BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS re...BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.展开更多
目的针对当前甲状腺结节检出率上升以及超声医生应用甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)不规范的问题,探索通过案例教学法(Case-based Learning,CBL)与PDCA循环相结合的培训模式提升超声医生...目的针对当前甲状腺结节检出率上升以及超声医生应用甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)不规范的问题,探索通过案例教学法(Case-based Learning,CBL)与PDCA循环相结合的培训模式提升超声医生对TI-RADS的掌握程度。方法于2023年9月—2023年11月在陕西省人民医院超声科开展培训,内容涵盖TI-RADS理论学习、分层病例阅片、病理知识讲解及临床实践反馈,比较培训前后理论测试、阅片准确率及临床应用变化。结果共有50名超声医生完成培训,对甲状腺结节良恶性判断的准确率得到提升(57.6%vs.63.3%,P=0.003),TI-RADS 4a类分类准确率由38.0%提高至58.0%(P<0.001),而超声报告4类及4a类的占比明显下降,以及超声造影(60.0%vs.82.0%,P<0.001)和细针穿刺活检(80.0%vs.90.0%,P<0.001)结果中恶性占比显著提高。结论CBL与PDCA循环相结合的培训模式可有效提升超声医生对TI-RADS的掌握能力。展开更多
目的探讨中国版甲状腺影像报告与数据系统(Chinese-thyroid imaging reporting and data system,C-TI-RADS)4类甲状腺结节超声特点,分析超声造影联合弹性成像评分在结节性质校正中的价值。方法回顾性分析东南大学附属中大医院溧水分院2...目的探讨中国版甲状腺影像报告与数据系统(Chinese-thyroid imaging reporting and data system,C-TI-RADS)4类甲状腺结节超声特点,分析超声造影联合弹性成像评分在结节性质校正中的价值。方法回顾性分析东南大学附属中大医院溧水分院2020年4月~2023年12月80例患者资料,共105个结节。以细针穿刺活检或手术病理为“金标准”,Kappa检验评估诊断一致性,受试者工作特征(ROC)曲线评估诊断方法的区分度和准确性。结果经手术病理或穿刺活检证实,恶性结节68个(恶性组),良性结节37个(良性组)。经超声造影增强后,恶性结节低强度、向心性增强、不均匀增强、增强后结节边界模糊、增强后结节增大、增强后结节不规则占比显著高于良性组,而环状增强占比低于良性组(P<0.05)。超声造影评分诊断C-TI-RADS 4类甲状腺结节总符合率为83.81%(88/105),与病理结果相比,Kappa值为0.644。经ROC曲线分析计算,超声造影评分诊断结节良恶性的灵敏度为84.51%,特异度为82.35%,正确指数为0.669,阴性似然比为0.188,阳性似然比为4.789。应变弹性成像评分诊断C-TI-RADS 4类甲状腺结节总符合率为85.71%(90/105),与病理结果相比,Kappa值为0.689。经ROC曲线分析计算,应变弹性成像评分诊断结节良恶性的灵敏度为88.24%,特异度为81.08%,正确指数为0.693,阴性似然比为0.145,阳性似然比为4.664。超声造影增强特征、超声造影评分联合应变弹性成像评分AUC=0.922(0.876~0.968),准确率92.91%,联合诊断识别真正恶性结节与良性结节的能力较强。结论超声造影联合弹性成像评分在甲状腺C-TI-RADS 4类结节校正中具有重要价值,有助于提高诊断准确性。展开更多
Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for re...Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.展开更多
目的评价甲状腺影像报告和数据系统(thyriod imaging reporting and data system,TI-RADS)、超声造影(contrast-enhanced ultrasound,CEUS)及两者联合应用对甲状腺结节良恶性鉴别诊断的价值。方法回顾性分析196例274个甲状腺结节(恶性结...目的评价甲状腺影像报告和数据系统(thyriod imaging reporting and data system,TI-RADS)、超声造影(contrast-enhanced ultrasound,CEUS)及两者联合应用对甲状腺结节良恶性鉴别诊断的价值。方法回顾性分析196例274个甲状腺结节(恶性结节141个、良性结节133个)的常规超声TI-RADS分类、超声造影及两者联合应用结果,将病变分类为良性、可能良性、不能确定、可能恶性及恶性,并分别与手术病理结果对照分析,应用受试者工作特征曲线(ROC曲线)评价三种方法的诊断效果。结果 TI-RADS分类系统和超声造影联合检查诊断甲状腺癌ROC曲线下面积(0.917±0.019)大于单独TI-RADS分类(0.826±0.026)及超声造影(0.851±0.025),且有统计学意义(P=0.000、0.000、0.000)。结论 TI-RADS分类系统和超声造影对甲状腺良恶性结节鉴别诊断具有重要价值,两者联合应用能提高超声对甲状腺癌的诊断准确性。展开更多
