超声弹性成像对眼内肿瘤的鉴别诊断价值

Value of ultrasonic elastosonography in differential diagnosis of intraocular tumors

目的:通过对比分析脉络膜黑色素瘤、脉络膜血管瘤、脉络膜转移癌和视网膜母细胞瘤等眼内常见肿瘤的超声弹性应变率比值,探讨超声弹性成像对鉴别眼内肿瘤良恶性的诊断价值。方法:选取2016年6—10月于首都医科大学附属北京同仁医院眼科就诊的眼内肿瘤患者65例(67只眼),对患眼进行二维超声、彩色多普勒超声、超声弹性成像检查,测算肿瘤与周围正常组织的应变率比值;并根据临床诊断结果,比较眼内恶性与良性肿瘤之间及几种眼内恶性肿瘤之间应变率比值,从而分析超声弹性成像鉴别诊断眼内肿瘤良恶性的价值。结果:65例(67只眼)眼内肿瘤测得的应变率比值分别为:脉络膜黑色素瘤42.27±18.88、脉络膜血管瘤14.40±12.66、脉络膜转移癌50.69±6.20、视网膜母细胞瘤48.28±12.05。应用方差分析对上述肿瘤的应变率比值进行比较,脉络膜黑色素瘤、脉络膜转移癌及视网膜母细胞瘤之间差异无统计学意义,而它们与脉络膜血管瘤之间差异均有统计学意义。结论:眼内恶性肿瘤脉络膜黑色素瘤、脉络膜转移癌及视网膜母细胞瘤与良性肿瘤脉络膜血管瘤之间硬度有显著差异,超声弹性成像可作为眼内肿瘤良恶性鉴别的重要检查方法。

Objective:To evaluate the diagnostic value of ultrasonic elastosonography in the differential diagnosis of benign and malignant tumors by comparing the strain ratios of choroidal melanoma, choroidal hemangioma, choroidal metastatic carcinoma and retinoblastoma.Methods:A total of 65 cases (67 eyes) of intraocular tumors were selected from June to October 2016 in Eye Center of Beijing Tongren Hospital, Capital Medical University. All eyes were examined by two-dimensional ultrasound, color Doppler ultrasound and ultrasonic elastosonography. The strain ratios of the tumors to surrounding normal tissues were calculated. According to the results of clinical diagnosis, the differences in strain ratio between malignant and benign tumors, and among various intraocular malignant tumors were compared. And then the value of ultrasonic elastosonography in the diagnosis of benign and malignant intraocular tumors was analyzed.Results:The strain ratios of 65 cases (67 eyes) were measured respectively: 42.27±18.88 in choroidal melanoma, 14.40±12.66 in choroidal hemangioma, 50.69±6.20 in choroidal metastatic carcinoma, and 48.28±12.05 in retinoblastoma. The strain ratios of these tumors were analyzed by using variance analysis. There was no signiifcant difference among choroidal melanoma, choroidal metastatic carcinoma and retinoblastoma. However, there were significant differences between the three malignant tumors and choroidal hemangioma.Conclusion:There is a signiifcant difference in hardness between intraocular malignant tumors (choroidal melanoma, choroidal metastatic carcinoma and retinoblastoma ) and benign tumors (choroidal hemangioma). Ultrasonic elastosonography can be used as an important examination method for identification of benign and malignant intraocular tumors.