前房深度的改变在开放性眼球损伤中MSCT诊断价值的探讨

摘要

Objective To determine the diagnostic value of the anterior chamber depth (ACD) of a globe as seen on CT images for detecting open-globe injury. Methods 62 patients with unilateral open-globe injury confirmed by surgery and 62 patients with other types of unilateral orbital trauma non open-globe injury were enrolled respectively as the observing group and the control group at the same time. The ACDs of the patients were measured and the differences were compared between the 2 groups. The diagnostic value of the difference of the ACDs between globes was evaluated by ROC analysis and the Youden's index was used to judge the cutoff value. Results ① The ACDs were measured only in 49 patients with open-globe injuries. The difference value , respectively, were (0. 48 ±0. 16) mm on the observing group and (0. 16± 0. 09) mm on the control group. There was statistical significance between the 2 groups ( z =-8. 255, P = 0. 000) ; ② In both observing and control group, the difference value of ACDs between injuried eye and the normal eye had statistical significance ( z =-4.328, -2.215, -2.674, P =0.000, 0. 027, 0. 007); ③ Under the ROC analysis, Youden's index was maximum (0. 816) when the difference value of ACD was 0. 35 mm. The sensitivity, specificity and accuracy for diagnosis of open-globe injury, if we used the difference value of ACD≥0. 35 mm as the diagnosis threshold, were 81. 6%, 100% and 91. 9% respectively; ④ Combining the change of ACD with the presence on CT images to diagnose the open-globe injury, the sensitivity, specificity and accuracy was 95. 2% ,100% and 97. 6%. Conclusion Change in the ACD is a helpful CT finding for detecting open-globe injury. When the difference value in the ACD≥0. 35 mm, the specificity and diagnostic accuracy are high. If combining with other presence on CT images, the diagnostic accuracy should be improved.%目的 探讨眼前房深度(anterior chamber depth,ACD)的改变在开放性眼球损伤中的诊断价值.方法 选取62例手术证实为单侧开放性眼球损伤的患者为观察组,另选择同时期单侧非开放性眼球损伤的患者62例为对照组,测量患者的ACD,并比较两组患者ACD改变有无差异;采用ROC分析来评价ACD改变对开放性眼球损伤的诊断价值,用最大约登指数来判断其截断值.结果 ①观察组仅49例患者进行了ACD的测量,其ACD差值为(0.48±0.16)mm;对照组ACD差值为(0.16±0.09)mm,两者比较差异有统计学意义(Z=-8.255,P=0.000);②观察组伤眼ACD与观察组正常眼ACD、对照组正常眼及伤眼的ACD比较,差异均有统计学意义(Z＝-4.328、-2.215、-2.674,P=0.000、0.027、0.007);③ROC分析中,当ACD差值取0.35mm时,约登指数最大(为0.816),以ACD差值≥0.35mm为诊断阀值,其诊断眼球开放性损伤的敏感性、特异性、准确度分别为81.6％、100.0％、91.9％;④将ACD的改变结合其它CT表现来诊断开放性眼球损伤,其敏感性、特异性、准确度分别为95.2％、100.0％、97.6％.结论 ACD的改变是诊断开放性眼球损伤有价值的CT表现,当双眼ACD差值≥0.35mm时,有很高的特异性和较高的敏感性、准确度,若结合眼球损伤的其它CT表现,可有效提高开放性眼球损伤的诊断准确率.