单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,“,”,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,“,”,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,甲状腺,TI-RADS,分类,岳林先,2016,1,甲状腺TI-RADS 分类岳林先 1,2,2,20112013,3,201120133,456,例,TPC95%,4,456例 TPC95%4,5,5,F,50,6,F,506,7,7,甲状腺结节,单发、多发,囊性、实性、混合性,增生性、肿瘤性,良性、恶性,恶性的类型,？,8,甲状腺结节单发、多发8,甲状腺结节,良性？恶性？,不处理,观察,随访时间,FNA,手术,临床需要明确,9,甲状腺结节良性？恶性？临床需要明确9,Thyroid imaging200920112013,10,Thyroid imaging200920112013,Ultrasonic feature of thyroid malignant,US,恶性征象,实质性,低回声,纵横比,1,边界模糊,微钙化,11,Ultrasonic feature of thyroid,Thyroid Imaging Reporting and Data System of US Features,TI-RADS,12,Thyroid Imaging Reporting and,甲状腺超声检查报告,TI-RADS,Thyroid Imaging Reporting and Data System,of Ultrasonography,13,甲状腺超声检查报告TI-RADSThyroid Imag,二、,TI-RADS,的基本分类,14,二、TI-RADS的基本分类14,TI-RADS:0,类,弥漫性,改变,的甲状腺,无,结节,Risk of malignant =0,15,TI-RADS:0类15,TI-RADS,：,0,类,不需分类,桥本甲状腺炎,16,TI-RADS： 0类不需分类桥本甲状腺炎16,TI-RADS:1,类,正常甲状腺,（术后完全切除甲状腺）,Risk of malignant =0,17,TI-RADS:1类正常甲状腺17,18,18,TI-RADS:2,类,囊性为主结节,实性良性结节,Risk of malignancy =0,高度提示良性,以实性为主，边界清楚，有蛋壳样或粗大钙化,19,TI-RADS:2类19,TI-RADS-2,类,20,TI-RADS-2类20,21,21,M-41,22,M-4122,腺瘤型甲状腺肿,F-42,23,腺瘤型甲状腺肿F-4223,TI-RADS: 3,类,实性为主,可能良性,恶性风险率,5%,24,TI-RADS: 3类24,结节性甲状腺肿,25,结节性甲状腺肿25,腺瘤样结甲肿,26,腺瘤样结甲肿26,TI-RADS:4,类,可疑恶性,（恶性风险,5,85%,）,27,TI-RADS:4类可疑恶性 27,Park 2011,US-feature,实质性,低回声,/,极低回声,无包膜,微钙化,纵横比,1,28,Park 2011US-feature28,29,29,F-51,F-42,30,F-51F-4230,TI-RADS 5,类,高度提示恶性（,45,项恶性征象）,Risk of malignancy =,87.5100,无论穿刺结果如何均考虑手术,31,TI-RADS 5类31,F-19,恶性？,TI-RADS=4,、,5,？,32,F-19恶性？TI-RADS=4、5？32,TI-RADS=4,、,5,？,33,TI-RADS=4、5？33,TI-RDAS 6,类,被病理证实的恶性结节,经,FNA,细胞学和组织学证实，,US,复查之结节,34,TI-RDAS 6类34,DQS,F25,CF,M36,TPC in FNA,35,DQS,F25CF,M36TPC in FNA35,三、恶性结节的解读,36,三、恶性结节的解读36,TI-RADS,US,恶性征象,实质性,低回声,纵横比,1,边界模糊,微钙化,Thyroid Imaging Reporting and Date System,of US Features,37,TI-RADSUS恶性征象Thyroid Imaging R,F-59,JB-2Y-Nor,38,F-59,JB-2Y-Nor38,TI-RADS-,？,实质性,solid,M51,，不同时，不同机，不同医师,1,st,-,腺瘤,2,nd,-4A,39,TI-RADS-？实质性 solid2nd-4A39,良性,/,恶性？,腺瘤、结甲、癌,达州曾,z-f33,TI-RADS-3,、,4,、,5,？,40,良性/恶性？,TI-RADS: 3? 4?,Margin Irregular Microlobulate or spiculate ill cicumscribe,41,TI-RADS: 3? 4?Margin Irr,HypoechogenicityMake hypoechogenicity,42,HypoechogenicityMake hypoec,低回声,/,极低回声：,-,亚急性甲状腺炎,-,极低回声,2014-10-f63,2014-12,不是结节,43,低回声/极低回声： -亚急性甲状腺炎-极低回声201,44,44,TI-RADS-,恶性征象,?,Micricalcification,良性钙化：粗大、环状,恶性钙化：微小钙化（,12mm,）,45,TI-RADS-恶性征象?Micricalcific,46,46,？,TPC,(),47,？TPC()47,微分叶和毛刺,包膜：毛刺、分叶,-TPC,不明显,-,甲状腺微分叶,乳腺,48,微分叶和毛刺 包膜：毛刺、分叶 -TPC,四、统一认识,49,四、统一认识49,50,50,Table 4. Abnormality Hierarchy,BI-RADS 2013 US and Mamography,51,Table 4. Abnormality Hierarchy,52,52,TI-RADS-?,0,类：弥漫性甲状腺炎，无结节,1,类：正常甲状腺,2,类：囊性（为主,50%,）,实性，形态规则，包膜完整,腺瘤,3,类：不典型的良性结节（结甲）,53,TI-RADS-?0类：弥漫性甲状腺炎，无结节53,可疑恶性,TI-RADS 4,类,4a: 1,项恶性征象,4b: 2,项恶性征象,4c: 3,项恶性征象,54,可疑恶性54,TI-RADS: 4,类,除外,CDFI,、弹性、,CEUS,55,TI-RADS: 4类除外CDFI、弹性、CEUS55,56,56,TI-RADS-,统一,57,TI-RADS-统一57,颈部转移性淋巴结,强有力的佐证,F,56y,偶然发现颈部包块,58,颈部转移性淋巴结强有力的佐证F,56y偶然发现颈部包块5,59,59,F,44,岁，颈部包块就诊,60,F,44岁，颈部包块就诊60,女，,23,岁,8,月术后,多次病检恶性证据不足,多处淋巴结转移,61,女，23岁61,TI-RADS,分类,不加入,CDFI,弹性,CEUS,62,TI-RADS 分类不加入CDFI弹性CEUS6,THANK YOU,2015-06,63,THANK YOU2015-0663,