BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS re...BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.展开更多
Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for re...Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.展开更多
目的评价甲状腺影像报告和数据系统(thyriod imaging reporting and data system,TI-RADS)、超声造影(contrast-enhanced ultrasound,CEUS)及两者联合应用对甲状腺结节良恶性鉴别诊断的价值。方法回顾性分析196例274个甲状腺结节(恶性结...目的评价甲状腺影像报告和数据系统(thyriod imaging reporting and data system,TI-RADS)、超声造影(contrast-enhanced ultrasound,CEUS)及两者联合应用对甲状腺结节良恶性鉴别诊断的价值。方法回顾性分析196例274个甲状腺结节(恶性结节141个、良性结节133个)的常规超声TI-RADS分类、超声造影及两者联合应用结果,将病变分类为良性、可能良性、不能确定、可能恶性及恶性,并分别与手术病理结果对照分析,应用受试者工作特征曲线(ROC曲线)评价三种方法的诊断效果。结果 TI-RADS分类系统和超声造影联合检查诊断甲状腺癌ROC曲线下面积(0.917±0.019)大于单独TI-RADS分类(0.826±0.026)及超声造影(0.851±0.025),且有统计学意义(P=0.000、0.000、0.000)。结论 TI-RADS分类系统和超声造影对甲状腺良恶性结节鉴别诊断具有重要价值,两者联合应用能提高超声对甲状腺癌的诊断准确性。展开更多
目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2...目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2017年6月—2018年1月于上海交通大学医学院附属仁济医院超声医学科行超声检查的甲状腺结节患者66例(共67个结节,结节最大直径5.0~10.0 mm,为常规TI-RADS 4~5级)。所有甲状腺结节经常规超声检查后,均采用TI-RADS分级进行评估,并行3D-SWE技术检查、细针穿刺活检及BRAFV600E基因检测。所有结节依据手术病理或细针穿刺细胞学联合BRAFV600E基因突变检测结果分为良性组及恶性组,计算由3D-SWE区分的甲状腺良、恶性结节的阈值,并应用病灶杨氏模量参数进一步调整分级成为联合TI-RADS分级(即经常规超声联合3D-SWE技术调整后的联合TI-RADS分级),用于结节的良、恶性检测。结果·67个甲状腺结节中,恶性组38个,良性组29个。以三维矢状面最大杨氏模量(three-dimensional maximum Young's modulus in sagittal plane,3D-S-Emax)为诊断指标,鉴别甲状腺结节良恶性的阈值、曲线下面积(area under the curve,AUC)、灵敏度、特异度和准确度分别为24.6 kPa、0.683、65.8%、65.5%和65.7%。采用常规TI-RADS分级和联合TI-RADS分级分别对甲状腺结节行良恶性鉴别诊断发现,AUC分别为0.794和0.801且差异无统计学意义;而敏感度、特异度和准确度分别为63.2%、82.8%、71.6%以及86.8%、69.0%、79.1%,仅敏感度间差异具有统计学意义(P=0.004)。结论·常规超声联合3D-SWE技术调整的联合TI-RADS分级与常规TI-RADS分级虽然对甲状腺微小癌具有相似的诊断价值,但前者具有较高的诊断敏感度及较低的漏诊率。展开更多
目的:观察甲状腺癌患者超声影像特征,通过甲状腺影像学报告及数据系统(Thyroid imaging reporting and data system,TI-RADS)对甲状腺癌性结节进行分级,期望对甲状腺癌术前定性做出更好预测。方法:将2008年9月至2011年8月天津医科大学...目的:观察甲状腺癌患者超声影像特征,通过甲状腺影像学报告及数据系统(Thyroid imaging reporting and data system,TI-RADS)对甲状腺癌性结节进行分级,期望对甲状腺癌术前定性做出更好预测。方法:将2008年9月至2011年8月天津医科大学总医院收治并经病例证实的甲状腺癌患者160例共235枚病灶纳入研究。对所有患者行常规彩色多普勒超声检查观察病灶的大小、数量、外部形态、边界清晰程度及病变肿块、周围血流分布特征,235个病灶按TI-RADS分级进行评分,评价TI-RADS评分在甲状腺恶性结节的诊断价值。结果:本组病例所示恶性结节176枚,其中形态欠规则,边界不清楚144枚(81.8%),内部不均匀低回声或稍低回声152枚(86.4%),内部探及沙砾样钙化灶144枚病灶(81.8%)。TI-RADS分级评分4、5级160枚(90.91%),TI-RADS分级评分2、3级16枚(9.09%)。结论:甲状腺彩超声像图中出现边界不清,形态不规则,低回声或稍低回声肿块,肿块内探及沙砾样钙化灶,肿块内部丰富血流信号是诊断甲状腺癌的重要指标,甲状腺癌病灶结节中TI-RADS分级评分为4、5级者有较高阳性率,对甲状腺癌术前定性预测有一定意义。展开更多
文摘BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
文摘Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.
