葡萄膜转移癌的超声诊断特征分析

Ultrasound diagnosis and analysis of uveal metastatic carcinoma

目的:探讨葡萄膜转移癌的超声诊断特征。方法:回顾性分析2012年1月—2016年11月北京同仁医院眼科收治的葡萄膜转移癌患者25例(29只眼),分析超声检查中病变的位置、形态、隆起高度、基底-高度比率、内回声及其特点、有无挖空征和脉络膜凹陷征、有无继发视网膜脱离和玻璃体混浊、彩色多普勒血流成像(color Doppler flow imaging,CDFI)检查病变内血流情况等。其中14例(14只眼)行超声造影检查,并进行时间-强度曲线分析。结果:25例(29只眼)葡萄膜转移癌患者,累及左眼8例(32.0%)、右眼13例(52.0%)、双眼4例(16.0%);位于虹膜睫状体4只眼(13.8%)、脉络膜25只眼(86.2%);7只眼(24.1%)病变超声表现为扁平隆起回声、7只眼(24.1%)为半球形隆起回声、15只眼(51.7%)病变表面回声不规则(可见切迹或呈波浪状);病变隆起高度平均为(3.5±2.2)mm,基底-高度比率平均为3.7±2.1;27只眼(93.1%)病变内回声表现为低于相邻眶内组织的低回声;2只眼(6.9%)挖空征阳性,5只眼(17.2%)脉络膜凹陷征阳性;21只眼(72.4%)出现继发视网膜脱离,11只眼(38.0%)合并玻璃体混浊。CDFI检查显示,21只眼(72.4%)病变内可见树枝状血流信号。14例(14只眼)行超声造影检查,其中13只眼(92.9%)病变的时间-强度曲线表现为快进快出型。结论:葡萄转移癌超声检查有一定的特征性表现,可为临床提供可靠的诊断和鉴别诊断依据。

Objective:To investigate the ultrasonographic characteristics of uveal metastatic carcinoma.Methods:The data of 29 eyes of 25 patients diagnosed of uveal metastatic carcinoma from January 2012 to November 2016 were retrospectively analyzed. The B-mode ultrasonography and color Doppler flow imaging (CDFI) were performed on them. Contrast-enhanced ultrasound was performed on 14 cases (14 eyes), and the characteristics of the time-intensity curve of the contrast agent were analyzed.Results:Among 25 cases (29 eyes) of uveal metastatic carcinoma, left eye was involved in 8 cases (32.0%), right eye was involved in 13 cases (52.0%) and both eyes were involved in 4 cases (16.0%). Four eyes (13.8%) located in the iris ciliary body and 25 eyes (86.2%) in the choroid. Ultrasound showed lfat echo lesion in 7 eyes (24.1%), hemispherical echo in 7 eyes (24.1%), and irregular surface of notch or wavy in 15 eyes (51.7%). The mean height of the lesions was (3.5±2.2) mm, and the mean base-height ratio was 3.7±2.1. In 27 eyes (93.1%) the echo of the lesions was lower than that of the adjacent orbital tissues. Two eyes (6.9%) showed hollowing out, and 5 eyes (17.2%) showed choroidal excavation. Secondary retinal detachment occurred in 21 eyes (72.4%), and vitreous opacity in 11 eyes (38.0%). CDFI examination showed branch-shaped blood lfow signal in 21 eyes (72.4%). The time-intensity curve in 13 eyes (92.9%) showed “quick in and quick out”.Conclusion:Uveal metastatic carcinoma has certain ultrasonographic characteristics, which can provide a reliable basis for clinical diagnosis and differential diagnosis.