超声联合硬度评分系统诊断TI-RADS

目的 探讨超声联合硬度评分系统诊断甲状腺影像报告和数据系统（TI-RADS） 4类甲状腺结节的应用价值。方法 对105个接受手术切除并经病理证实的TI-RADS 4类甲状腺结节、术前分别行实时弹性成像和声脉冲辐射力成像测定其硬度。在此基础上，以联合硬度评分系统对甲状腺结节硬度进行评定，以硬度为依据，对甲状腺TI-RADS分类进行校正，以最终病理为标准，绘制ROC曲线，比较校正前后ROC曲线下面积。结果 TI-RADS分类校正前后诊断甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为40.50%（32/79）、92.30%（24/26）、94.11%（32/34）、33.80%（24/71）、53.33%（56/105）和73.41%（58/79）、88.46%（23/26）、95.08%（58/61）、52.27%（23/44）、77.14%（81/105）。ROC曲线下面积分别为0.66、0.84，二者差异有统计学意义（Z=10.85，P<0.001）。结论 联合硬度评分系统有助于提高对TI-RADS 4类甲状腺结节的鉴别诊断准确性。

United stiffness score system for diagnosis of TI-RADS 4 classification thyroid nodules

Objective To explore the value of united stiffness score system (USSS) in the diagnosis of thyroid imaging reporting and data system (TI-RADS) 4 thyroid nodules. Methods A total of 105 TI-RADS 4 thyroid nodules underwent thyroidectomy and proved by the pathological results were included. Real-time elastography (RTE) and acoustic radiation force impulse (ARFI) were performed. USSS was taken to re-evaluate the stiffness of the thyroid nodules. Then TI-RADS classifications were adjusted according to USSS scores. The ROC curves were drawn to evaluate their accuracy according to the final pathological results. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of TI-RADS classification for diagnosis of thyroid nudules were 40.50% (32/79), 92.30% (24/26), 94.11% (32/34), 33.80% (24/71) and 53.33% (56/105), respectively. After the correction of TI-RADS by USSS, these values were 73.41% (58/79), 88.46% (23/26), 95.08% (58/61), 52.27% (23/44) and 77.14% (81/105). The areas under the ROC curve were 0.66 and 0.84 before and after the correction and the difference was statistically significant (Z=10.85, P<0.001). Conclusion USSS is helpful in differential diagnosis of benign and malignant thyroid nodules of TI-RADS 4 classification.