超声造影评分在ACR甲状腺影像报告和数据系统分类中的应用  

Contrast-enhanced Ultrasound Scoring in ACR Thyroid Imaging Report and Data System Stratification

作　　者：马策 刘昕[1] 穆维娜[1] MA Ce;LIU Xin;MU Weina(Department of Ultrasound,Baoding No.1 Centre Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院超声科

出　　处：《中国医学影像学杂志》2019年第7期547-551,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨超声造影(CEUS)评分在2017版美国放射协会(ACR)甲状腺影像报告和数据系统(TI-RADS)分类中鉴别甲状腺良、恶性结节的应用价值。资料与方法回顾性分析经手术或穿刺活检病理证实的223个甲状腺结节,均有完整的二维超声及CEUS资料。对结节进行TI-RADS分类和CEUS评分,根据结节直径分为直径≥1 cm组与直径<1 cm组;再将直径≥1 cm的结节依据TI-RADS分类分为穿刺和随访2个亚组,对每个分组联合CEUS评分评估结节,分析CEUS评分在TI-RADS分类中的应用价值。结果对于≥1 cm组(n=133)的结节,TI-RADS分类及CEUS评分最佳临界值分别为6和3分,两者联合诊断的受试者工作特征(ROC)曲线下面积为0.932(95%CI 0.875~0.968),大于TI-RADS分类(0.884,95%CI 0.818~0.933)及CEUS评分(0.892,95%CI 0.826~0.939),差异有统计学意义(P均<0.05)。穿刺亚组(n=121)不必要穿刺率为26.3%(35/133),联合CEUS评分后,不必要穿刺率为3.8%(5/133),差异有统计学意义(P<0.001)。在<1 cm组(n=90)中,TIRADS分类及CEUS评分最佳临界值分别为7和3分,两者联合的ROC曲线下面积为0.946(95%CI 0.877~0.982),大于TIRADS分类的ROC曲线下面积(0.810,95%CI 0.714~0.885),差异有统计学意义(P<0.05),但与CEUS评分ROC曲线下面积(0.892,95%CI 0.809~0.948)比较,差异无统计学意义(P>0.05)。结论TI-RADS分类对鉴别甲状腺良恶性具有一定的诊断价值,通过CEUS评分,有效提高了其诊断效能,同时降低了穿刺率。Purpose To explore the application value of contrast-enhanced ultrasound(CEUS)scoring in v2017 American College of Radiology(ACR)thyroid imaging report and data system(TI-RADS)stratification in differentiating benign and malignant nodules of thyroid.Materials and Methods Two hundred and twenty-three thyroid nodules with completed two dimension ultrasound and CEUS materials which were pathologically confirmed by surgery or biopsy were retrospectively explored.TI-RADS stratification and CEUS scoring were performed to the nodules and the nodules were divided into≥1 cm group and<1 cm group according to diameters of nodules.Then the nodules greater than or equal to 1 cm were divided into two subgroups,namely biopsy and follow-up group regarding TI-RADS stratification.The nodules in each group were assessed combined CEUS scoring to analyze application value of CEUS scoring in TI-RADS stratification.Results For nodules in≥1 cm group(n=133),optimal cutoff values of TI-RADS stratification and CEUS scoring were 6 and 3 points,respectively.Area under curve of the receiver operating characteristics(ROC)diagnosed by the two was 0.932(95%CI 0.875-0.968)which was greater than TI-RADS stratification(0.884,95%CI 0.818-0.933)and CEUS scoring(0.892,95%CI 0.826-0.939).The difference was of statistical significance(all P<0.05).Unnecessary biopsy rate in biopsy subgroup(n=121)was 26.3%(35/133).After combining CEUS scoring,unnecessary biopsy rate was 3.8%(5/133).The difference was of statistical significance(P<0.001).In<1 cm group(n=90),optimal cutoff values of IT-RADS stratification and CEUS scoring were 7 and 3 points.The ROC area under the curve combined by the two was 0.946(95%CI 0.877-0.982),which was greater than that of TI-RADS stratification(0.810,95%CI 0.714-0.885).The difference was of statistical significance(P<0.05).However,comparison with ROC AUC(0.892,95%CI 0.809-0.948)in CEUS scoring was of no statistical significance(P>0.05).Conclusion ACR TI-RADS stratification is of certain diagnostic value in identifying benign a

关 键 词：甲状腺结节 甲状腺肿瘤 超声检查 多普勒 彩色 造影剂 甲状腺影像报告和数据系统 诊断 鉴别 

分 类 号：R581[医药卫生—内分泌] R445.1[医药卫生—内科学]