目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2...目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2017年6月—2018年1月于上海交通大学医学院附属仁济医院超声医学科行超声检查的甲状腺结节患者66例(共67个结节,结节最大直径5.0~10.0 mm,为常规TI-RADS 4~5级)。所有甲状腺结节经常规超声检查后,均采用TI-RADS分级进行评估,并行3D-SWE技术检查、细针穿刺活检及BRAFV600E基因检测。所有结节依据手术病理或细针穿刺细胞学联合BRAFV600E基因突变检测结果分为良性组及恶性组,计算由3D-SWE区分的甲状腺良、恶性结节的阈值,并应用病灶杨氏模量参数进一步调整分级成为联合TI-RADS分级(即经常规超声联合3D-SWE技术调整后的联合TI-RADS分级),用于结节的良、恶性检测。结果·67个甲状腺结节中,恶性组38个,良性组29个。以三维矢状面最大杨氏模量(three-dimensional maximum Young's modulus in sagittal plane,3D-S-Emax)为诊断指标,鉴别甲状腺结节良恶性的阈值、曲线下面积(area under the curve,AUC)、灵敏度、特异度和准确度分别为24.6 kPa、0.683、65.8%、65.5%和65.7%。采用常规TI-RADS分级和联合TI-RADS分级分别对甲状腺结节行良恶性鉴别诊断发现,AUC分别为0.794和0.801且差异无统计学意义;而敏感度、特异度和准确度分别为63.2%、82.8%、71.6%以及86.8%、69.0%、79.1%,仅敏感度间差异具有统计学意义(P=0.004)。结论·常规超声联合3D-SWE技术调整的联合TI-RADS分级与常规TI-RADS分级虽然对甲状腺微小癌具有相似的诊断价值,但前者具有较高的诊断敏感度及较低的漏诊率。展开更多
文摘BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
文摘目的针对当前甲状腺结节检出率上升以及超声医生应用甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)不规范的问题,探索通过案例教学法(Case-based Learning,CBL)与PDCA循环相结合的培训模式提升超声医生对TI-RADS的掌握程度。方法于2023年9月—2023年11月在陕西省人民医院超声科开展培训,内容涵盖TI-RADS理论学习、分层病例阅片、病理知识讲解及临床实践反馈,比较培训前后理论测试、阅片准确率及临床应用变化。结果共有50名超声医生完成培训,对甲状腺结节良恶性判断的准确率得到提升(57.6%vs.63.3%,P=0.003),TI-RADS 4a类分类准确率由38.0%提高至58.0%(P<0.001),而超声报告4类及4a类的占比明显下降,以及超声造影(60.0%vs.82.0%,P<0.001)和细针穿刺活检(80.0%vs.90.0%,P<0.001)结果中恶性占比显著提高。结论CBL与PDCA循环相结合的培训模式可有效提升超声医生对TI-RADS的掌握能力。
文摘目的探讨中国版甲状腺影像报告与数据系统(Chinese-thyroid imaging reporting and data system,C-TI-RADS)4类甲状腺结节超声特点,分析超声造影联合弹性成像评分在结节性质校正中的价值。方法回顾性分析东南大学附属中大医院溧水分院2020年4月~2023年12月80例患者资料,共105个结节。以细针穿刺活检或手术病理为“金标准”,Kappa检验评估诊断一致性,受试者工作特征(ROC)曲线评估诊断方法的区分度和准确性。结果经手术病理或穿刺活检证实,恶性结节68个(恶性组),良性结节37个(良性组)。经超声造影增强后,恶性结节低强度、向心性增强、不均匀增强、增强后结节边界模糊、增强后结节增大、增强后结节不规则占比显著高于良性组,而环状增强占比低于良性组(P<0.05)。超声造影评分诊断C-TI-RADS 4类甲状腺结节总符合率为83.81%(88/105),与病理结果相比,Kappa值为0.644。经ROC曲线分析计算,超声造影评分诊断结节良恶性的灵敏度为84.51%,特异度为82.35%,正确指数为0.669,阴性似然比为0.188,阳性似然比为4.789。应变弹性成像评分诊断C-TI-RADS 4类甲状腺结节总符合率为85.71%(90/105),与病理结果相比,Kappa值为0.689。经ROC曲线分析计算,应变弹性成像评分诊断结节良恶性的灵敏度为88.24%,特异度为81.08%,正确指数为0.693,阴性似然比为0.145,阳性似然比为4.664。超声造影增强特征、超声造影评分联合应变弹性成像评分AUC=0.922(0.876~0.968),准确率92.91%,联合诊断识别真正恶性结节与良性结节的能力较强。结论超声造影联合弹性成像评分在甲状腺C-TI-RADS 4类结节校正中具有重要价值,有助于提高诊断准确性。
