[多普勒超声在评估脉络膜黑色素瘤血供中的应用：与造影血管造影和组织学检查的对比]

[Doppler ultrasound in the assessment of blood supply to choroidal melanoma: parallels with contrast angiography and histography].

作者信息

Panova I E, Samkovich E V, Nechiporenko P A

机构信息

Saint Petersburg branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Saint Petersburg, Russia.

Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.

出版信息

Vestn Oftalmol. 2023;139(1):27-34. doi: 10.17116/oftalma202313901127.

DOI:10.17116/oftalma202313901127

PMID:36924512

Abstract

PURPOSE

Evaluation of blood supply to choroidal melanoma based on comparison of Doppler characteristics of blood flow with angiographic variant of angioarchitectonics and densitometric parameters of the tumor.

MATERIAL AND METHODS

The study was performed in 135 patients (135 eyes) with choroidal melanoma. The initial prominence of the tumors varied from 0.6 to 15.2 mm (mean 5.07±3.58 mm), the diameter of the tumor base varied from 4.1 to 22 mm (mean 10.97±3.62 mm). Taking into account the biometric characteristics of choroidal melanoma, all patients were divided into 3 groups: «small» (=49), «medium» (=34) and «large» (=52). In addition to standard diagnostic examination, the following instrumental methods for assessing the blood supply of choroidal melanoma were carried out: angiography with indocyanine green, optical coherence tomography angiography, ultrasound in color Doppler mapping mode, ultrasound histography.

RESULTS

Comparative analysis of Doppler ultrasound and contrast angiography data in assessing the blood supply of choroidal melanoma established that the first angiographic type, presented by straight and parallel vessels (65%, =0.037), is characteristic for hypovascular and avascular masses, the second type - for hypervascular choroidal melanomas, in which the new vessels can take the form of arches, loops and nets (68%, =0.027). The study of densitometric characteristics in choroidal melanoma of various sizes indicates a natural decrease in the acoustic density of the tumor tissue with increase in the prominence of the mass, while there are significant differences in the acoustic density values in hypo/avascular (36.53±5.37 dB) and hypervascular variants (29.28±4.53 dB) of blood supply to tumor tissue.

CONCLUSION

The obtained data on acoustic density of choroidal melanoma can be used in clinical practice for indirect assessment of the nature of blood supply to choroidal melanoma.

摘要

目的

通过比较脉络膜黑色素瘤血流的多普勒特征与血管构筑造影变异及肿瘤密度参数，评估脉络膜黑色素瘤的血供情况。

材料与方法

对135例（135眼）脉络膜黑色素瘤患者进行研究。肿瘤初始突出度为0.6至15.2毫米（平均5.07±3.58毫米），肿瘤基底直径为4.1至22毫米（平均10.97±3.62毫米）。根据脉络膜黑色素瘤的生物测量特征，将所有患者分为3组：“小”（=49）、“中”（=34）和“大”（=52）。除标准诊断检查外，还采用以下仪器方法评估脉络膜黑色素瘤的血供：吲哚菁绿血管造影、光学相干断层扫描血管造影、彩色多普勒映射模式超声、超声组织学检查。

结果

在评估脉络膜黑色素瘤血供时，对多普勒超声和对比血管造影数据的比较分析表明，第一种血管造影类型，表现为直的和平行的血管（65%，P=0.037），是低血供和无血供肿块的特征，第二种类型 - 是高血供脉络膜黑色素瘤的特征，其中新血管可呈弓形、环状和网状（68%，P=0.027）。对不同大小脉络膜黑色素瘤密度特征的研究表明，随着肿块突出度增加，肿瘤组织的声学密度自然降低，而肿瘤组织低血供/无血供（36.53±5.37分贝）和高血供变异（29.28±4.53分贝）的声学密度值存在显著差异。