成人眼球内葡萄膜黑色素瘤与非黑色素瘤MRI比较研究

目的比较分析成人眼球内葡萄膜黑色素瘤与非黑色素瘤性肿块的MRI征象,寻找最佳联合诊断特征。方法回顾性分析首都医科大学附属北京同仁医院2005年3月至2015年12月经手术病理或临床随访确诊的254例成人眼球内肿块患者的MRI资料,包括128例葡萄膜黑色素瘤和126例非黑色素瘤性肿块。采用χ2检验或独立样本t检验比较两组肿块的MRI征象,包括部位、形态、边缘、T1WI和T2WI信号(分别与脑灰质和玻璃体相比)特征及均匀度、高度、基底径、基底径与高度比值、强化程度、强化方式、有无伴发视网膜脱离;采用二元logistic回归分析获取具有鉴别诊断价值的MRI征象,并采用受试者操作特征(ROC)曲线分析其诊断黑色素瘤的灵敏度、特异度和准确率,建立logistic回归模型构建联合参数,评价其诊断效能。结果黑色素瘤与非黑色素瘤间肿块部位、形态、边缘、T1WI和T2WI信号(分别与脑灰质和玻璃体相比)、信号均匀度、强化程度、伴发视网膜脱离,肿瘤高度、基底径与高度比值差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,肿块的T1WI和T2WI信号(与脑灰质相比)、高度、形态、部位、强化程度及伴发视网膜脱离是诊断黑色素瘤的有效指标,其中肿块的T2WI信号(与脑灰质相比)优势比(12.237)最大,准确率为86.2%。与脑灰质相比T2WI呈低信号和T1WI呈高信号的诊断准确率高于与玻璃体相比(Delong检验,P<0.001)。肿块的高度、强化程度、T1WI和T2WI信号(与脑灰质相比)联合诊断黑色素瘤的灵敏度、特异度和准确率分别为90.6%、92.1%和96.1%,高于任何单一指标(P<0.001)。结论综合分析肿块的T1WI和T2WI信号(与脑灰质相比)、高度、形态、部位、强化程度和伴发视网膜脱离情况可提高鉴别诊断葡萄膜黑色素瘤和非黑色素瘤性肿块的准确率,以脑灰质为参照物评估肿块的T1WI和T2WI信号优于玻璃体。

Value of MRI in the differential diagnosis of uveal melanoma and other intraocular masses in adults

Objective To compare MRI findings of uveal melanomas and other intraocular masses in adults and to evaluate the optimal MRI features for the differential diagnosis.Methods The MRI data of 254 patients with intraocular masses confirmed by histopathologic or clinical follow-up results from March 2005 to December 2015 in Beijing Tongren Hospital,Capital Medical University was analyzed retrospectively.A total of 128 patients with uveal melanoma and 126 patients with other intraocular masses were enrolled.MRI findings of the masses including the location,shape,margin,signal intensity on T1WI and T2WI compared to the gray matter and vitreous body,homogeneity and degree of enhancement of the mass,secondary retinal detachment,height,and ratio of basal diameter to height were compared between uveal melanoma and other intraocular masses byχ2 test or independent t test.The logistic regression analysis was performed to identify the most discriminating MRI features.The diagnostic performance of different predictive models was analyzed by receiver operating characteristic(ROC)curve.The model of multiple parameters was established by logistic analysis,and the diagnostic efficacy was evaluated.Results The location,shape,margin,signal intensity on T1WI and T2WI compared to the gray matter and vitreous body,homogeneity and degree of enhancement of the mass,secondary retinal detachment,height and ratio of basal diameter to height were significantly different between the uveal melanoma and other intraocular masses(all P<0.05).The results of logistic regression analysis showed that the signal intensity on T1WI and T2WI compared to the gray matter,height,shape,location,degree of enhancement of the mass,and secondary retinal detachment were associated with higher likelihood of uveal melanoma.The mass with hypointense on T2WI(compared with gray matter)was the best MRI feature in the differential diagnosis of uveal melanoma and other intraocular masses(odds ratio 12.237),with the accuracy of 86.2%.The diagnostic accuracy of low signal on T2WI and high signal on T1WI(compared with gray matter)was significantly higher than those of vitreous(Delong test,P<0.001).The sensitivity,specificity and accuracy of the combination of height,degree of enhancement,T1WI and T2WI signal compared to the gray matter were 90.6%,92.1%and 96.1%,respectively.The diagnostic performance of combination features was higher than that of each single sign(P<0.001).Conclusion MRI features including the signal intensity on T1WI and T2WI compared to the gray matter,height,shape,degree of enhancement of the mass,and secondary retinal detachment are helpful in the differential diagnosis between uveal melanoma and other intraocular masses.In addition,the gray matter as the reference is superior to the vitreous body in the evaluation of the signal intensity of intraocular masses.