背景：计算机断层扫描（CT）的使用增加导致甲状腺偶发瘤的检出率更高。目前，还没有广泛商定的指导方针来管理这些偶发瘤。本研究旨在调查 CT 检测到的甲状腺偶发瘤的患病率、随访实践和恶性率。方法：我们对 PubMed、Embase 和 Cochrane 数据库进行了全面检索，以识别 2024 年 4 月 12 日之前发表的相关研究 (PROSPERO #42024535501)。报告包括通过 CT 检测到的甲状腺偶发瘤的患病率、随访情况和恶性肿瘤 (ROM) 风险的研究。使用汇总比例和随机效应模型对综合结果进行分析。使用随机试验的 Cochrane 偏倚风险工具 (RoB 2) 和纽卡斯尔-渥太华量表工具评估偏倚风险。根据偶发瘤大小、CT 面积和研究人群年龄等特征进行亚组分析。结果：患病率分析纳入了涉及 195,959 名患者的 38 项研究，显示 CT 上甲状腺偶发瘤的患病率为 8.3%（置信区间 [CI]，7.4-9.3）。颈部 CT 的患病率（16.5%，CI，11.0-22.1）高于胸部 CT（6.6%，CI，5.3-7.9）。 27.0% (CI, 12.9-41.1) 的患者发现多发偶发瘤。在结节中，46.3% (CI, 32.3-60.3) ≥1 cm，28.6% (CI, 19.9-37.3) ≥1.5 cm。分别有 34.9% (CI, 26.1-43.7)、28.4% (CI, 19.9-36.9) 和 8.2% (CI, 2.1-14.4) 的病例进行了甲状腺超声检查、活检和手术。此外，涉及 6272 名患者的 25 项研究报告称，CT 检测到的甲状腺偶发瘤的 ROM 为 3.9%（CI，3.0-4.9）。与 <1 cm 的偶发瘤 (0.1%, CI, 0-0.8) 相比，≥1 cm (11.7%, CI, 3.9-19.4) 和 ≥1.5 cm (24.9%, CI, 0-52.7) 的偶发瘤具有更高的 ROM <1.5 厘米（0%，CI，0-0.2）。结论：大多数 CT 发现的甲状腺偶发瘤是良性的。在放射科医生和甲状腺专家之间实施协作协议来管理高风险甲状腺偶发瘤可以确保适当的随访和最佳的患者护理。

Background: The increased utilization of computed tomography (CT) has led to a higher detection rate of thyroid incidentalomas. Currently, there are no widely agreed-upon guidelines for managing these incidentalomas. This study aims to investigate the prevalence, follow-up practices, and malignancy rates of thyroid incidentalomas detected by CT. Methods: We conducted a comprehensive search of PubMed, Embase, and Cochrane databases to identify relevant studies published before April 12, 2024 (PROSPERO #42024535501). Studies reporting on the prevalence, follow-up, and risk of malignancy (ROM) of thyroid incidentalomas detected by CT were included. Combined outcomes were analyzed using pooled proportion with a random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Newcastle-Ottawa Scale tool. Subgroup analyses were conducted based on characteristics including size of the incidentaloma, CT area, and age of the study population. Results: Thirty-eight studies involving 195,959 patients were included in the prevalence analysis, revealing a prevalence of thyroid incidentalomas on CT of 8.3% (confidence interval [CI], 7.4-9.3). The prevalence was higher in neck CT (16.5%, CI, 11.0-22.1) compared with chest CT (6.6%, CI, 5.3-7.9). Multiple incidentalomas were found in 27.0% (CI, 12.9-41.1) of patients. Of the nodules, 46.3% (CI, 32.3-60.3) were ≥1 cm, and 28.6% (CI, 19.9-37.3) were ≥1.5 cm. Thyroid ultrasounds, biopsies, and surgeries were performed in 34.9% (CI, 26.1-43.7), 28.4% (CI, 19.9-36.9), and 8.2% (CI, 2.1-14.4) of cases, respectively. Additionally, 25 studies with 6272 patients reported a ROM of 3.9% (CI, 3.0-4.9) for thyroid incidentalomas detected on CT. A higher ROM was observed in incidentalomas ≥1 cm (11.7%, CI, 3.9-19.4) and ≥1.5 cm (24.9%, CI, 0-52.7) compared with those <1 cm (0.1%, CI, 0-0.8) and <1.5 cm (0%, CI, 0-0.2). Conclusions: Most thyroid incidentalomas identified on CT are benign. Implementing a collaborative protocol between radiologists and thyroid specialists to manage high-risk thyroid incidentalomas can ensure appropriate follow-up and optimal patient care.