Ocular Oncology Service, Department of Ophthalmology, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Etelä-Pohjanmaa Central Hospital, Seinäjoki, Finland.
Helsinki Medical Imaging Centre, University of Helsinki, Helsinki, Finland.
Am J Ophthalmol. 2020 Aug;216:156-164. doi: 10.1016/j.ajo.2020.03.049. Epub 2020 Apr 9.
To evaluate the consistency of hepatic ultrasonography (US) with staging computed tomography (CT) and magnetic resonance imaging (MRI), to analyze why US was inconsistent with CT/MRI, and to compare CT/MRI.
Reliability analysis.
Two hundred fifteen patients whose primary uveal melanoma was managed in the Helsinki University Hospital and who were diagnosed with hepatic metastases by US within 60 days of staging CT/MRI from January 1999 to December 2016 were included. Patients attended a real-life follow-up schedule including hepatic US, liver function tests (LFT), and a confirmatory CT/MRI. We evaluated the consistency of US with staging CT/MRI regarding the presence and number of metastases.
The enrolled patients underwent 215 US, 167 CT, and 69 MRI examinations, and 67% of them had biopsy-confirmed metastases. Screening was regular for 98% of the patients, and 66% were asymptomatic. US was fully consistent with CT/MRI in detecting metastases in 113 (53%) patients, in 63 (29%) CT/MRI showed more metastases, and in 16 (7%) CT/MRI showed fewer metastases than US. CT/MRI was inconsistent with US in 23 (11%) patients. The sensitivity of US in detecting metastases was 96% (95% confidence interval, 92-98). US failed to suggest metastases in 10 patients. LFT were abnormal in 6 of them, and a newly detected hepatic lesion was present by US in 4.
Hepatic US is a sensitive screening modality in detecting metastases in patients with primary uveal melanoma, if combined with LFT and, in case of any newly detected lesion, a confirmatory MRI.
评估肝脏超声（US）与分期计算机断层扫描（CT）和磁共振成像（MRI）的一致性，分析 US 与 CT/MRI 不一致的原因，并比较 CT/MRI。
可靠性分析。
纳入了 1999 年 1 月至 2016 年 12 月期间在赫尔辛基大学医院接受治疗的 215 例原发性眼葡萄膜黑色素瘤患者，这些患者在分期 CT/MRI 后 60 天内通过 US 诊断为肝转移。患者参加了真实的随访计划，包括肝脏 US、肝功能检查（LFT）和确认性 CT/MRI。我们评估了 US 与分期 CT/MRI 在转移灶的存在和数量方面的一致性。
纳入的患者接受了 215 次 US、167 次 CT 和 69 次 MRI 检查，其中 67%的患者有活检证实的转移灶。98%的患者进行了常规筛查，66%的患者无症状。US 在 113 例（53%）患者中完全与 CT/MRI 一致地检测到转移灶，在 63 例（29%）患者中 CT/MRI 显示更多转移灶，在 16 例（7%）患者中 CT/MRI 显示比 US 更少的转移灶。CT/MRI 在 23 例（11%）患者中与 US 不一致。US 检测转移灶的敏感性为 96%（95%置信区间，92-98）。US 未能提示 10 例患者存在转移灶。其中 6 例 LFT 异常，4 例 US 检测到新的肝内病变。
如果将 US 与 LFT 结合使用，并在发现任何新的病变时使用确认性 MRI，那么肝脏 US 是一种敏感的筛查方法，可用于检测原发性眼葡萄膜黑色素瘤患者的转移灶。
