甲状腺影像报告和数据系统联合超声弹性成像对甲状腺良恶性结节的诊断价值

摘要

Objective:To assess sonographic features of thyroid nodules associated with malignancy and to establish a scoring and categorizing method based on sonographic features.Methods:A total of 2 045 patients with 2 045 thyroid nodules were included and divided into 2 groups:benign (1 293) and malignant (752).First,11 sonographic features,including shape,border,margin,internal content,echogenicity,microcalcifications,posterior echo,halo,vascularization distribution,vascularization degree,and SR,were defined,and all nodules were retrospectively evaluated.Second,the features associated with malignancy were selected by statistical analysis and were assigned weightings according to their odds ratios.Third,a total score for each nodule was obtained after the assigned weightings of the suspicious features were summed.Fourth,the malignancy rate of each total score was calculated.Then a modified version of the Thyroid Imaging Reporting and Data System (TI-RADS) was established with reference to the American College of Radiology's Breast Imaging Reporting and Data System.Results:Six independent features associated with malignancy were a taller-than-wide shape,an irregular margin,solid internal content,marked hypoechogenicity and hypoechogenicity,microcalcifications and qualitative hard.The TI-RADS included 5 categories with different malignancy rates:category 3(＜2％),4A(3％～10％),4B(11％～50％),4C(51％～94％),and 5(≥95％).Conclusions:A modified version of TI-RADS was established on the basis of the sonographic features with different weightings according to the relative risk of malignancy.This system could be of great use in predicting the nature of thyroid nodules in a quantified and standardized way and also helping clinicians decide on the clinical management.%目的:评估与恶性肿瘤相关的甲状腺结节的超声特征,并建立基于超声特征的评分和分类方法.方法:共纳入2 045例患者共计甲状腺结节2 045个,分为良性(1 293个)和恶性(752个)两组.首先,定义11个声像图特征,包括形态、边界、边缘、结构、回声、微钙化、后方回声、声晕、血流分布、血供程度、应变率比值(SR),并回顾性评估所有结节.其次,通过统计分析选择与恶性肿瘤相关的特征,并根据它们的优势比分配权重.第三,在对可疑特征分配权重求和之后获得每个结节的总分数.第四,计算每个总分的恶性率.然后参考美国放射学会的乳腺影像报告和数据系统建立甲状腺影像报告和数据系统(TI-RADS).结果:与恶性肿瘤相关的6个独立特征是垂直方位、边缘不规则、实性结构、极低回声和低回声、微钙化和质地硬.TI-RADS包括5个具有不同恶性率的类别:3类(≤2％),4A类(3％～10％),4B类(11％～50％),4C类(51％～94％)和5类(≥95％).结论:根据恶性肿瘤的相对风险,依靠声像图特征和不同的权重建立TI-RADS系统,该系统可以通过量化评分的方式预测甲状腺结节的性质,并帮助临床医生决定治疗方案.