彩色多普勒超声在视网膜母细胞瘤诊断中的应用价值

Value of color Doppler ultrasonography in the evaluation of retinoblastoma

目的分析彩色多普勒超声在视网膜母细胞瘤(RB)诊断中的应用价值。方法选取2012年6月至2016年6月在首都医科大学附属北京同仁医院就诊的RB患者182例(共199只眼),全部患眼均接受眼球摘除手术,并行病理学检查证实。分别观察其二维及彩色多普勒超声特征,采用单因素方差分析比较不同形态RB基底部宽度及高度,有统计学意义再行LSD-t检验比较2组间差异;采用χ2检验比较2种方法 RB检出率差异。结果 RB的超声表现以球内实性病变为特征,可呈半球形、球形、不规则形或充满玻璃体腔,或沿视网膜弥漫生长,方差分析结果显示病变基底部宽度及高度半球形<球形<不规则形,差异均有统计学意义(F=29.134、24.474,P<0.001),LSD-t检验半球形与球形、球形与不规则形、半球形与不规则形两两比较,差异均有统计学意义(基底部宽度比较t=2.457、-2.333、-6.205,P均<0.05,高度比较t=3.917、-6.711、-7.244,P均<0.05)。全部病变回声不均匀,93.47%(186/199)出现钙斑,52.76%(105/199)可见低回声区,46.73%(93/199)继发视网膜脱离,31.16%(62/199)存在玻璃体混浊。彩色多普勒超声病变内部98.49%(196/199)可见血流信号,血流呈点状及分枝状。二维超声192眼诊断为RB,检出率为96.5%(192/199),彩色多普勒超声198眼诊断为RB,检出率为99.5%(198/199),彩色多普勒检出率高于二维超声,差异有统计学意义(χ2=4.167,P=0.031)。结论 RB具有特征性的超声表现,彩色多普勒超声在RB的诊断中有重要价值。

Objective To evaluate the value of color Doppler ultrasonography in the diagnosis of retinoblastoma(RB).Methods One hundred and eighty-two patients(199eyes)with RB confirmed by pathology from June2012to June2016in Beijing Tongren Hospital were included in this study.The two-dimensional gray-scale image and color Doppler imaging ultrasound features were observed.The variance analysis was used to compare the width and height of different morphologies.Comparison the detection rate of the two methods byχ2test.Results The ultrasonography of RB was characterized by substantial masses of the eyeball,which could be hemispherical,spherical,irregular,filled with vitreous cavity,or diffuse along the retina.The results of variance analysis showed statistical difference in three shapes(F=29.134,24.474,P<0.001),LSD-t test showed difference between hemisphere and spherical,spherical and irregular shape,hemispherical and irregular shape.The t values of basal width were2.457,-2.333and-6.205,respectively and all P<0.05respectively.The t value of height were3.917,-6.711and-7.244,respectively and all P<0.05.All lesions were uneven echo.Calcification and localized low echo area within the mass was observed in93.47%(186/199)and52.76%(105/199)eyes respectively.46.73%(93/199)retinal detachment and31.16%(62/199)vitreous opacity is present.Colorful blood flow signals extended from the central retinal vessels could be seen inside the masses of98.49%(196/199)eyes.Two-dimensional image and color Doppler imaging ultrasound were consistent with the pathological diagnosis in96.5%(192/199)and99.5%(198/199)RB cases,respectively.The difference was statistically significant(χ2=4.167,P=0.031).Conclusions Retinoblastoma has characteristic ultrasound manifestations.Color Doppler ultrasonography is a valuable clinical tool in the diagnosis of RB.