文摘目的评价甲状腺影像报告和数据系统(thyriod imaging reporting and data system,TI-RADS)、超声造影(contrast-enhanced ultrasound,CEUS)及两者联合应用对甲状腺结节良恶性鉴别诊断的价值。方法回顾性分析196例274个甲状腺结节(恶性结节141个、良性结节133个)的常规超声TI-RADS分类、超声造影及两者联合应用结果,将病变分类为良性、可能良性、不能确定、可能恶性及恶性,并分别与手术病理结果对照分析,应用受试者工作特征曲线(ROC曲线)评价三种方法的诊断效果。结果 TI-RADS分类系统和超声造影联合检查诊断甲状腺癌ROC曲线下面积(0.917±0.019)大于单独TI-RADS分类(0.826±0.026)及超声造影(0.851±0.025),且有统计学意义(P=0.000、0.000、0.000)。结论 TI-RADS分类系统和超声造影对甲状腺良恶性结节鉴别诊断具有重要价值,两者联合应用能提高超声对甲状腺癌的诊断准确性。
文摘目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2017年6月—2018年1月于上海交通大学医学院附属仁济医院超声医学科行超声检查的甲状腺结节患者66例(共67个结节,结节最大直径5.0~10.0 mm,为常规TI-RADS 4~5级)。所有甲状腺结节经常规超声检查后,均采用TI-RADS分级进行评估,并行3D-SWE技术检查、细针穿刺活检及BRAFV600E基因检测。所有结节依据手术病理或细针穿刺细胞学联合BRAFV600E基因突变检测结果分为良性组及恶性组,计算由3D-SWE区分的甲状腺良、恶性结节的阈值,并应用病灶杨氏模量参数进一步调整分级成为联合TI-RADS分级(即经常规超声联合3D-SWE技术调整后的联合TI-RADS分级),用于结节的良、恶性检测。结果·67个甲状腺结节中,恶性组38个,良性组29个。以三维矢状面最大杨氏模量(three-dimensional maximum Young's modulus in sagittal plane,3D-S-Emax)为诊断指标,鉴别甲状腺结节良恶性的阈值、曲线下面积(area under the curve,AUC)、灵敏度、特异度和准确度分别为24.6 kPa、0.683、65.8%、65.5%和65.7%。采用常规TI-RADS分级和联合TI-RADS分级分别对甲状腺结节行良恶性鉴别诊断发现,AUC分别为0.794和0.801且差异无统计学意义;而敏感度、特异度和准确度分别为63.2%、82.8%、71.6%以及86.8%、69.0%、79.1%,仅敏感度间差异具有统计学意义(P=0.004)。结论·常规超声联合3D-SWE技术调整的联合TI-RADS分级与常规TI-RADS分级虽然对甲状腺微小癌具有相似的诊断价值,但前者具有较高的诊断敏感度及较低的漏诊率。
文摘目的:观察甲状腺癌患者超声影像特征,通过甲状腺影像学报告及数据系统(Thyroid imaging reporting and data system,TI-RADS)对甲状腺癌性结节进行分级,期望对甲状腺癌术前定性做出更好预测。方法:将2008年9月至2011年8月天津医科大学总医院收治并经病例证实的甲状腺癌患者160例共235枚病灶纳入研究。对所有患者行常规彩色多普勒超声检查观察病灶的大小、数量、外部形态、边界清晰程度及病变肿块、周围血流分布特征,235个病灶按TI-RADS分级进行评分,评价TI-RADS评分在甲状腺恶性结节的诊断价值。结果:本组病例所示恶性结节176枚,其中形态欠规则,边界不清楚144枚(81.8%),内部不均匀低回声或稍低回声152枚(86.4%),内部探及沙砾样钙化灶144枚病灶(81.8%)。TI-RADS分级评分4、5级160枚(90.91%),TI-RADS分级评分2、3级16枚(9.09%)。结论:甲状腺彩超声像图中出现边界不清,形态不规则,低回声或稍低回声肿块,肿块内探及沙砾样钙化灶,肿块内部丰富血流信号是诊断甲状腺癌的重要指标,甲状腺癌病灶结节中TI-RADS分级评分为4、5级者有较高阳性率,对甲状腺癌术前定性预测有一定意义。
