背景眼眶肿瘤因其复杂的组织病理学类型，临床上鉴别诊断相对困难，亟需利用新的诊断学技术鉴别其良恶性。
目的分析眼眶肿瘤患者的超声造影特点，比较眼眶良性肿瘤和眼眶恶性肿瘤的增强模式及增强类型的差异，评价超声造影对眼眶肿瘤的诊断价值。
方法对2010年9月至2013年9月在湖北医药学院附属太和医院确诊的眼眶恶性肿瘤患者24例和眼眶良性肿瘤51例的临床资料进行回顾性分析。所有患者术前在口头知情同意下采用MyLab Twice型彩色超声诊断仪进行超声造影检查，患者由肘静脉注射2.0 ml SonoVue造影剂，收集眼眶肿瘤造影的静态和动态图像，用SonoLiver分析软件进行分析，参考《超声造影临床应用指南》中关于肝脏超声造影的增强水平和增强模式的分类方法对眼眶肿瘤超声造影的特点进行分析，总结不同组织学类型超声造影增强模式及增强类型特点，利用SonoLiver软件定量分析法获得时间－强度曲线(TIC)和动态血管模式(DVP)参数，比较眼眶恶性肿瘤与眼眶良性肿瘤的超声造影影像学特征。
结果按照增强强度分型法发现，眼眶恶性肿瘤和良性肿瘤中病灶出现高增强者百分比分别为62.5%(15/24)和27.5%(14/51)，等增强者百分比分别为20.8%(5/24)和49.0%(25/51)，眼眶恶性肿瘤超声造影的增强水平明显高于良性肿瘤，差异有统计学意义( χ 2＝26.40， P<0.01)。按照增强模式分型法发现，眼眶恶性肿瘤和良性肿瘤病灶非均匀性增强者百分比分别为75.0%(18/24)和25.5%(13/51)，均匀性增强者百分比分别为25.0%(6/24)和47.1%(24/51)，眼眶恶性肿瘤病灶的非均匀增强比例明显高于良性肿瘤，差异有统计学意义( χ 2＝30.40， P<0.01)。眼眶恶性肿瘤中58.3%的病灶TIC形态表现为快升快降型，75.0%的DVP曲线形态表现为正负双相波型，眼眶良性肿瘤中78.7%的TIC形态表现为快升慢降型，74.5%的DVP曲线形态表现为正向波型，不同曲线形态的眼数分布差异均有统计学意义(TIC： Z＝－3.130， P＝0.002；DVP： Z＝－4.730， P＝0.000)。
结论超声造影检查显示不同组织病理学类型眼眶肿瘤增强方式及曲线形态不同，超声造影有助于眼眶恶性肿瘤与眼眶良性肿瘤的鉴别诊断。
BackgroundOrbital tumor has complex histological types and it is difficult for clinical differential diagnosis.Therefore, it is badly in need of a new diagnostic technology to distinguish its benign and malignancy.
ObjectiveThis study aimed to analyze and compare the characteristics of contrast ultrasound image between benign and malignant orbital neoplasms and evaluate the diagnostic value of contrast ultrasound to orbital tumor.
MethodsThe clinical data of 24 patients with malignant orbital neoplasms and 51 patients with benign orbital neoplasms were retrospectively analyzed in Taihe Hospital of Hubei University of Medicine from September 2010 to September 2013.Contrast ultrasound examination was carried out on all the patients using MyLab Twice color ultrasonic device under the informed consent.SonoVue solution of 2.0 ml was intravenously injected and then the state and dynamic graphs of orbital tumors were collected.According to the classification of enhanced levels and patterns, the imaging features of orbital neoplasms were evaluated, and time-intensity curve (TIC) and dynamic vascular pattern (DVP) curve were obtained with SonoLiver software.The general ultrasonic signs and contrast ultrasonic characteristics between benign and malignant neoplasms were compared.
ResultsHyper-enhanced lesions were found in 62.5%(15/24) and 27.5% (14/51), and iso-intensity lesions were found in 20.8% (5/24) and 49.0% (25/51) in the malignant orbital neoplasm patients and benign ones, respectively, with a significant difference in enhanced types between them ( χ 2=26.40, P<0.01). Based on the enhanced mode, heterogeneity enhancement lesions were found in 75.0% (18/24) and 25.5% (13/51), and hemogeneity enhancement lesions were seen in 25.0% (6/24) and 47.1% (24/51) in the malignant orbital neoplasm patients and benign ones, respectively, showing a significant differnce between them ( χ 2=30.40, P<0.01). The 58.3% patients showed rapid rising and sharp descending TIC curves, and 75.0% patients showed the biphasic wave DVP curves in the malignant lesions; while in the benign lesions, the TIC curves of 78.7% patients were quick lift and slow dessend, and the DVP curves of 74.5% patients appeared to be positive phasic wave.These curve features were significantly different between the malignant lesions and benign ones (TIC: Z=-3.130, P=0.002; DVP: Z=-4.730, P=0.000).
ConclusionsContrast-ultrasound examination shows that different tissue-derived orbital neoplasms have varied enhanced modes and types.Contrast-ultrasound examination is helpful for the differential diagnosis of orbital neoplasms.
柏刚,武犁,李蓬,等. 超声造影在眼眶肿瘤诊断中的临床价值[J]. 中华实验眼科杂志,2015,33(11)：1028-1032.
DOI:10.3760/cma.j.issn.2095-0160.2015.11.014版权归中华医学会所有。
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