摘要目的 回顾性研究不同观察者使用甲状腺影像报告与数据系统(TI-RADS )词典对甲状腺结节描述的一致性,并确定不同 TI-RADS分类对恶性甲状腺结节的阳性预测值.方法 对2016年6－11月获得病理结果的172例连续患者的188个甲状腺结节使用TI-RADS超声词典进行评估,计算不同超声征象及TI-RADS最终分类的κ值,计算不同 TI-RADS 分类对恶性甲状腺结节的阳性预测值.结果 对于甲状腺结节结构、回声、形态、边缘、局灶性强回声的判断,κ值分别为0.743 (0.713 －0.772) 、 0.418 (0.319－0.517 ) 、 0.468 (0.389 －0.547 ) 、 0.397 (0.291 －0.503 ) 、 0.566 (0.514 －0.617) (括号内为95% 可信区间);对于结节 TI-RADS分类的判断,κ值为0.782 (0.749 －0.815 ) .TI-RADS 1～5类的阳性预测值分别为0 (0／8)、 0 (0／23)、 14.3% (4／28)、 29.7% (11／37)和85.7%(78／91) .结论 不同医师对结构判断的一致性很好,对于回声、形态、局灶性强回声判断的一致性中等,对于边缘判断的一致性不够理想.但最终得到甲状腺结节总体 TI-RADS分类一致性很好,表明该分类系统在不同医师间的应用不易导致对患者最终临床处置的不同,具有较好的应用价值.

abstractsObjective To retrospectively evaluate interobserver variability between radiologists by using lexicon of the Thyroid Imaging Reporting and Data System ( TI-RADS ) to classify lesions on ultrasonography and retrospectively determine the positive predictive value ( PPV) of each TI-RADS level. Methods Five radiologists retrospectively reviewed 188 consecutive thyroid nodules with known pathologic diagnosis of 172 patients from June,2016 to November,2016. Each observer described each lesion with TI-RADS terminology and final TI-RADS level were assigned by adding the points from all categories. Cohen κ statistic was used to assessed the interobserver variability for each ultrasonographic ( US ) descriptors and final TI-RADS level. PPV for all TI-RADS levels were determined for all readers combined. Results For each US descriptor,composition,echogenicity,shape,margin,echogenic foci,their κ were 0.743 (0.713－0.772),0.418 (0.319－0.517),0.468 (0.389－0.547),0.397 (0.291－0.503) and 0.566 (0.514－0.617) respectively ( data in parentheses are 95% confidential intervals). The κ for TI-RADS level was 0.782 (0.749 －0.81). PPV for TI-RADS level 1 to 5 were 0(0/8),0(0/23),14.3% (4/28),29.7%(11/37) and 85.7% (78/91). Conclusions Interobserver agreement with the TI-RADS terminology is substantial for composition, moderate for echogenicity, shape and echogenic foci, fair for margin. Interobserver agreement is substantial for TI-RADS level. Consequently different understanding in US images has little influence in patient management,justifying the use of ACR-TIRADS in clinical practice.