超声造影剂时间-强度曲线在眼内肿瘤诊断及鉴别诊断的应用

摘要

Objective To observe the time-intensity curve characteristics of contrast agents in intraocular tumor.Methods A total of 236 patients (238 eyes) with intraocular tumor were enrolled in this study.All the patients received regular ophthalmologic examination,two dimensional ultrasound,color doppler ultrasonography and contrast-enhanced ultrasonography.There were 166 patients (166 eyes) with choroidal melanoma,16 patients (18 eyes) with choroidal metastatic carcinoma,52 patients (52 eyes) with choroidal hemangioma,two patients (two eyes) with retinal hemangioma.The whole process of contrast-enhanced ultrasound were recorded, and exported as t images of Dicom format.These images were processed by Sonoliver software (Tomteck Company, Germany) to drawn the time-intensity curve of contrast agents in the intraocular tumors.Results All intraocular lesions were completely filled with contrast agent,concentric filling from the periphery to the center can be documented in some cases.The time-intensity curve of choroidal hemangioma and retinal hemangioma were basically the same.The time-intensity curve of choroidal melanoma and choroidal metastatic carcinoma were also basically the same.In the filling phase,all tumors were rapid filling type.In the regression phase,contrast agent subsided earlier than in control tissue within the melanoma or metastatic carcinoma lesions,but subsided synchronous or slightly faster than in control tissue within the choroidal hemangioma and retinal hemangioma lesions.Among 166 eyes with choroidal melanoma,138 eyes (83.1％) were in full compliance with the above changes,28 eyes (16.9％) were largely in line with these changes.All the eyes (100.0％) with choroidal metastatic carcinoma,choroidal hemangioma and retinal hemangioma were in full compliance with the above changes.Conclusion Time-intensity curve is quickly filling and fast regression for malignant intraocular tumors,but is quickly filling and slow regression for benign intraocular tumors.%目的 观察超声造影剂在眼内肿瘤内的时间强度曲线特征.方法 临床诊断的眼内肿瘤236例238只眼纳入研究.所有患者均行常规眼科检查及二维超声、彩色多普勒超声、超声造影检查.其中,脉络膜黑色素瘤166例166只眼；脉络膜转移癌16例18只眼；脉络膜血管瘤52例52只眼；视网膜血管瘤2例2只眼.记录超声造影的全过程,以Dicom格式输出图像,应用德国Tomteck公司的Sonoliver软件对输出的图像进行处理,绘制肿瘤内造影剂的时间-强度曲线.结果 所有患眼肿瘤病灶完全被造影剂填充,部分患眼可见自周边向中心的向心性填充.脉络膜黑色素瘤和脉络膜转移癌的时间强度曲线特征基本一致；脉络膜血管瘤和视网膜血管瘤的时间-强度曲线基本相同.所有肿瘤在充盈期的表现均为快速充盈型；但在肿瘤的消退期,前者表现为病变内的造影剂消退早于对照组织,后者表现为病灶内造影剂消退与对照组织同步或略晚于对照组织.脉络膜黑色素瘤166只眼中,完全符合上述变化特点者138只眼,占83.1％；基本符合上述变化特点者28只眼,占16.9％.脉络膜转移癌、脉络膜血管瘤和视网膜血管瘤均完全符合上述变化特点,占100.0％.结论 常见眼内恶性肿瘤的时间-强度曲线的特点为快进快出型；常见血管性良性肿瘤的时间-强度曲线的特点为快进慢出型.