超声造影与增强MRI在眼眶肿瘤病中的诊断价值

Value of Contrast-Enhanced Ultrasonography and Contrast-Enhanced MRI in the Diagnosis of Orbital Tumors

目的:比较超声造影(CEUS)与增强磁共振扫描两种检查方法在眼眶肿瘤中的诊断价值,并探讨两者增强模式对眼眶肿瘤良恶性鉴别诊断的价值。方法:选取我院眼科2011-2013年62例眼眶占位患者均行超声造影和MRI增强检查并分别做出诊断。以病理诊断为标准,计算两种检查方法在眼眶肿瘤中的诊断符合率、敏感性及特异率;然后依照病理结果将62例患者分为良恶性两组,比较两种检查方法增强强度在眼眶肿瘤良恶性组别中表达的差异性,分析增强模式的不同对良恶性鉴别的价值;应用Sonoliver软件分析所有62例眼科超声造影的病例,处理得到肿瘤造影时间-强度曲线(TIC),获取造影剂达到时间(AT)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)、半洗出时间进行定量分析;应用卡方检验及非参检验,P<0.05为差异有统计学意义。结果:1在对62列眼眶肿瘤的患者诊断中,CEUS与增强MRI的诊断符合率无差异,分别为82.3%和80.6%;敏感性分别为64.7%与70.2%,特异度分别为88.9%与84.4%,两者差异有统计学意义(P<0.05)。2在增强强度的比较中,CEUS增强强度在良恶性组别中分布存在不同(P<0.05);MRI增强强度在良恶性组别中分布无明显差异。3根据TIC获取的参数中:AT、RT、TTP、半洗出时间等参数在良恶性肿瘤分组中存在差异(P<0.05);而mTT在两者之间无明显差异。结论:超声造影在眼眶肿瘤的诊断符合率与MRI的表现无明显差异,而敏感性低于增强MRI,特异度高于增强MRI;超声造影的增强强度及造影时间-强度曲线在良恶性分组中存在明显差异,有利于进一步鉴别眼眶肿瘤的良恶性。在无法行增强MRI检查的病例中,超声造影作为一种补充检查方法有一定的临床价值。

Objective：To compare the value of contrast-enhanced ultrasound（CEUS）and contrast-enhanced MRI scan in the diagnosis of orbital tumors,and to explore the enhancement pattern in the differential diagnosis between benign and malignant orbital tumors.Methods：Sixty-two orbital space occupying lesion patients underwent the examination of ultrasonic imaging and MRI scanning respectively.After the final dianosis by pathology,coincidence rate,sensitivity and specificity of diagnosis by the two different methods were compared.The diagnositic value in differentiation of benigh and malignant tumors was also studied after contrast-enhanced by the two di-agnostic methods.Sonoliver software was used,and the indices such as contrast agent reach time（AT）,the rise time（RT）,time-to-peak（TTP）,mean transit time（determined by mTT）,half wash out time were obtained for quantitative analysis.Results：1in the diagnosis of patients with orbital tumors,coincidence rate of CEUS and MRI diagnosis was 82.3%and 80.6%respectively without significant difference.The sensitivity of CEUS and MRI was 64.7% and 70.2%respectively,while the specificity was 88.9%and 84.4%,respectively;and both showed significant difference（P〈0.05）.2In the enhancement pattern,contrast-enhanced echo intensity distribution is different between the benign and malignant groups（P〈0.05）;While contrast enhancement did not showed such value by MRI.3There was significant difference between benigh and malignant tumors in AT,RT,TTP,and half wash-out time（all P〈0.05）.Conclusion：Both untrasound and MRI are valuable in the diagniosis of orbital tumors.Contrast enhancement is helpful for the differential diagniosis of beigh and malignant orbital tumor.CEUS is a supplementary examination for the patients who can not undergo MRI scanning.