The Value Of ACR TI-RADS Grading Scoring And Contrast-enhanced Ultrasound In The Diagnosis Of Thyroid Nodules

Objective The present study aims(1)to investigate the value of the American Radiological Society Thyroid Imaging Reporting and Data System(ACR TI-RADS)and contrast-enhanced ultrasound in assessing the risks of thyroid nodules and the diagnostic efficacy of the ACR TI-RADS grading system for nodules of different sizes to provide guidance on whether FNA and/or surgery should be performed for particular patients in clinical practice so that unnecessary invasive procedures and excessive follow-up observations can be avoided;and(2)to investigate the diagnostic value of meaningful characteristics of ultrasound images for the evaluation of high-risk nodules to simplify the ultrasound characteristics of high-risk nodules for establishing an ultrasound contrast scoring system.Materials and methodsCollect 122 cases of thyroid nodule resection in our hospital from January 2018 to January 2019,a total of 136 nodules,using two-dimensional ultrasound to perform ACR TI-RADS grading score for all nodules,and observe the sensitivity and specificity distribution of ACR TI-RADS grading under ROC curve area,The diagnostic value of ultrasonic ACR TI-RADS grading for thyroid nodules and the effect on diagnosis of different large nodules were compared by using the area under Curve(AUC).Contrast-enhanced ultrasonography was performed on 53 nodules with grades of TR3,TR4,and TR5 after ACR TI-RADS classification.Unilateral analysis of angiographic features and nodules was performed using the χ2 test to determine meaningful signs of contrast.For meaningful angiographic signs of nodules,a meaningful angiographic sign is positive,with a score of 1;no or no uncertainty is negative,with 0 points.According to the number of meaningful angiographic signs appearing in the nodules as the contrast score of the nodule,the pathological results were used as a standard to plot the ROC curve of meaningful angiographic signs,comparing contrast-enhanced ultrasound(CEUS)with ACR TI-RADS grading.Then,multiple linear regression analysis was used to analyze the value of meaningful angiographic signs in the evaluation of high-risk nodules.Results1.The area under the ROC curve obtained by the two-dimensional ACR TI-RADS classification score was 0.8553(0.7537,0.9141),and the best cut-off point was 6.5.There was no crossover between the nodule diameter >1 cm and the nodule diameter ≤1 cm ACR TI-RADS grading score AUC 95% CI,so there was a statistically significant difference in the diagnostic effect of ACR TI-RADS grading score between >1 cm and ≤1 cm nodule.2.There were six signs in the angiographic signs and the benign and malignant χ2 test results of the nodules were statistically significant,such as centripetal enhancement,uneven enhancement,low enhancement,the arrive time,irregular edge of the nodule after angiography,clear outline change.The area under the ROC curve of the contrast-enhanced ultrasound score was: 0.998(0.993,1.0000),the optimal cut-off point was 3.5,and the area under the curve of the contrast-enhanced ultrasound score was larger than the area under the curve of the two-dimensional ultrasound ACR TI-RADS score(0.998>0.855).In the multiple linear regression analysis,the p-values of centripetal enhancement,heterogeneity enhancement,low enhancement,and clear outline change were all less than 0.001,and the Beta values were 0.214,0.598,0.159,and 0.092,respectively,indicating that these four signs were statistically significant.Conclusions1.The ACR TI-RADS grading system is valuable for judging the risk of thyroid nodules.When the ACR TI-RADS score was >6.5(TR5),the malignant risk of nodule increased significantly.The ACR TI-RADS classification is superior to the nodule with diameter ≤ 1 cm for the diagnosis of thyroid nodules >1 cm in diameter.2.There are six signs of angiography associated with the evaluation of benign and malignant thyroid nodules,which are centripetal enhancement,uneven enhancement,low enhancement,arrival-time,irregular edge of the nodule after angiography,and clear outline change.The 3.5-point nodule has a higher risk of malignancy.Among them,the four signs of centripetal enhancement,uneven enhancement,low enhancement,and clear range change are more valuable for assessing the high risk of thyroid nodules.The first three can be used as the main angiographic signs to judge the high risk of nodule." Clear outline change" can be used as a secondary angiogram.The contrast-enhanced ultrasound angiography score is superior to the two-dimensional ultrasound ACR TI-RADS grading score in the diagnosis of thyroid nodules.