中小脉络膜黑色素瘤的超声诊断及鉴别诊断分析  

Ultrasound diagnosis and differential diagnosis of medium and small choroidal melanomas

作　　者：王子杨 杨文利 李栋军 陈伟 赵琦 李逸丰 崔蕊 沈琳 魏文斌 Wang Ziyang;Yang Wenli;Li Dongjun;Chen Wei;Zhao Qi;Li Yifeng;Cui Rui;Shen Lin;Wei Wenbin(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology &Visual Sciences Key Lab.,Beijing Key Lab.of lntraocular Tumor Diagnosis and Treatment,Beijing 100730,China)

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,眼科学与视觉科学北京市重点实验室,眼内肿瘤诊治研究北京市重点实验室,100730

出　　处：《中华眼科杂志》2018年第11期843-848,共6页Chinese Journal of Ophthalmology

基　　金：眼内肿瘤诊治研究北京市重点实验室2015年度科技创新基地培育与发展专项项目(Z151100001615052).

摘　　要：目的 探讨中小脉络膜黑色素瘤的超声诊断及鉴别诊断特征.方法 回顾性病例对照研究.收集2016年1月至2017年1月在首都医科大学附属北京同仁医院北京同仁眼科中心收治的拟诊为中小脉络膜黑色素瘤的患者36例(36只眼)为研究对象,其中男性16例,女性20例,年龄(50±12)岁,所有病变隆起高度不超过5 mm、基底不超过15 mm.并选取相同体积脉络膜血管瘤69例(69只眼)患者和脉络膜转移癌16例(19只眼)患者进行鉴别诊断,其中脉络膜血管瘤男性45例,女性24例,年龄(45±11)岁,脉络膜转移癌男性4例,女性12例,年龄(50±11)岁.分析超声检查中病变的位置、形态、隆起高度、基底-高度比率、内回声及内回声特性、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等超声检查特点.3种肿瘤间超声检查指标的比较采用x2检验、Fisher精确检验及方差分析;多因素分析采用Logistic回归法.结果 91.7%(33/36)的脉络膜黑色瘤、94.2%(65/69)的脉络膜血管瘤表现为扁平或半球形的隆起病变,而63.2%(12/19)的脉络膜转移癌形态不规则,表面可见切迹或呈波浪状,3组间差异有统计学意义(x2=43.480,P<0.001);脉络膜黑色素瘤隆起高度为(4.02±0.70)mm,脉络膜转移癌为(3.10±1.08)mm,脉络膜血管瘤为(2.75±0.87)mm,3组间差异有统计学意义(F=18.931,P<0.001);脉络膜黑色素瘤基底-高度比率为2.62±0.48,脉络膜转移癌为4.09±1.18,脉络膜血管瘤为3.16±0.58,3组间差异有统计学意义(F=28.853,P<0.001);86.1%(31/36)的脉络膜黑色素瘤和84.2%(16/19)的脉络膜转移癌的内回声表现为低于相邻眶内组织的低回声,92.8%(64/69)的脉络膜血管瘤内回声等于或高于眶内回声,3组间差异有统计学意义(x2=76.896,P<0.001);16.7%(6/36)的脉络膜黑色素瘤脉络膜凹陷征阳性,而所有脉络膜转移癌及脉络膜血管瘤均无脉络膜凹陷征,3组间差异有统计学意义(P=0.001);80.6%(29/36)的脉络�Objective To analyze the ultrasound diagnosis and differential diagnosis of medium and small choroidal melanomas.Methods It was a retrospective case series study.Thirty-six cases (36eyes) with medium or small choroidal melanoma were collected between January 2016and January 2017in Beijing Tongren Hospital,including 16males and 20females aged (50±12)years old.All tumors'apical heights were within 5mm and the largest basal diameter was within 15mm.Sixty-nine cases (69eyes)with choroidal hemangioma,including 45males and 24females aged (45±11)years old,and 16cases (19eyes) with choroidal metastasis,including 4males and 12females aged (50±11)years old,of equal size were also analyzed as differential diagnosis.Univariate (Chi-square test,Fisher's exact test,and analysis of variance) and multivariate analyses (Logistic regression)were used for statistical analysis.Results There were significant differences in morphology,height,base-height ratio,internal echo,choroidal excavation and secondary retinal detachment among the three types of tumors(all P<0.05).Approximately 91.7%(33/36)of choroidal melanomas and 94.2%(65/69)of hemangiomas were flat or dome,while 63.2%(12/19)of metastatic tumors showed a polygonal shape and an irregular surface contour.The average height was (4.02±0.70)mm for choroidal melanoma,(3.10±1.08)mm for metastasis and (2.75±0.87)mm for hemangioma.The base-height ratio of choroidal melanoma,metastasis,and hemangioma was 2.62±0.48,4.09±1.18and 3.16±0.58,respectively.About 86.1%(31/36)of choroidal melanomas and 84.2%(16/19)of metastases showed lower echo than adjacent orbital tissue,while 92.8%(64/69)of hemangiomas had similar or higher echo. About 16.7%(6/36)of choroidal melanomas showed choroidal excavation,but no such signs were found in other tumors.Approximately 80.6%(29/36)of choroidal melanomas,78.9%(15/19)of metastases and 52.2% (36/69)of hemangiomas showed secondary retinal detachment.The internal echo,height and base-height ratio were taken as significant independent influencing factor

关 键 词：超声检查 脉络膜肿瘤 黑色素瘤 血管瘤 脉络膜转移癌 

分 类 号：R739.7[医药卫生—肿瘤]