基于ACR TI-RADS探究PET/CT发现甲状腺偶发瘤的临床价值

Clinical Value of PET/CT associated Thyroid Incidentalomas:Based on ACR TI-RADS Classification System

目的:基于甲状腺超声ACR TI-RADS评价正电子发射计算机体层显像仪(positron emission tomography and computed tomography,PET/CT)发现甲状腺偶发瘤(thyroid incidentalomas,TIs)的临床价值。方法:回顾性分析2019年1月—2020年9月珠海市人民医院核医学科经PET/CT检查的资料共1 593份,纳入甲状腺偶发瘤患者157例(9.9%),22例患者甲状腺偶发瘤经病理学检查获得最终诊断确认。结果:超声评估甲状腺结节低度恶性风险组(ACR TI-RADS 1~3类结节和/或甲状腺实质弥漫性病变)与高度恶性风险组(ACR TI-RADS 4~5类)平均SUVmax分别为(5.6±3.0)和(4.0±2.1),组间SUVmax值具有显著差异(P<0.05)。恶性甲状腺偶发瘤均出现在局限型FDG摄取增高组内,良性组的平均SUVmax显著低于恶性组(P<0.05),SUVmax的最佳截断值为3.3,灵敏度和特异度分别为87.5%和78.6%。两种方法判断结果的cohen’s Kappa系数为0.712 (95%CI为0.412~1.012,P<0.05)。结论:局部FDG摄取增加(SUVmax>3.3)表明TIs有恶性风险,恶性TIs的平均SUVmax高于良性组,但组间SUVmax重叠较多,基于ACR TI-RADS标准的超声检查可提高PET/CT相关甲状腺偶发瘤性质判断的准确性,降低穿刺率。

Objective Evaluation of the clinical value of positron emission tomography and computed tomography(PET/CT) in the detection of thyroid Incidentalomas(TIS) based on thyroid ultrasound ACR TI-RADS.Methods A total of 1593 data examined by PET/CT in the nuclear medicine department of Zhuhai People’s Hospital from January 2019 to September 2020 were analyzed retrospectively.157 patients(9.9%) with thyroid Incidentalomas were included,and the final diagnosis of thyroid Incidentalomas was obtained by pathological examination in 22 patients.Results The average SUVmax of the low-malignant risk group and the highmalignant risk group of thyroid nodules evaluated by ultrasound was(5.6±3.0) and(4.0±2.1),respectively.There was a significant statistical difference in SUVmax between the groups(P <0.05).The average SUVmax of benign group was significantly lower than that of malignant group(P <0.05).The optimal cutoff value of SUVmax was 3.3,and the sensitivity and specificity were 87.5% and78.6% respectively.The cohen ’s Kappa coefficient judged by PET/CT and ultrasound was 0.712(95% CI:0.412~1.012,P <0.05).Conclusion Increased localized FDG uptake(SUVmax> 3.3) suggests that TIs have a risk of malignancy.The average SUVmax of malignant TIs is higher than that of the benign group,but there is more overlap of SUVmax between the groups.Re evaluation of ultrasonography is helpful to reduce the puncture rate of FNA.