Abstract | PURPOSE: To investigate whether contrast-enhanced ultrasound (CEUS) may help to diagnose retinal/ choroidal detachment and may help to differentiate intraocular lumps in cases with equivocal features on conventional grayscale and Doppler modes. MATERIALS AND METHODS: The institutional review board approved this retrospective study. The need for informed consent was waived. A computerized data search was performed in the database of our institution for patients with vitreous hemorrhage who underwent CEUS of the eye to assess retinal/ choroidal detachment and/or associated masses. This process yielded a total of 31 patients (18 men, 13 women, age range: 39 - 88 years) in whom CEUS was performed because the findings on conventional grayscale and Doppler modes were equivocal. CEUS was performed using low acoustic power contrast-specific modes. A 2.4 - 4.8 mL bolus of SonoVue was injected, followed by a saline flush. All examinations were digitally recorded for retrospective analysis. Confirmation of CEUS findings was obtained at surgery (n = 20) or with binocular indirect fundoscopy performed after clearance of the ocular media (n = 11). Two readers with different levels of ultrasound experience independently reviewed the imaging features. A five-degree scale ranging from definitely absent (score 1) to definitely present (score 5) was used to assess the presence or absence of retinal/ choroidal detachment on conventional ultrasound modes alone and with the addition of CEUS. ROC curve analysis was performed to assess the diagnostic accuracy of both methods. The inter-reader agreement was also evaluated. In patients with associated intraocular lumps, conventional Doppler modes and CEUS were used to differentiate non- tumor masses from tumor masses. RESULTS: According to the reference standard, 13 patients had retinal detachment, 4 had choroidal detachment, and 3 had both retinal and choroidal detachment. There were 8 associated intraocular lumps (4 subretinal hemorrhages, 3 malignant melanomas, 1 metastasis). The inter-reader agreement was good (K = 0.644) and very good (K = 0.833) for conventional modes and CEUS, respectively. The diagnostic performance of CEUS was high for both readers (area ± standard error under the ROC curve: 0.966 ± 0.031 and 0.900 ± 0.055 for readers 1 and 2, respectively). There were 2 false-positive results and 1 false-negative result in patients with proliferative diabetic retinopathy. CEUS was effective in differentiating subretinal hemorrhage from hypovascular tumors. CONCLUSION: CEUS can be used as a problem-solving technique when conventional ultrasound modes are not diagnostic for retinal/ choroidal detachment and when intraocular lumps cannot be characterized as tumor or non- tumor masses on conventional modes. The evaluation of patients with proliferative diabetic retinopathy, however, may be problematic.
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Authors | M Bertolotto, G Serafini, L M Sconfienza, F Lacelli, M Cavallaro, A Coslovich, D Tognetto, M A Cova |
Journal | Ultraschall in der Medizin (Stuttgart, Germany : 1980)
(Ultraschall Med)
Vol. 35
Issue 2
Pg. 173-80
(Apr 2014)
ISSN: 1438-8782 [Electronic] Germany |
PMID | 23450377
(Publication Type: Journal Article)
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Copyright | © Georg Thieme Verlag KG Stuttgart · New York. |
Chemical References |
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Choroid Diseases
(diagnostic imaging)
- Contrast Media
- Diagnosis, Differential
- Eye Neoplasms
(diagnostic imaging, secondary)
- Humans
- Image Enhancement
(methods)
- Male
- Melanoma
(diagnostic imaging)
- Middle Aged
- Observer Variation
- Retinal Detachment
(diagnostic imaging)
- Retinal Hemorrhage
(diagnostic imaging)
- Subretinal Fluid
(diagnostic imaging)
- Ultrasonography, Doppler, Color
(methods)
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