超声弹性成像对脉络膜黑色素瘤与脉络膜血管瘤鉴别诊断价值初探

The value of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma

目的:探讨超声弹性成像检查中的弹性评分法及应变率比值法在脉络膜黑色素瘤与脉络膜血管瘤鉴别诊断中的作用。方法:横断面研究。选取2016年7至10月于首都医科大学附属北京同仁医院眼科就诊的脉络膜黑色素瘤患者25例(25只眼)[男性13例,女性12例,年龄(48±12)岁]及同期就诊的脉络膜血管瘤患者25例(25只眼)[男性12例,女性13例,年龄(37±13)岁]。对脉络膜黑色素瘤、血管瘤患者患眼进行超声弹性成像检查,利用5分法对病变组织的硬度进行弹性评分,并测算肿瘤与周围正常组织的应变率比值。采用独立样本t检验比较脉络膜黑色素瘤与脉络膜血管瘤弹性评分及应变率比值差异。利用受试者操作特征(ROC)曲线比较弹性评分及应变率比值两种方法在脉络膜黑色素瘤与脉络膜血管瘤鉴别诊断中的效能,包括灵敏度、特异度及ROC曲线下面积(AUC)。结果:脉络膜黑色素瘤患者的弹性评分为2、3、4、5分者分别为3、8、13、1例,脉络膜血管瘤患者的弹性评分为2、3分者分别为18、7例。脉络膜黑色素瘤弹性评分高于脉络膜血管瘤弹性评分,差异有统计学意义[(3.48±0.77)分与(2.28±0.46)分比较;t=6.694,P<0.01]。脉络膜黑色素瘤及脉络膜血管瘤应变率比值分别为42.97±15.83及12.21±9.24,差异有统计学意义(t=8.392,P<0.01)。以弹性评分3分作为脉络膜黑色素瘤与脉络膜血管瘤鉴别诊断的弹性评分法临界点,弹性评分法的灵敏度为88.0%,特异度为72.0%,AUC为0.80(95%可信区间:0.663~0.900,P<0.01);以21.67作为脉络膜黑色素瘤与脉络膜血管瘤鉴别诊断的应变率比值临界点,应变率比值法的灵敏度为92.0%,特异度为92.0%,AUC为0.92(95%可信区间:0.808~0.978,P<0.01)。结论:超声弹性成像检查在脉络膜黑色素瘤与脉络膜血管瘤的鉴别诊断中可发挥一定作用,其中应变率比值法鉴别诊断价值高于弹性评分法。

Objective To explore the role of the scoring and strain ratio methods of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma.Methods A cross-sectional study.Twenty-five patients(25 eyes)with choroidal melanoma treated in the Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University from July to October 2016 were included in this study.There were 13 males and 12 females,with an average age of(48±12)years old.Twenty-five patients(25 eyes)with choroidal hemangioma treated in the same period were selected for differential diagnosis,including 12 males and 13 females,with an average age of(37±13)years.The lesions were examined by ultrasound elastography and scored,and the strain ratio of the tumor to the orbital tissue was measured.Two independent sample t test was used to compare the difference in the elasticity score and strain ratio between choroidal melanoma and choroidal hemangioma.The sensitivity,specificity and area under the receiver operating characteristic(ROC)curve were calculated to analyze the value of the two methods in the differential diagnosis of choroidal melanoma and choroidal hemangioma.Results The elastography score of choroidal melanoma was(3.48±0.77)points,including 2 points in 3 cases,3 points in 8 cases,4 points in 13 cases,and 5 points in 1 case.The elastography score of hemangioma was(2.28±0.46)points,including 2 points in 18 cases and 3 points in 7 cases.The difference in the elasticity score between patients with the two kinds of tumors was statistically significant(t=6.694,P<0.01).The strain ratio was 42.97±15.83 and 12.21±9.24 in the patients with choroidal melanoma and choroidal hemangioma,respectively,and the difference was statistically significant(t=8.392,P<0.01).Using 3 points as the diagnostic critical point of the elastography score,the sensitivity was 88.0%,the specificity was 72.0%,and the area under the ROC curve was 0.80(95%cofidence interval:0.663 to 0.900,P<0.01).Using 21.67 as the diagnostic critical point of the strain ratio,the sensitivity was 92.0%,the specificity was 92.0%,and the area under the ROC curve was 0.92(95%cofidence interval:0.808 to 0.978,P<0.01).Conclusions Ultrasound elastography plays a role in the differential diagnosis of choroidal melanoma and choroidal hemangioma.The differential diagnostic value of the strain ratio method is higher than the scoring method.