美国放射学会甲状腺成像和报告系统超声分级对甲状腺结节的诊断价值

Value of ultrasonic American College of Radiology thyroid imaging reporting and data system in the diagnosis of thyroid nodules

目的评价美国放射学会甲状腺成像和报告系统(ACR-TIRADS)超声分级对甲状腺结节的诊断价值。方法选取2018年9月至2020年1月广州医科大学附属第四医院因甲状腺结节住院患者313例(430个结节)作为研究对象,通过对称测量评估ACR-TIRADS分级与病理结果的关联性并构建ROC曲线,根据尤登指数选取最佳诊断界点,评估ACR-TIRADS分级和主要超声特征的诊断效能。结果430个结节中良性结节303个(70.47%),恶性结节127个(29.53%)。对称性测量显示,ACR-TIRADS分级与病理结果呈显著正相关(r>0,P<0.05);尤登指数提示最佳诊断界点为ACR-TIRADS分级4级,对甲状腺结节诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为88.19%、79.54%、64.37%、94.14%。主要超声特征为极低回声、实性结节、不规则边缘、微小钙化、纵横比≥1优势比均大于1,纵横比≥1优势比最高(OR=40.6,95%CI9.49~173.93)。结论超声ACR-TIRADS分级对甲状腺结节具有较高诊断价值,纵横比≥1可作为甲状腺恶性结节的诊断指标。

Objective To evaluate the value of ultrasonic American College of Radiology-thyroid imaging reporting and data system(ACR-TI-RADS)in the diagnosis of thyroid nodules.Methods A total of 313 patients with the diagnosis of thyroid nodules(including 430 thyroid nodules)admitted to the Fourth Affiliated Hospital of Guangzhou Medical University from September 2018 to Janurary 2020 were collected as the research subjects.Symmetric measures were used to assess the correlation between ACR-TIRADS categories and pathology results.ROC curve was construct-ed and the best diagnostic cut-off was determined according to the Youden index.the diagnostic value of ACR-TIRADS categories and the main ultra-sonic features were assessed.Results 303 nodules(70.47%)out of 430 thyroid nodules were benign and 127 nodules(29.53%)were malignant.Symmetric measures showed significant positive correlation between ACR-TIRADS categories and pathology results(r>0,P<0.05).Youden index indicated that the best diagnostic cut-off was stage 4.Sensitivity,specificity,positive predictive value and negative predictive value in the diagnosis of thyroid nodules were 88.19%,79.54%,64.37%and 94.14%respectively.Odds ratios of the main ultrasonic features,including marked hypoecho-genicity,solid composition,irregular margins,microcalcification and taller-than-wide shape were greater than 1,while the taller-than-wide shape showed the highest odds ratio(OR=40.6,95%CI 9.49-173.93).Conclusion Ultrasonic ACR-TIRADS have great clinical value in the diagnosis of thyroid nodules,the presence of taller-than-wide shape may be considered as a significant ultrasonic feature of malignant thyroid nodules.