ACR“3层系统”对偶发甲状腺结节的应用价值

Application value of ACR "3-tiered system" in incidental thyroid nodules

摘要:

目的 统计多种影像检查中报告的偶发甲状腺结节（ITN）病例，应用美国放射学会（ACR）“3层系统”对ITN进行评价，评估其应用价值。方法 回顾性分析河南省商丘市第一人民医院2021年9月至2022年8月间医学影像检查中报告的ITN病例，并测量ITN的横断面最大直径，使用Fisher确切概率法比较ACR“3层系统”与“美国甲状腺学会（ATA）标准”及“20 mm阈值”的进一步超声检查率。结果 胸部CT（含增强）报告了3 371例ITN，头颈部CTA报告ITN数量占检查本身比例为13.7%。在纳入的影像检查中报告了3 818例ITN（5.2%）。使用ACR“3层系统”评价后建议ITN的进一步超声检查率（33.1%）明显低于使用“ATA标准”建议ITN的进一步超声检查率（65.0%）（P<0.05）。ACR“3层系统”建议ITN的进一步超声检查率（33.1%）高于“20 mm阈值”评估后建议ITN的进一步超声检查率（15.7%）（P<0.05）。结论 胸部CT是报告ITN最多的影像学检查方式，头颈部CTA是报告ITN占其检查本身比例最高的检查方式。通过ACR“3层系统”对ITN进行再评价，其可以降低ITN的后续超声检查率，并且相比“ATA标准”可以减少更多的ITN后续超声检查。影像医师应结合我国实际情况，合理、适度降低影像检查中ITN的报告率。

Abstract:

Objective According to the statistics of incidental thyroid nodule (ITN) cases reported in the various imaging examination, the 3-tiered system of the American Society of Radiology (ACR) was used to evaluate ITN in order to evaluate its application value.Methods ITN cases reported in medical imaging examination in our hospital from September 2021 to August 2022 were retrospectively analyed, the maximum diameter of ITN cross section was measured, and Fisher's exact test was used to compare the subsequent ultrasound examination rate of ITN by 3-tiered system of ACR, "American Thyroid Association(ATA) standard" and 20 mm threshold.Results Chest CT (including enhancement) reported 3371 cases of ITN, with head and neck CTA reporting ITN accounting for 13.7% of the examination itself. Among the included imaging examinations, 3818 cases of ITN (5.2%) were reported, the further ultrasonic examination rate of ITN recommended by 3-tiered system of ACR (33.1%) was significantly lower than that of ITN recommended by "ATA standard" (65.0%) (P<0.05). The further ultrasonic examination rate of ITN recommended by 3-tiered system (33.1%) was higher than that of ITN recommended by 20 mm threshold evaluation (15.7%) (P<0.001).Conclusion Chest CT is the imaging examination method that reports the most ITN, and head and neck CTA is the examination method that reports the highest proportion of ITN in its examination itself. The 3-tiered system can reduce the rate of further ultrasound examination in ITN, reduce more ITN subsequent ultrasound examination than the "ATA standard". Imaging physicians should combine with the actual situation in our country to reasonably and moderately reduce the reporting rate of ITNs in imaging examinations.