脉络膜黑色素瘤的三种影像学检查对比分析  

Comparative analysis of three different imaging techniques of choroidal melanoma

作　　者：陈伟[1,2] 魏文斌[1] 杨文利[1] 史雪辉[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]北京市第六医院眼科,硕士研究生100730

出　　处：《眼科》2010年第5期349-353,共5页Ophthalmology in China

基　　金：首都特色临床医学技术发展研究(Z080507030808);北京市自然科学基金(7092021;7072019)

摘　　要：目的通过对比超声、磁共振成像及眼底血管造影三种影像学检查方法对脉络膜黑色素瘤的诊断结果与病理诊断的一致性,探讨脉络膜黑色素瘤影像学检查的合理应用方法,提高脉络膜黑色素瘤的确诊率。设计回顾性病例系列。研究对象疑诊为脉络膜黑色素瘤的26例(28眼)患者。方法对26例(28眼)疑诊为脉络膜黑色素瘤患者术前进行眼B超和(或)彩色超声多普勒血流成像(CDFI)、磁共振成像(MRI)、荧光素眼底血管造影(FFA)和(或)吲哚青绿血管造影(ICGA)检查,结合病理诊断,应用SPSS12.0软件对影像学检查结果与病理诊断的一致性进行统计学分析。主要指标眼部超声、MRI、眼底血管造影的表现及肿瘤病理诊断。结果三种影像学检查结果与病理诊断的一致性由好到差依次为:MRI(κ=0.494,P=0.010)、超声检查(κ=0.348,P=0.050)、眼底血管造影(κ=0.140,P=0.463);超声检查对脉络膜黑色素瘤诊断的敏感度和特异度分别为95.2%和33.3%,MRI的敏感度和特异度分别为85.7%和66.7%,眼底血管造影的敏感度和特异度分别为76.2%和40.0%。联合MRI和眼底血管造影或三种影像学检查的诊断结果与病理诊断的一致性最好(κ=0.886,P=0.000),其对脉络膜黑色素瘤诊断的敏感度和特异度分别为100%和83.3%。结论三种影像学检查联合是目前除病理外敏感性和特异性最佳的诊断方法,优于单独应用以及其他两两组合。Objective To determine the consistency of three different imaging results and pathological results in diagnosis of choroidal melanoma. To search for a better algorithm of the imaging techniques to diagnose choroidal melanoma. Design Retrospective case series. Participants 26 cases （28 eyes） of suspected diagnosis of choroidal melanoma. Methods We selected 26 cases （28 eyes） of suspected diagnosis of choroidal melanoma. Before operations, the examinations of B-mode ultrasonography and/or color Doppler flow imaging （CDFI）, magnetic resonance imaging （MRI）, and fundus fluorescein angiography （FFA） and /or indocyanine green angiography （ICGA） were performed on all patients. The final diagnosis was made according to histopathological findings after local resection surgery. The consistency of histopathological findings and imaging examinations was analyzed using SPSS12.0 statistic software. Main Outcome Measures Uhrasonography, MRI, fundus angiography （FFA and/or ICGA） results and pathological results. Results The agreement between MRI diagnosis and pathological results was the best, although not desirable （K=0.494, P=0.010）. And the agreement between fundus angiography diagnosis and pathological results was the poorest （K=0.140, P=0.463）. The sensitivity and specificity of ultrasonogra- phy, MRI, fundus angiography in diagnosing choroidal melanoma was 95.2% and 33.3%, 85.7% and 66.7% and 76.2% and 40.0% respectively. Finally, the agreement between the diagnosis of the combination of MRI and fundus angiography or three imaging techniques and pathological results was fair （K=0.886, P=0.000）, their sensitivity and specificity in diagnosing choroidal melanoma was 100% and 83.3% respectively. Conclusion The combination of three imaging techniques could redound to accurate diagnosis of choroidal melanoma, their sensitivity and specificity was better than other two combinations.

关 键 词：脉络膜黑色素瘤/诊断 超声 磁共振成像 荧光素眼底血管造影 吲哚青绿血管造影 

分 类 号：R739.7[医药卫生—肿瘤]