Abstract:

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.

Key words: Thyroid diseases, Thermal ablation techniques, Thyroid imaging reporting and data system, Ultrasonography