应用“3层系统”对头颈部CTA源图像偶发甲状腺结节的再评价

Re-evaluation of Incidental Thyroid Nodules on Head and Neck CTA Source Images by using “the 3-Tiered System”

目的探讨头颈部CTA源图像对偶发甲状腺结节(ITN)的观察价值并着重探讨应用"3层系统"对ITN的处理影响。方法搜集行头颈部CTA检查的患者12108例,从中检索影像医师所报告的ITN病例并测量ITN的横断面最大直径,比较固定数值(≥10 mm)和美国放射学会(ACR)推荐的"3层系统"两种方法对ITN的分类结果,符合"3层系统"的3组风险类别任意一组的为"ACR阳性",均不符合者为"ACR阴性"。两种方法通过使用配对χ~2检验进行统计比较。结果805例ITN患者纳入研究,通过"3层系统"筛选出"ACR阳性"者共282例(35.0%),其中第一组34例(4.2%),第二组3例(0.4%),第三组245例(30.4%)。503例(62.5%)ITN患者横截面最大结节直径≥10 mm。经过"3层系统"筛选后的ITN(35.0%)明显少于使用ITN横截面最大直径≥10 mm作为进一步超声评估的标准的ITN(62.5%)(P<0.001)。结论头颈部CTA源图像可以稳定的观察甲状腺组织并发现ITN,通过"3层系统"处理ITN,有望降低后续超声检查率,减少甲状腺癌的过度诊断。

Objective To investigate the value of head and neck CTA source images in the observation of incidental thyroid nodules(ITN),and to focus on the effect of"3-tiered system"on ITN processing.Methods A total of 12108 patients who underwent head and neck CTA examination from January to December 2018 were collected.The ITN cases reported by radiologists were collected and the maximum diameter of ITN cross-section dimensions were measured.The classification of ITN by the two methods of fixed value(≥10 mm)and the"3-tiered system"recommended by the American Radiological Society(ACR)was compared.Any of the three risk categories that conform to the"3-tiered system"were"ACR positive"and those that did not conform were"ACR negative".Comparisons of proportions of patients captured under the two tests were made by using the McNemar test.Results 805 ITN patients were included in the study.A total of 282 cases(35.0%)were screened out by the 3-tiered system,of which 34 cases(4.2%)were in the first group,3 cases(0.4%)in the second group and 245 cases(30.4%)in the third group.503(62.5%)ITN patients had the largest cross-sectional nodule diameter(≥10 mm).The ITN(35.0%)screened by the"3-tiered system"was significantly less than the ITN(62.5%)which used the maximum diameter of ITN cross section(≥10 mm)as the criterion for further ultrasound evaluation(P<0.001).Conclusion Head and neck CTA source image can appropriately observe thyroid tissue and identify ITN.ITN can be processed by"3-tiered system",which is expected to reduce the rate of follow-up ultrasound examination and reduce the overdiagnosis of thyroid carcinoma.