ACR-TIRADS与RJ-TIRADS描述词及分类在甲状腺结节评估者间的一致性研究

doi:10.16150/j.1671-2870.2019.02.006

摘要/Abstract

摘要：

目的：探讨美国放射学协会甲状腺影像报告和数据系统（American Radiological Society-thyroid imaging reporting and data system, ACR-TIRADS）与瑞金TIRADS（Ruijin-thyroid imaging reporting and data system, RJ-TIRADS）描述词及其分类标准在甲状腺结节评估者间的一致性。方法：回顾性分析经手术病理证实的597个甲状腺结节的超声图像，采用Cohen’s Kappa检验的统计方法评估2个版本TIRADS中的超声征象及其分类间的一致性。结果：①全部超声指标的描述词间均具有一致性。在ACR-TIRADS中，不同观察者间，甲状腺结节的边缘一致性弱、回声水平及病灶内强回声在观察者间的一致性均为中等，而结节内部结构一致性好。在RJ-TIRADS中，观察者间没有一致性弱的描述词，回声水平及内部血流均为中等一致，而边缘、边界、内部结构及钙化的一致性均好。②关于分类的一致性，在ACR-TIRADS中，甲状腺结节TIRADS 1类、2类、3类和5类的总体判读在不同观察者间一致性好，4类为中度一致;在RJ-TIRADS中，甲状腺结节TI-RADS 3类、4C类、5类的总体判读一致性好，4A及4B类为中度一致;若将4类作为一个整体来评估，则一致性好。结论：2个版本的TIRADS在甲状腺结节评估中均具有较好的临床价值。ACR-TIRADS中的边缘描述词在观察者间的一致性较弱，可分类合并后使用，即只分为光整或不光整两类进行评估，或在使用时应仔细、谨慎地评估;2个版本的分类中，TIRADS 4类均需进一步学习以提高观察者间的一致性，RJ-TIRADS中的4A和4B类可合并后使用，可提高诊断的一致性。

关键词: 超声, 甲状腺结节, 甲状腺影像报告和数据系统, 一致性

Abstract:

Objective: To evaluate the interobserver variability with the ACR TIRADS（American Radiological Society-Thyroid Imaging Reporting and Data System）and RJ-TIRADS (Ruijin-Thyroid Imaging Reporting and Data System）descriptive category terms of sonographic (US) features ofthyroid nodules. Methods: Retrospective analysis was conducted on 597 nodules. The US findings of each thyroid nodule were analyzed by two radiologists having at least 5 years of experience. All these cases had been pathologically confirmed. Interobserver variability was calculated using Cohen's Kappa statistics. Results: All the descriptive terms had statistical significance. In ACR-TIRADS, there were fair agreement for margin, moderate agreement forecho and calcification; internal structure showed substantial agreement.In RJ-TIRADS, there were no descriptive terms with weak agreement. Moderate agreement was found for echo level and internal blood flow, while substantial agreement was found with regard to margin, boundary, internal structure and calcification. With regard to category, for ACR-TIRADS, TIRADS 1, 2, 3 and 5 showed substantial agreement, while TIRADS 4 showed moderate agreement; for RJ-TIRADS, TI-RADS3, 4C and 5 showed substantial agreement, while TIRADS 4A and 4B showed moderate agreement. If the TIRADS 4 category was evaluated as a whole, the agreement between observerswas better. Conclusions: Both versions of TIRADS have good clinical value in evaluating thyroid nodules. In ACR-TIRADS, the agreement for margin is somewhat weaker, and should be evaluated as a whole or evaluated carefully when used. Both versions of TIRADS require further study to improve the agreement between observers, and classes 4A and 4B in RJ-TIRADS could be combined for elevating the agreement.

Key words: Ultrasound, Thyroid nodule, Thyroid imaging reporting and data system, Interobserver variability

中图分类号:

R582

徐上妍, 贾晓红, 倪晓枫, 詹维伟. ACR-TIRADS与RJ-TIRADS描述词及分类在甲状腺结节评估者间的一致性研究[J]. 诊断学理论与实践, 2019, 18(2): 149-154.

XU Shangyan, JIA Xiaohong, NI Xiaofeng, ZHAN Weiwei. Interobserver variability in sonographic evaluation of thyroid nodules with ACR-TIRADS and RJ-TIRADS[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(2): 149-154.

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评估指标	0分	1分	2分	3分
结构（取其一）	囊性或基本囊性;海绵状结构	混合性	实性或基本实性	-
回声（取其一）	无回声	高回声或等回声	低回声	极低回声
形态（取其一）	纵横比≤1	-	-	纵横比>1
边缘（取其一）	光滑，边界不清	-	分叶或不规则	甲状腺外侵犯
局灶性强回声（叠加）	胶质，无钙化	粗钙化	边缘钙化	微钙化

评估指标	阳性	阴性
实性	3	0
极低或低回声	2	0
纵横比>1	3	0
边缘不光整	4	0
边界模糊	2	0
微钙化	4	0
内部血流	1	0

影像学特征		κ值	P值
边缘	光整或边界清楚/分叶或不规则/甲状腺外侵犯	0.243	<0.001
回声水平	极低回声/低回声/等或高回声/无回声	0.414	<0.001
内部结构	实性或基本实性/混合性/囊性或囊性为主/海绵状	0.715	<0.001
病灶内强回声	微钙化/粗钙化/边缘钙化/胶质	0.525	<0.001

指标		κ值	P值
边缘	光整、不光整	0.613	<0.001
边界	清晰、模糊	0.677	<0.001
回声水平	极低或低回声、非极低或低回声	0.504	<0.001
内部结构	实性为主、非实性为主	0.698	<0.001
钙化	微钙化、非微钙化	0.702	<0.001
内部血流	有、无	0.525	<0.001

TIRADS分类	1类	2类	3类	4类	5类	总体
例数	98/89	73/79	65/59	189/203	172/167
κ值	0.723	0.751	0.695	0.602	0.785	0.720
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001