甲状腺结节恶性风险分层系统ACR TI-RADS对294例甲状腺滤泡性肿瘤的诊断价值分析

Diagnostic Value of Thyroid Nodule Malignant Risk Stratification System ACR TI-RADS in 294 Thyroid Follicular Tumors Patients

[目的]探讨甲状腺结节恶性风险分层系统ACR TI-RADS对甲状腺滤泡性肿瘤的诊断价值。[方法]回顾性分析经术后病理的证实的69例甲状腺滤泡癌(FTC)和225例甲状腺滤泡腺瘤(FTA)患者的临床及超声影像资料。分析ACR TI-RADS定义赋分的5项声学特征:结节成分、回声、形态、边缘、局灶性强回声及其分类结果。还分析了结节周围声晕及内部血流信号,以及伴结节性甲状腺肿、多发结节和伴桥本氏炎等特征的诊断价值。[结果]FTC和FTA组伴结节性甲状腺肿的病例分别占58%(40/69)和30%(68/225)(P<0.05),伴桥本氏炎病例分别占9%(6/69)和4%(9/225),多发病灶分别占10%(7/69)和5%(11/225)(P均>0.05)。在ACR TI-RADS定义赋分的5项声学特征中,FTC与FTA两组的结节成分、回声、边缘与局灶性强回声差异均有统计学意义(P<0.05),两组结节形态无明显差异(P>0.05)。ACR TI-RADS对良恶性滤泡性肿瘤有鉴别能力(χ2=22.66,P<0.05)。FTC和FTA组病灶内部血流信号分级特征有显著性差异(P<0.05)。[结论]ACR TI-RADS对良恶性甲状腺滤泡性肿瘤具有诊断价值,参考结节周围声晕、内部血流及临床信息等综合判断,可提高诊断能力。

[Objective]To investigate the diagnostic value of thyroid nodule malignant risk stratification system(ACR TI-RADS)for thyroid follicular tumors patients.[Methods]The clinical and ultrasonic data of 69 follicular thyroid carcinoma(FTC)patients and 225 follicular thyroid adenoma(FTA)patients confirmed by postoperative pathology were analyzed retrospectively.Five acoustic characteristics defined by ACR TI-RADS were analyzed,including composition,echogenicity,shape,margin,echogenic foci and classification results.In addition,the diagnostic value of sound halo around the nodule and internal blood flow signals,as well as the characteristics of nodular goiter,multiple nodules and Hashimoto’s disease were also analyzed.[Results]In FTC and FTA groups,the cases with nodular goiter accounted for 58%(40/69)and 30%(68/225)respectively(P<0.05);cases with Hashimoto’s disease accounted for 9%(6/69)and 4%(9/225)respectively(P>0.05);and cases with multiple lesions accounted for 10%(7/69)and 5%(11/225)respectively(all P>0.05).Among the five acoustic features defined by ACR TI-RADS,there were significant differences in composition,echogenicity,margin and echogenic foci between FTC and FTA groups(P<0.05),but there was no significant difference in shape(P>0.05).ACR TI-RADS has the ability to distinguish benign and malignant follicular tumors(χ2=22.66,P<0.05).There was a significant difference in the grading characteristics of blood flow signals between FTC and FTA(P<0.05).[Conclusion]ACR TI-RADS has diagnostic value for benign and malignant thyroid follicular tumors,which can be further improved by the comprehensive judgment of sound halo around the nodule,internal blood flow and clinical information.