三种甲状腺影像报告和数据系统临床应用评估

The assessment of clinical application of three kinds of thyroid imaging reporting and data system

目的:评估3种甲状腺影像报告和数据系统(TIRADS)的临床应用价值。方法:选取168例患者的257个甲状腺结节,根据美国放射学会(ACR)TIRADS(ACR-TIRADS)、欧洲甲状腺协会(EU)TIRADS(EU-TIRADS)和韩国甲状腺协会(KTA)/韩国甲状腺放射科学会(KSThR)TIRADS(KTA/KSThR-TIRADS)的归类,构建受试者工作特征(ROC)曲线,评价并比较其诊断价值,计算不同风险分层诊断灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果:患者的257个甲状腺结节中有7个结节无法纳入EU-TIRADS进行分类。3种风险分层均随着分类级别提高,恶性率呈增高趋势。ACR-TIRADS、EU-TIRADS和KTA/KSThR-TIRADS的ROC曲线下面积(AUC)分别为0.874、0.855和0.880。ACR-TIRADS与KTA/KSThR-TIRADS间诊断灵敏度无显著性差异,但均大于EU-TIRADS,差异有统计学意义(x^2=0.083,x^2=0.083;P<0.05),EU-TIRADS特异度及准确率高于ACR-TIRADS和KTA/KSThR-TIRADS,差异有统计学意义(xACR-TIRADS2=0.030,x^2=0.010;xKTA/KSThR-TIRADS2=0.033,x^2=0.010,P<0.05)。结论:3种风险分层对于鉴别甲状腺结节良恶性均有临床应用价值,其中ACR-TIRADS和KTA/KSThR-TIRADS灵敏度高,EU-TIRADS特异度及准确率高。

Objective:To assess the value of clinical application of three kinds of thyroid imaging reporting and data system(TI-RADS).Methods:The 257 thyroid nodules of 168 patients were selected.And all nodules were categorized according to the ACR-TIRADS,EU-TIRADS and KTA/KSThR-TIRADS.Receiver operating characteristic(ROC)curve was constructed to evaluate and compare the diagnostic value of them.The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy of different risk grades were calculated.Results:Seven of 257 thyroid nodules could not be classified by the EU-TIRADS.The malignant rates appeared increasing trend with the enhancing of classification grade of 3 kinds of risk stratification.The areas under curve(AUC)of ROC curves of ACRTIRADS,EU-TIRADS and KTA/KSThR-TIRADS were 0.874,0.855 and 0.880,respectively.There were no significant differences for diagnostic sensitivity between ACR-TIRADS and KTA/KST hR-TIRADS,while that of them was significantly larger than that of EU-TIRADS(x^2=0.083,x^2=0.083,P<0.01),respectively.Besides,both specificity and accuracy of EU-TIRADS were significantly higher than those of ACR-TIRADS(x^2=0.030,P<0.01,x^2=0.010,P<0.01)and KTA/KSThR-TIRADS(x^2=0.033,P<0.01 and x^2=0.010,P<0.01).Conclusion:Each kind of three kinds of risk stratifications has value of clinical application in identifying benign and malignant thyroid nodule,and the sensitivities of ACR-TIRADS and KTA/KSThR-TIRADS are higher,and the specificity and accuracy of EU-TIRADS are higher.