ACR TI-RADS分级评分系统对甲状腺结节的诊断价值

目的:研究美国放射学会甲状腺影像报告和数据系统（ACR TI-RADS）对甲状腺结节风险的诊断价值，分析ACR TI-RADS分级对于不同大小结节（以结节大小1 cm为界）的诊断效能，以指导临床。方法:收集2018年1月至2019年1月于我院行甲状腺结节切除术患者122例，利用二维超声对其136个结节进行了ACR TI-RADS分级评分，与病理结果对照绘制ROC曲线下面积，并观察ACR TI-RADS分级的灵敏度及特异度分布，利用曲线下面积（AUC）比较超声ACR TI-RADS分级对甲状腺结节的诊断价值及对不同大小结节在诊断上的效果。结果:二维ACR TI-RADS分级评分得到的ROC曲线下面积为0.855 3（0.753 7， 0.914 1），最佳界值点为6.5。＞1 cm与≤1 cm甲状腺结节间ACR TI-RADS分级评分的AUC 95%CI 无交叉，因此对于＞1 cm与≤1 cm结节间的ACR TI-RADS分级评分的诊断效果差异有统计学意义。结论:ACR TI-RADS分级系统对于判断甲状腺结节风险有价值，诊断的灵敏度95.3%、特异度62.7%，分级为TR5级的结节恶性风险明显增加。ACR TI-RADS分级对于直径>1 cm的甲状腺结节的诊断效能优于直径≤1 cm的结节。

Diagnostic value of ACR TI-RADS grading scoring system for thyroid nodules

Objective: To study the diagnostic value of the American Radiological Society Thyroid Imaging Reporting and Data System (ACR TI-RADS) in assessing the risk of thyroid nodules, and to analyze the diagnostic efficacy of the ACR TI-RADS classification for nodules of different sizes(with a nodule size of 1cm) to guide clinical practice. Methods:122 cases of thyroid nodule resection in our hospital from January 2018 to January 2019 were collected. The 136 nodules were graded by ACR TI-RADS using two-dimensional ultrasound, and the area under ROC curve was drawn by compared with the pathological results. The sensitivity and specificity distribution of ACR TI-RADS grading were observed. The diagnostic value of ultrasonic ACR TI-RADS grading for thyroid nodules and the diagnostic effect on nodules of different size were compared by using the area under curve(AUC). Results:The area under the ROC curve obtained by the two-dimensional ACR TI-RADS classification score was 0.855 3(0.753 7, 0.914 1), and the best cut-off point was 6.5. There was no crossover between the thyroid nodule diameter >1 cm and the nodule diameter ≤1 cm by ACR TI-RADS grading score AUC 95% CI, so there was a statistically significant difference in the diagnostic effect of ACR TI-RADS grading score between >1 cm and ≤1 cm nodule. Conclusion: The ACR TI-RADS grading system is valuable for judging the risk of thyroid nodules. The diagnostic sensitivity is 95.3% and the specificity is 62.7%. The malignant risk of nodules classified as TR5 is significantly increased. The ACR TI-RADS classification for the diagnosis of thyroid nodule diameter >1 cm is superior to the nodule with diameter ≤ 1 cm.