5类中的恶性构成比分别为0.0%(0/7)、0.0%(0/21)、5.0%(3/60)、24.1%(32/133)、84.8%(400/472),且随着TI-RADS分类的升高恶性构成比不断增加。结论 ACR TI-RADS分类系统在定性诊断甲状腺结节中具有较高的临床应用价值,且以结节得分>6分(TR5类)作为诊断恶性的标准时诊断效能最高。Objective To explore the applicational value of Thyroid Imaging Reporting and Data System（TIRADS）which was developed by American College of Radiology in diagnosing thyroid nodules.Methods A total of693 nodules in 661 patients were analyzed.The sonographic images and pathological results of the nodules were obtained.Points and TI-RADS levels were assigned to each nodule according to ACR TI-RADS.With pathological results set as golden standard,the receiver operating characteristic（ROC）curve of the points was drawn.Then the diagnostic value of the guideline was evaluated with the best cut-off value.Results（1）The area under ROC curve was0.89（95%CI：0.864-0.916）.According to ROC curve,the optimal diagnostic point was 6 points.With〉6 points set as the standard of malignancy for TI-RADS,the sensitivity,specificity and Youden index was 92.0%,72.1% and0.641.（2）The risk levels for TR1,TR2,TR3,TR4 and TR5 nodules were 0.0%（0/7）,0.0%（0/21）,5.0%（3/60）,24.1%（32/133）and 84.8%（400/472）and the risk of malignancy was increased with the TI-RADS level increased.Conclusions ACR TI-RADS stratification has high applicational value in diagnosing thyroid nodules.And with 〉6 points（TR5）set as the standard of malignancy for TI-RADS,it has the highest diagnostic value.

关 键 词：甲状腺影像报告和数据系统 甲状腺结节 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]