甲状腺影像报告和数据系统分级结合超声弹性成像对甲状腺结节的诊断效能

目的探讨甲状腺影像报告和数据系统（Thyroid Imaging Reporting and Data System,TI-RADS）分级结合超声弹性成像对甲状腺结节的诊断效能。方法回顾性收集2014年1～6月期间在四川大学华西医院行超声检查并进行手术的209例甲状腺结节患者（共222个结节）的临床资料,以病理学结果作为金标准,探讨TI-RDAS分级结合超声弹性成像对≤1 cm结节和〉1 cm结节的诊断价值。结果 222个甲状腺结节中,TI-RDAS分级结合超声弹性成像诊断为恶性结节178个,良性结节44个。对于〉1 cm的甲状腺结节,形态不规则（OR=6.376）、存在微钙化灶（OR=21.525）及有被膜浸润（OR=3.852）者的恶性风险高（P〈0.05）;对于≤1 cm的甲状腺结节,纵横比≥1（OR=3.406）和存在被膜浸润（OR=3.922）者的恶性风险高（P〈0.05）,且弹性评分越高,恶性风险越大（OR=1.606,P=0.045）。对于〉1 cm的甲状腺结节,TI-RADS分级联合超声弹性成像的灵敏度为98.3%（59/60）,特异度为68.6%（24/35）,准确率为87.4%（83/95）,阳性预测值为84.3%（59/70）,阴性预测值为96.0%（24/25）,约登指数为66.9%;对于≤1 cm的甲状腺结节,TI-RADS分级联合超声弹性成像的灵敏度为98.5%（67/68）,特异度为30.5%（18/59）,准确率为66.9%（85/127）,阳性预测值为62.0%（67/108）,阴性预测值为94.7%（18/19）,约登指数为29.0%。结论 TI-RADS分级结合超声弹性成像对≤1 cm与〉1 cm甲状腺结节的诊断价值有所不同,但对〉1 cm甲状腺结节其诊断效能更好。

The Diagnostic Value of Thyroid Imaging Reporting and Data System Combined with Sonography in Elastography for Thyroid Nodule

Objective To evaluate the diagnostic performance of Thyroid Imaging Reporting and Data System（TI-RADS）classification and elastography in differentiating benign and malignant thyroid nodules according to size.Methods A total of 222 thyroid nodules（209 cases） with solid or predominantly solid internal contentdiagnosed at pathological findings were enrolled in this study, all the 209 cases underwent surgery in our hospital from Jan.2014 to Jun.2014. The diagnostic performance of TI-RADS classification and elastography in differentiating benign and malignant thyroid nodules according to size nodules were evaluated（for ≤ 1 cm and 1 cm respectively）. Results By using TI-RADS category and elastography, 178 thyroid nodules were diagnosed as malignant nodules, and 44 thyroid nodules were diagnosed as benign nodules. The high predictive factors for malignant thyroid nodules of 1 cm were irregular shape（OR=6.376）, microcalcification（OR=21.525）, and capsule invasion（OR=3.852）, P 0.05. The factors for thyroid nodules of ≤ 1 cm were anteroposterior to transverse diameter ratio ≥ 1（OR=3.406）, capsule invasion（OR=3.922）, and high elastography score（OR=1.606）, that suggested the possibility of malignant（P 0.05）. For nodules of 1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of TI-RADS combining with elastography were 98.3%（59/60）, 68.6%（24/35）, 87.4%（83/95）, 84.3%（59/70）, 96.0%（24/25）, and 66.9% respectively;for nodules of ≤1 cm, the sensitivity, specificity, accuracy, positive predictive value,negative predictive value, and Youden index were 98.5%（67/68）, 30.5%（18/59）, 66.9%（85/127）, 62.0%（67/108）, 94.7%（18/19）, and 29.0% respectively. Conclusions TI-RADS category combined with elastography for diagnosis of thyroid nodules in different size has just a bit differently diagnostic indicators, but that play a high diagnostic performance on the thyroid nodules with maximum diamet