中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2013年
5期
428-432
,共5页
脉络膜肿瘤%黑色素瘤%造影剂%超声检查,多普勒,彩色
脈絡膜腫瘤%黑色素瘤%造影劑%超聲檢查,多普勒,綵色
맥락막종류%흑색소류%조영제%초성검사,다보륵,채색
Choroid neoplasms%Melanoma%Contrast media%Ultrasonography,doppler,color
目的 探讨脉络膜黑色素瘤的超声造影诊断特征和参数特点.方法 病例对照研究.2007年10月至2008年12月北京同仁医院眼科共收治脉络膜黑色素瘤患者21例(21只眼),其中男性13例,女性8例,年龄18 ～76岁,平均57岁.作为鉴别诊断,选择同期收治的脉络膜血管瘤患者14例(14只眼),其中男性9例,女性5例,年龄24 ～71岁,平均51岁.所有患者均行超声造影检查,将造影剂(六氟化硫微泡)沿肘静脉注射人体内,连续记录造影剂在病变内白充盈到消退的过程,应用Sonoliver软件对所记录的造影过程进行分析,计算病变区和病变核心区内部造影剂上升时间、达峰时间、峰值强度及平均渡越时间.通过logistic回归方程预测上述参数对脉络膜黑色素瘤诊断的敏感度和特异度,分析脉络膜黑色素瘤和脉络膜血管瘤不同的超声造影特点,提出有鉴别诊断价值的参数.结果 脉络膜黑色素瘤的超声造影特点:病变完全被造影剂填充,典型病例为白外周向中心的向心性填充,部分病例在病变内可见造影剂充盈缺损区；病变内的造影剂充盈时间晚于正常对照组织(眼球壁及眶内组织),但消退时间早于正常对照组织.定量分析的结果表明,脉络膜黑色素瘤病变内造影剂的达峰时间[(22.80±9.85)s]小于正常对照组织[(29.57 ±24.76)s],峰值强度[(191.31±146.90)％]大于正常对照组织[(100.00±0.00)％]；上升时间[(18.52±7.09)s]小于正常对照组织[(26.45 ±21.83)s]；平均渡越时间[(63.56 ±26.04)s]小于正常对照组织[(149.87±182.68)s]；以上结果经统计学分析处理,其中峰值强度和平均渡越时间的差异有统计学意义(t=-2.848、2.197,P＜0.01).将峰值强度和平均渡越时间两个有意义的参数,用logistic回归方程预测脉络膜黑色素瘤和脉络膜血管瘤的敏感度为90.5％(19/21),特异度为12/14.结论 超声造影检查是一种新的眼内肿瘤的诊断方法,病变内造影剂的峰值强度和平均渡越时间可以为脉络膜黑色素瘤的诊断和鉴别诊断提供帮助.
目的 探討脈絡膜黑色素瘤的超聲造影診斷特徵和參數特點.方法 病例對照研究.2007年10月至2008年12月北京同仁醫院眼科共收治脈絡膜黑色素瘤患者21例(21隻眼),其中男性13例,女性8例,年齡18 ～76歲,平均57歲.作為鑒彆診斷,選擇同期收治的脈絡膜血管瘤患者14例(14隻眼),其中男性9例,女性5例,年齡24 ～71歲,平均51歲.所有患者均行超聲造影檢查,將造影劑(六氟化硫微泡)沿肘靜脈註射人體內,連續記錄造影劑在病變內白充盈到消退的過程,應用Sonoliver軟件對所記錄的造影過程進行分析,計算病變區和病變覈心區內部造影劑上升時間、達峰時間、峰值彊度及平均渡越時間.通過logistic迴歸方程預測上述參數對脈絡膜黑色素瘤診斷的敏感度和特異度,分析脈絡膜黑色素瘤和脈絡膜血管瘤不同的超聲造影特點,提齣有鑒彆診斷價值的參數.結果 脈絡膜黑色素瘤的超聲造影特點:病變完全被造影劑填充,典型病例為白外週嚮中心的嚮心性填充,部分病例在病變內可見造影劑充盈缺損區；病變內的造影劑充盈時間晚于正常對照組織(眼毬壁及眶內組織),但消退時間早于正常對照組織.定量分析的結果錶明,脈絡膜黑色素瘤病變內造影劑的達峰時間[(22.80±9.85)s]小于正常對照組織[(29.57 ±24.76)s],峰值彊度[(191.31±146.90)％]大于正常對照組織[(100.00±0.00)％]；上升時間[(18.52±7.09)s]小于正常對照組織[(26.45 ±21.83)s]；平均渡越時間[(63.56 ±26.04)s]小于正常對照組織[(149.87±182.68)s]；以上結果經統計學分析處理,其中峰值彊度和平均渡越時間的差異有統計學意義(t=-2.848、2.197,P＜0.01).將峰值彊度和平均渡越時間兩箇有意義的參數,用logistic迴歸方程預測脈絡膜黑色素瘤和脈絡膜血管瘤的敏感度為90.5％(19/21),特異度為12/14.結論 超聲造影檢查是一種新的眼內腫瘤的診斷方法,病變內造影劑的峰值彊度和平均渡越時間可以為脈絡膜黑色素瘤的診斷和鑒彆診斷提供幫助.
