Loyola University Chicago Stritch School of Medicine, Department of Radiology, 2160 S. First Ave., Maywood, IL 60153, United States of America.
Clinical Research Office, Loyola University Chicago Health Sciences Division, United States of America.
Clin Imaging. 2020 Oct;66:93-97. doi: 10.1016/j.clinimag.2020.04.034. Epub 2020 May 3.
To evaluate diagnostic performance of PACS-based quantitative gray-scale ultrasound as an objective method in evaluation of pediatric thyroiditis.
Quantitative measurements of the echo-intensity level of the thyroid were obtained from ultrasound images, retrospectively using a PACS-based tool in 37 children with the tissue-proven diagnosis. Thyroid/muscle ratio was calculated by dividing the mean echo intensity of thyroid by that of adjacent strap muscle. Heterogeneity index (HI) was calculated by dividing thyroid standard deviation (SD) by thyroid mean values. For qualitative evaluation, two radiologists independently reviewed ultrasounds twice for the presence of thyroiditis. A consensus session was performed for patients for whom there was disagreement. Intra- and inter-observer reliability were assessed. Thyroid/muscle ratio and HI were correlated with final pathology.
Lymphocytic thyroiditis was found by histopathology in 19/37 (51%). No significant difference between thyroiditis and normal thyroid groups was found for either thyroid/muscle ratio (1.51 and 1.62, respectively, p = .82) or HI (0.23 and.23, respectively, p = .37). A larger proportion of patients for whom the consensus review indicated thyroiditis were confirmed by histopathology than would be expected by chance alone (12/19 (63%), p = .03). There was fair inter-observer agreement (κ with 95% confidence intervals of 0.36 (0.14-0.57), p = .004) and slight intra-observer agreement for each radiologist (κ with 95% confidence intervals of 0.13 (0.17-0.43), p = .39 and 0.17 (0.15-0.49), p = .31).
Quantitative gray-scale echo intensity analysis of US was not sufficient to diagnose thyroiditis in a pediatric population. Consensus qualitative analysis of ultrasound was more consistent with pathological diagnosis.
评估基于 PACS 的定量灰阶超声作为一种客观方法在评估小儿甲状腺炎中的诊断性能。
使用基于 PACS 的工具对 37 例经组织证实的甲状腺炎患儿的超声图像进行回顾性定量测量。甲状腺/肌肉比值通过将甲状腺的平均回声强度除以相邻颈肌的回声强度来计算。异质性指数（HI）通过将甲状腺标准差（SD）除以甲状腺平均值来计算。对于定性评估，两名放射科医生分别对超声结果进行两次阅片，以评估是否存在甲状腺炎。对于存在分歧的患者，进行共识会议。评估了观察者内和观察者间的可靠性。甲状腺/肌肉比值和 HI 与最终病理结果相关。
组织病理学发现淋巴细胞性甲状腺炎 19/37 例（51%）。甲状腺炎组和正常甲状腺组的甲状腺/肌肉比值（分别为 1.51 和 1.62，p=0.82）或 HI（分别为 0.23 和 0.23，p=0.37）均无显著差异。共识审查表明为甲状腺炎的患者中，经组织学证实为甲状腺炎的比例大于单纯随机预期（12/19（63%），p=0.03）。两名放射科医生之间的观察者间一致性为中等（κ值 95%置信区间为 0.36（0.14-0.57），p=0.004），每位放射科医生的观察者内一致性为轻度（κ值 95%置信区间为 0.13（0.17-0.43），p=0.39 和 0.17（0.15-0.49），p=0.31）。
在小儿人群中，定量灰阶超声回声强度分析不足以诊断甲状腺炎。超声的共识定性分析与病理诊断更为一致。
