目的

对采用美国放射学会的甲状腺影像报告与数据系统（ACR-TIRADS）评估甲状腺消融区声像图的临床应用现状进行调查分析，避免ACR-TIRADS误用于甲状腺消融区评估。

方法

本研究于2024年2月至2024年4月进行了包含20个问题的问卷调查，系统地分析相关从业医师对于ACR-TIRADS评估甲状腺消融区声像图的临床应用现状。选取30例经热消融治疗的良性甲状腺结节（BTN）、30例甲状腺乳头状癌（PTC）和5例Grave's病甲状腺功能亢进（GD）患者的消融术前和术后6个月配对声像图。将65例患者的配对声像图交由4名低年资超声技师和4名高年资超声医师，根据ACR-TIRADS计分规则对所有配对图像进行评分。比较2组读图计分结果的差异，分析BTN、PTC和GD三种疾病消融后ACR-TIRADS分值变化的趋势。

结果

参与问卷调查共172人，超声专业人员占96.51%（166/172）。其中，使用ACR-TIRADS评估甲状腺消融区的比例为38.55%（64/166），熟知ACR-TIRADS者采用其评估甲状腺消融区的比例显著高于知晓程度较低者（45.92% vs 27.94%，P=0.012），从事甲状腺热消融治疗者采用其评估甲状腺消融区的比例与不从事消融治疗者相比，差别无统计学意义（40.28% vs 37.23%，P=0.690）。低年资超声技师和高年资超声医师对三种疾病消融区声像的ACR-TIRADS评分变异系数相近（33.4% vs 39.0%），两组间的评分M（Q_R）分别为5（2）和5（2），差异无统计学意义（Z=-0.486，P=0.627）。与消融前相比，消融后BTN和GD的ACR-TIRADS分值升高（BTN：Z=-18.193，P＜0.001；GD：Z=-8.257，P＜0.001），差值M（Q_R）分别为2（2）和6（3），而PTC在消融后ACR-TIRADS分值显著下降（Z=-4.810，P＜0.001），差值M（Q_R）为0（2）。

结论

国内临床超声检诊工作中使用ACR-TIRADS评估甲状腺疾病热消融治疗并非个别现象；而在使用ACR-TIRADS评估甲状腺消融区声像时，以BTN和GD为代表的良性疾病会出现治疗后TIRADS评分升高、恶性风险上升的现象。因此，仍需强调ACRTIRADS不宜用于甲状腺消融区声像评估，对于消融后结节的超声评估，未来可能需要考虑建立新的参考标准。

Objective

To analyze the current clinical utilization of the American College of Radiology Thyroid Imaging Reporting and Data System （ACR-TIRADS） in assessing ultrasound images of ablated thyroid areas， with the objective of preventing inappropriate application of ACR-TIRADS for evaluation purposes.

Methods

A survey was conducted from February 2024 to April 2024 using a questionnaire consisting of 20 questions to systematically analyze the current clinical application status of ACR-TIRADS evaluation for ablated thyroid area sonograms among relevant medical practitioners.Thirty cases of benign thyroid nodules （BTN） treated with thermal ablation， thirty cases of papillary thyroid carcinoma （PTC）， and five cases of hyperthyroidism due to Graves' disease were selected for paired sonograms before and six months after ablation. The paired sonograms of 65 patients were evaluated by four junior ultrasound technicians and four senior ultrasound physicians in accordance with the ACR-TIRADS scoring criteria. The differences in scoring results between the two groups of image readings were compared，and the trends in ACR-TIRADS score changes after ablation for three types of diseases （BTN， PTC， and GD）were analyzed.

Results

A total of 172 medical practitioners participated in the survey， of which ultrasound professionals accounted for 96.51% （166/172）. Among them， the percentage of individuals utilizing ACRTIRADS for evaluating thyroid ablation areas stood at 38.55% （64/166）. The percentage of medical practitioners who were familiar with ACR-TIRADS and employed it for assessing ablated thyroid areas was significantly higher compared to the percentage of those with lesser awareness （45.92% vs 27.94%， P=0.012）.There was not a statistically significant difference in the percentage of individuals employing ACR-TIRADS for evaluating ablated thyroid areas between those conducting thermal ablation therapy and those not （40.28%vs 37.23%， P=0.690）. There was no statistically significant difference in the coefficient of variation for ACR-TIRADS scoring of the ablative area sonograms between inexperienced ultrasound technicians and experienced ultrasound physicians （33.4% vs 39.0%）. The score M （Q_R） for both groups was 5 （2）， indicating similarity in their evaluations （Z=-0.486， P=0.627）. After ablation， the ACR-TIRADS scores of BTN and GD increased compared to those before ablation （BTN: Z=-18.193， P＜0.001； GD: Z=-8.257， P＜0.001），with the difference value M （Q_R） being 2 （2） and 6 （3）， respectively. However， the ACR-TIRADS score of PTC significantly decreased after ablation （Z=-4.810， P＜0.001）， with the difference value M （Q_R） being 0（2）.

Conclusion

The use of ACR-TIRADS for evaluating thyroid diseases in thermal ablation treatment is not an isolated phenomenon in clinical ultrasound diagnosis in China. However， when using ACR-TIRADS to evaluate the sonograms of the ablated area， benign diseases represented by BTN and GD may show an increase in TIRADS score and malignant risk after treatment. Therefore， it is still emphasized that ACRTIRADS should not be used for evaluating sonograms of the ablated area， and new reference standards may need to be considered for ultrasound evaluation of nodules after ablation.