목적 탐토맥락막흑색소류적초성조영진단특정화삼수특점.방법 병례대조연구.2007년10월지2008년12월북경동인의원안과공수치맥락막흑색소류환자21례(21지안),기중남성13례,녀성8례,년령18 ～76세,평균57세.작위감별진단,선택동기수치적맥락막혈관류환자14례(14지안),기중남성9례,녀성5례,년령24 ～71세,평균51세.소유환자균행초성조영검사,장조영제(륙불화류미포)연주정맥주사인체내,련속기록조영제재병변내백충영도소퇴적과정,응용Sonoliver연건대소기록적조영과정진행분석,계산병변구화병변핵심구내부조영제상승시간、체봉시간、봉치강도급평균도월시간.통과logistic회귀방정예측상술삼수대맥락막흑색소류진단적민감도화특이도,분석맥락막흑색소류화맥락막혈관류불동적초성조영특점,제출유감별진단개치적삼수.결과 맥락막흑색소류적초성조영특점:병변완전피조영제전충,전형병례위백외주향중심적향심성전충,부분병례재병변내가견조영제충영결손구；병변내적조영제충영시간만우정상대조조직(안구벽급광내조직),단소퇴시간조우정상대조조직.정량분석적결과표명,맥락막흑색소류병변내조영제적체봉시간[(22.80±9.85)s]소우정상대조조직[(29.57 ±24.76)s],봉치강도[(191.31±146.90)％]대우정상대조조직[(100.00±0.00)％]；상승시간[(18.52±7.09)s]소우정상대조조직[(26.45 ±21.83)s]；평균도월시간[(63.56 ±26.04)s]소우정상대조조직[(149.87±182.68)s]；이상결과경통계학분석처리,기중봉치강도화평균도월시간적차이유통계학의의(t=-2.848、2.197,P＜0.01).장봉치강도화평균도월시간량개유의의적삼수,용logistic회귀방정예측맥락막흑색소류화맥락막혈관류적민감도위90.5％(19/21),특이도위12/14.결론 초성조영검사시일충신적안내종류적진단방법,병변내조영제적봉치강도화평균도월시간가이위맥락막흑색소류적진단화감별진단제공방조.
Objective To investigate the characteristics of choroidal melanoma in contrast-enhanced ultrasonography.Methods Case-control study.From October 2007 to December 2008,21 choroidal melanoma patients (21 eyes) were treated in Beijing Tongren Hospital,including 13 males and 8 females with average age at 57 years (ranged from 18 to 76 years).Fourteen cases (14 eyes) of choroidal hemangioma treated during the same period,including 9 males and 5 females,with average age at 51 years (ranged from 24 to 71 years) were selected for the comparison.All patients were examined with contrast-enhance ultrasound,the contrast agent (sulfur hexafluoride) was injected into elbow vein,continuous recording of contrast agent in the lesions was conducted from filling to subside stages.Sonoliver software was used to analyze the imaging process.Logistic regression was used to compare the data collected from choroidal melanoma and hemangioma to develop a differential diagnosis equation for the diagnosis of choroidal melanoma.Results Contrast-enhanced ultrasonography in choroidal melanoma showed the following characteristics:the lesions were completely filled with the contrast reagent,the typical filling process began from the peripheral area to the center,filling defects were found in some cases,filling time in the melanoma was later than that in the normal tissues and faded early than that in the normal tissues.Quantitative analysis in choroidal melanoma lesions showed that the time to peak of contrast material [(22.80 ± 9.85) s] was less than that in the control group [(29.57±24.76)s],maximum intensity [(191.31 ± 146.90) ％] was greater than that in the control group [(100.00 ±0.00)％] ;rising time [(18.52 ±7.09)s] was less than that in the control group [(26.45 ± 21.83) s] and mean transit time [(63.56 ± 26.04) s] was less than that in the control group [(149.87 ± 182.68) s].The differences of maximum intensity and mean transit time between the melanoma and the controls were statistically significant (t =-2.848,2.197 ; P ＜ 0.01).Logistic regression equation using the maximum intensity and mean transit time parameters could distinguish choroidal melanoma and hemangioma with a sensitivity at 90.5％ (19/21) and specificity at 12/14.Conclusions Contrast-enhanced ultrasonography is a new method for the diagnosis of malignant tumors in the eye.Contrast-enhanced ultrasonography combining with quantitative analysis can be helpful for the diagnosis and different diagnosis of choroidal melanoma.(Chin J Ophthalmol,2013,49:428-432)
