脉络膜骨瘤的多模式影像分析

目的：探讨脉络膜骨瘤患眼的眼底多模式影像特征。

方法：回顾性病例观察研究。选取2015-10/2019-08在西安市第三医院眼科检查确诊且资料完整的脉络膜骨瘤患者9例15眼纳入研究。所有患者均接受眼底彩色照相、短波长眼底自发荧光(SW-AF)、红外眼底自发荧光(IR-AF)、眼底荧光素血管造影(FFA)、吲哚菁绿血管造影(ICGA)、光学相干断层扫描成像(OCT)以及眼眶X线电子计算机断层扫描(CT)检查。

结果：眼底彩色像显示15眼中，病变累及黄斑及视盘5眼(33%)，仅累及黄斑8眼(53%)，位于视盘旁2眼(13%)； 所有患眼的脉络膜骨瘤均呈橙红色或黄白色，表面有色素沉着。SW-AF检查显示15眼(100%)的脉络膜骨瘤及其周围均有斑驳状低荧光及高荧光，而IR-AF检查则显示所有脉络膜骨瘤所在部位有点、片状高荧光及低荧光。FFA显示15眼(100%)的脉络膜骨瘤在造影过程中亮度逐渐增强，其中6眼(40%)有剧烈渗漏荧光的视网膜下新生血管(SRNV)呈现。ICGA显示9眼(60%)存在SRNV，造影早期所有脉络膜骨瘤对应部位呈低荧光，造影过程中瘤体亮度逐渐增强。OCT显示10眼(67%)的脉络膜骨瘤呈强、弱不均匀反射，5眼(33%)的脉络膜骨瘤呈弱反射，所有患眼均有视网膜神经上皮下暗反射腔。15眼(100%)的脉络膜骨瘤在CT图像上均呈高密度骨性肿块。

结论：脉络膜骨瘤呈橙红色或黄白色，其在CT图像上为骨性表现，这是诊断脉络膜骨瘤的重要依据。脉络膜骨瘤所在区域有视网膜色素上皮受损所致斑驳状强、弱不均的SW-AF及IR-AF。FFA及ICGA可明确病变区域异常循环状况。OCT可显示瘤体切面反射强弱不一，并有助于观察视网膜下积液及新生血管状况。

Analysis of multimodel imagings for choroidal osteoma

AIM: To explore the multimodal imaging features of choroidal osteoma.

METHODS:Retrospectively observational case series. Nine patients(15 eyes)with choroidal osteoma presented to Xi''an No.3 hospital from October 2015 to August 2019 were included in the study. Among them, there were 2 males and 7 females. All patients received the best corrected visual acuity, fundus color photography, short wavelength fundus autofluorescence(SW-AF), infrared fundus autofluorescence(IR-AF), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA), optical coherence tomography(OCT)and orbital X-ray computed tomography(CT).

RESULTS: In 15 affected eyes, lesions were involved in macula and optic disc in 5 eyes(33%), lesions were located in macula in 8 eyes(53%), peripapillar lesions in 2 eyes(13%). Choroidal osteomas presented as orange-red or yellow-white lesions with pigmentation on the surface in fundus color photographies. SW-AF images showed that choroidal osteomas presenting with mottled hypofluorescence and hyperfluorescence in 15 eyes(100%), while IR-AF images showed that all of the choroidal osteomas presenting punctate and patchy hypofluorescence and hyperfluorescence. FFA showed that 15 eyes(100%)of choroidal osteoma had gradually enhanced brightness, of which 6 eyes(40%)had severe leakage of fluorescence from sub-retinal neovascularization(SRNV). ICGA images revealed SRNV in 9 eyes(60%), all corresponding area of choroidal osteomas showed low fluorescence in the early stage of angiography, and the brightness of tumors increased during angiography gradually. OCT images showed that choroidal osteomas with inhomogeneous reflection in 10 eyes(67%); choroidal osteomas presented with hypo-reflectivity in 5 eyess(33%). All of the choroidal osteomas(100%)presented as high density bone mass on CT images.

CONCLUSION: Choroidal osteoma is orange-red or yellow-white, and expressed as bone mass on CT images, which is an important basis for diagnosis of choroidal osteoma. Damaged RPE leads to appearance of strong and weak mottled SW-AF and IR-AF in the location of choroidal osteomas. FFA and ICGA are helpful to clarify the abnormal circulation in the lesion area. The intensity of cross-sectional reflection in choroidal osteomas are different on OCT images, meanwhile, OCT was helpful to observe the condition of subretinal effusion and neovascularization.