眼科B超诊断眼底病变的符合率及其临床分析

Consistency in the diagnosis of fundus disease using B-scan ultrasonography and an analysis of its clinical appearance

目的 探讨眼科B超检查诊断眼底病变的临床符合率、敏感度、特异度以及各种病例的临床分析和超声表现,为屈光介质混浊眼眼底病变的B超诊断提供参考.方法 回顾性分析2006年6月至2008年9月期间行常规眼部B超检查的1092只屈光介质混浊眼的病例资料,通过计算B超诊断结果和最终眼底病变诊断之间的符合率、敏感度、特异度、假阳性率、假阴性率等指标对B超诊断进行一致性、可靠性和真实性评价.结果 眼科B超诊断眼底病变的临床符合率为85.07%,调整一致率为84.15%;一致性分析的Kappa值为0.6802;B超诊断灵敏度为84.51%,特异度为85.37%,正确诊断指数（Youden指数）为0.70;B超诊断眼底病变的阳性似然比为5.78,阴性似然比为0.18.B超检出率最高的眼底疾病为糖尿病性视网膜病变、外伤和年龄相关性黄斑变性;最易误诊的疾病为视网膜病变、视神经病变和视网膜水肿;最易漏诊的为年龄相关性黄斑变性和糖尿病性视网膜病变.结论 眼科B超应用于屈光介质混浊眼眼底病变的诊断有较高的临床符合率,可为治疗方案的选择和预后的评估提供相应指导.

Objective To analyze the results from ophthalmic B-scan ultrasonography for consistency, sensitivity and specificity in the diagnosis of fundus disease. All data from clinical analysis and ultrasonography were compared to support the use of B-scan as a reference for assessing refractive media opacity in fundus disease. Methods One thousand ninety-two eyes with refractive media opacity were examined with conventional B-scan ultrasonography from June 2006 to September 2008, and the data were reviewed and analyzed to evaluate for consistency, sensitivity, specificity,and the positive and negative predictive values between the B-scan ultrasonography results and the final diagnosis of fundus disease. The results of the B-scan ultrasonography were evaluated for consistency, reliability, and authentic assessment. Results The coincidence rate of B-scan ultrasonography for fundus disease was 85.07%, and the adjusted agreement was 84.15%; the Kappa index was 0.6802; The sensitivity was 84.51%, the specificity was 85.37%, and the Youden index was 0.70; the positive likelihood ratio was 5.78, and the negative likelihood ratio was 0.18. Fundus disease found out by B-scan most were diabetic retinopathy, trauma, and age related degeneration;the disease misdiagnosed easiest were retinopathy, optic neuropathy, and retina edema; the disease missed diagnosed easiest were age related degeneration and diabetic retinopathy. Conclusion Ophthalmic B-scan ultrasonography used in eyes with refractive media opacity has a high clinical coincidence rate in diagnosing fundus disease, and can be used as a guide for therapy and prognosis.