文摘Purpose: The objective of the study was to design and implement an electronic synoptic report for thyroid sonography that incorporates the thyroid imaging reporting and data system (TIRADS) and assess potential for reducing unnecessary fine needle aspiration biopsies (FNAB) of thyroid nodules. Methods: The electronic synoptic report was developed using a relational database based on elements from TIRADS and a multidisciplinary consensus statement for thyroid reporting. A retrospective analysis of 138 patients with previously reported thyroid sonographic exams was evaluated for the presence of these elements. The electronic synoptic report calculates the TIRADS score and generates a formal report. Using the TIRADS score the potential decrease in unnecessary FNAB was estimated. Results: Key TIRADS elements were variously reported ranging from 43% for the thyroid nodule’s architecture as solid or cystic. Thyroid nodule echogenicity and calcification was commented in 27% and 23%, respectively. Other features of the TIRADS score were commented in 0% to 8% of the official reports. Estimated reduction for potentially reduced need for FNAB was 34.5%. Conclusions: This study is the first implementation of synoptic reporting using a relational database for sonography of thyroid nodules. Implementation of an electronic standardized synoptic reporting system may facilitate more accurate, and more comprehensive reporting for thyroid ultrasound scanning of thyroid nodules. The use of TIRADS was estimated to be able to potentially reduce the need for FNAB which was significant.
文摘目的评价甲状腺影像报告和数据系统(thyriod imaging reporting and data system,TI-RADS)、超声造影(contrast-enhanced ultrasound,CEUS)及两者联合应用对甲状腺结节良恶性鉴别诊断的价值。方法回顾性分析196例274个甲状腺结节(恶性结节141个、良性结节133个)的常规超声TI-RADS分类、超声造影及两者联合应用结果,将病变分类为良性、可能良性、不能确定、可能恶性及恶性,并分别与手术病理结果对照分析,应用受试者工作特征曲线(ROC曲线)评价三种方法的诊断效果。结果 TI-RADS分类系统和超声造影联合检查诊断甲状腺癌ROC曲线下面积(0.917±0.019)大于单独TI-RADS分类(0.826±0.026)及超声造影(0.851±0.025),且有统计学意义(P=0.000、0.000、0.000)。结论 TI-RADS分类系统和超声造影对甲状腺良恶性结节鉴别诊断具有重要价值,两者联合应用能提高超声对甲状腺癌的诊断准确性。
文摘目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2017年6月—2018年1月于上海交通大学医学院附属仁济医院超声医学科行超声检查的甲状腺结节患者66例(共67个结节,结节最大直径5.0~10.0 mm,为常规TI-RADS 4~5级)。所有甲状腺结节经常规超声检查后,均采用TI-RADS分级进行评估,并行3D-SWE技术检查、细针穿刺活检及BRAFV600E基因检测。所有结节依据手术病理或细针穿刺细胞学联合BRAFV600E基因突变检测结果分为良性组及恶性组,计算由3D-SWE区分的甲状腺良、恶性结节的阈值,并应用病灶杨氏模量参数进一步调整分级成为联合TI-RADS分级(即经常规超声联合3D-SWE技术调整后的联合TI-RADS分级),用于结节的良、恶性检测。结果·67个甲状腺结节中,恶性组38个,良性组29个。以三维矢状面最大杨氏模量(three-dimensional maximum Young's modulus in sagittal plane,3D-S-Emax)为诊断指标,鉴别甲状腺结节良恶性的阈值、曲线下面积(area under the curve,AUC)、灵敏度、特异度和准确度分别为24.6 kPa、0.683、65.8%、65.5%和65.7%。采用常规TI-RADS分级和联合TI-RADS分级分别对甲状腺结节行良恶性鉴别诊断发现,AUC分别为0.794和0.801且差异无统计学意义;而敏感度、特异度和准确度分别为63.2%、82.8%、71.6%以及86.8%、69.0%、79.1%,仅敏感度间差异具有统计学意义(P=0.004)。结论·常规超声联合3D-SWE技术调整的联合TI-RADS分级与常规TI-RADS分级虽然对甲状腺微小癌具有相似的诊断价值,但前者具有较高的诊断敏感度及较低的漏诊率。
