标题：超声在测量甲状腺结节中观察者内和观察者间的变异性

      作者：刘丽敏，欧阳征仁，孟莉娟，游志辉，刘玲，欧阳靖霖，陈曼    (南华大学附属第二医院超声科，湖南 衡阳 421001)

      卷次： 2018年29卷20期

      【摘要】 目的 评估灰阶超声在测量甲状腺结节中观察者内和观察者间的变异性。方法 2017年 10月至2018年4月，通过超声测量来自南华大学附属第二医院41例患者中51个最大径≥5 mm甲状腺结节的前后径、左右径、上下径和最大径，并通过椭圆形公式来估算结节体积，两名超声科医师对每个结节独立测量两次，使用布兰德-奥特曼(Bland-Altman)来评估观察者内和观察者间的变异性，通过配对 t检验比较差异性的绝对值。结果 95%的观察者内和观察者间的协议范围(LOA)分别为±2.15、±1.39、±2.85 (前后径)；±1.29、±1.90、±3.10 (左右径)；±2.75、±1.60、±3.00 (上下径)；±2.50、±1.45、±2.65 (最大径)；±1 309.90、±952.05、±1 328.40 (体积)，四条径线和体积的变异性的绝对值在观察者内均低于观察者间，差异有显著统计学意义(P<0.01)。结论 超声在测量甲状腺结节中，观察者内和观察者间均存在一定的变异性，观察者内变异性小于观察者间，以上变异性在超声随访甲状腺结节中需要被关注。
      【关键词】 甲状腺结节；超声；观察者内；观察者间；变异性
      【中图分类号】 R581 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2877—04

Intraobserver and interobserver variability in measurements of thyroid nodules by ultrasound.
LIU Li-min,OUYANG Zheng-ren, MENG Li-juan, YOU Zhi-hui, LIU Ling, OUYANG Jing-lin, CHEN Man. Department of Ultrasound,the Second Affiliated Hospital of University of South China, Hengyang 421001, Hunan, CHINA
【Abstract】 Objective To assess the intraobserver and interobserver variability in measurements of thyroid nod-ules by grayscale ultrasound (US). Methods From October 2017 to April 2018, 41 patients with thyroid nodules whoadmitted to the Second Affiliated Hospital of University of South China were enrolled into this study, and 51 thyroid nod-ules with maximum diameterd ≥5 mm were measured in US. The measurements included 4 dimensions: anteroposteri-or, transverse, longitudinal, maximum diameters, and the volume was estimated by using the ellipsoid formula. Two so-nographers independently measured each nodule twice. The intraobserver and interobserver variability was assessed byBland-Altman analysis of agreement. The absolute values for intraobserver and interobserver differences were comparedby a paired t test. Results The 95% intraobserver and interobserver LOA (limits of agreement) were respectively as fol-lows: ±2.15, ±1.39, ±2.85 (anteroposterior diameters); ±1.29, ±1.90, ±3.10 (transverse diameters); ±2.75, ±1.60, ±3.00(longitudinal diameters); ±2.50, ±1.45, ±2.65 (maximum diameters); ±1 309.90, ±952.05, ±1 328.40 (volume). The abso-lute values of the four diameters and volume for intraobserver variability were lower than interobserver variability of allmeasurements, and the differences were statistically significant (P<0.01). Conclusion In US measurement of thyroidnodules, there existed considerable intraobserver and interobserver variability, and the interobserver variability was great-er than intraobserver variability, which should be noted in follow-up US of thyroid nodules.
      【Key words】 Thyroid nodule; Ultrasound (US); Interobserver; Intraobserver; Variability·论 著·doi:10.3969/j.issn.1003-6350.2018.20.020