泪囊区原发恶性肿瘤的MRI表现及临床病理分析

目的 探讨眼眶泪囊区不同恶性肿瘤的MRI表现与临床病理的关系。设计 回顾性病例系列。研究对象 北京同仁医院2005-2014年13例经病理证实为泪囊区恶性肿瘤患者的MRI表现及临床资料。方法  所有患者均行眼眶MRI平扫及增强检查,其中10例行动态增强扫描,根据时间-信号强度曲线（TIC）分为三种类型（Ⅰ型稳定增强型,Ⅱ型平台型,Ⅲ型流出型）。11例手术切除,2例活检。主要指标 MRI表现,强化程度,TIC类型及病变的累及范围。结果 病变主体均位于泪囊窝内。病理结果显示淋巴瘤5例、恶性黑色素瘤2例,睑板腺癌、基底细胞癌、基底样鳞状细胞癌、腺样囊性癌、低分化腺癌、皮脂腺癌各1例。MRI表现：淋巴瘤T1WI、T2WI均呈等信号,增强扫描轻度均匀强化。恶性黑色素瘤T1WI呈高信号、T2WI呈低信号,增强扫描轻中度均匀强化。睑板腺癌及低分化腺癌T1WI、T2WI均呈等信号。另4例T1WI呈等信号,T2WI呈略长信号,增强扫描呈轻中度强化。TIC：Ⅰ型、Ⅱ型各2例,Ⅲ型6例。12例病变累及鼻泪管,9例累及邻近皮肤,7例累及眼睑,2例累及眼眶肌锥内间隙。结论 泪囊恶性肿瘤因病理类型不同MRI表现不同,常累及邻近结构,MRI可准确显示肿瘤累及范围。TIC三型均有,以流出型为主。（眼科,2015, 24： 313-316）     

眼眶淋巴瘤的磁共振成像特征

目的 分析眼眶淋巴瘤在MR常规序列、DWI及动态增强检查中的影像特征,探讨磁共振对眼眶淋巴瘤诊断的价值。设计 回顾性病例系列。研究对象 21例病理证实为原发性眼眶淋巴瘤患者的眼眶磁共振资料。 方法 所有患者均行T1WI、T2WI及T1WI压脂增强检查,8例（9眶）行动态增强、3例（4眶）行DWI检查。主要指标 病灶位置及范围、形态、界限、与周围结构关系、信号特征、动态增强曲线特征。 结果  单侧发病17例、双侧发病4例,共25眶;16眶病变范围局限、9眶病变弥漫;病变位于眶隔前区6眶,泪腺区7眶,肌锥内6眶,肌锥区4眶,肌锥外12眶,视神经区2眶,骨膜下区1眶;病灶呈结节状10眶、铸型9眶、条片状2眶,7眶为眼外肌或视神经增粗或被包绕;病变界限清楚者13眶、界限不清者12眶;T1WI等信号23眶、稍低信号2眶,T2WI等信号19眶、稍高信号1眶、稍低信号5眶;4眶病灶DWI均呈等信号;增强扫描均匀明显强化者24眶,裂隙状不均匀明显强化者1眶;动态增强时间信号曲线呈平台型7眶,流入-流出型9眶,以上两种类型混合存在1眶。 结论  MR常规序列能够清晰显示眼眶淋巴瘤的位置、形态、内部特征及与周围器官的关系。DWI及动态增强可反映病灶的良恶性及恶性程度。（眼科, 2016, 25: 371-375）     

泪腺炎症及淋巴细胞增生性病变的CT及磁共振成像诊断

目的研究泪腺炎症及淋巴细胞增生性病变的CT和MRI表现及其诊断价值。设计回顾性病例系列。研究对象泪腺炎症及淋巴细胞增生性病变患者46例。方法回顾分析46例经病理学或临床证实的泪腺炎症及淋巴细胞增生性病变患者的CT及MRI影像资料。主要指标病变形态、信号(密度)、累及范围。结果46例患者中炎性假瘤32例,表现为泪腺体积增大,CT示泪腺呈均匀等密度,MRI T_1WI及T_2WI呈等或低信号,1例可见多发囊变,MRI增强扫描病变强化明显。Mikulicz病4例,均为双侧泪腺弥漫增大,CT呈均匀等密度,MRI T_1WI及T_2WI均呈低信号,增强后呈明显均匀强化。反应性淋巴细胞增生5例,表现为泪腺体积增大,CT呈均匀等密度,MRI T_1WI、T_2WI呈低或等信号,1例T_2WI呈高信号,增强扫描呈明显强化。非典型性淋巴细胞增生1例,CT表现为双侧泪腺弥漫性增大,密度均匀。泪腺淋巴瘤4例(B细胞淋巴瘤3例,组织细胞肉瘤1例),表现为双侧泪腺弥漫性增大。结论泪腺炎症及淋巴细胞增生性病变的影像表现相似,CT及MRI有助于病灶与泪腺上皮性肿瘤的鉴别,并可准确显示病变累及范围。(眼科,2007,16:308-311)     

MRI常规扫描结合扩散加权成像诊断眼眶淋巴瘤的价值

目的 探讨眼眶淋巴瘤常规磁共振成像(magnetic resonance imaging,MRI)及扩散加权成像(diffusion-weighted imaging,DWI)特点,以提高其术前诊断准确率.方法 经手术病理检查证实的眼眶淋巴瘤18例,术前均行常规MRI及DWI检查,回顾性分析其影像学表现.结果 18例患者中14例为单侧发病,4例为双侧发病.13例位于眼眶前部,边界清楚;5例累及肌锥内外呈弥漫生长.15例平扫及增强扫描信号均匀,与眼外肌相比,T1WI/T2WI均为等信号,增强扫描病灶中等度强化;3例患者病变信号不均,T1,WI为等-低混杂信号,T2WI为等-高信号.DWI均为稍高信号,扩散系数值为(0.71±0.32)×103mm2·s-1.结论 常规MRI结合DWI扫描有利于眼眶淋巴瘤的定性诊断.     

眼眶淋巴瘤临床及影像学分析

目的 通过分析眼眶淋巴瘤的临床表现以及B超、CDI、CT、MRI等影像学表现,探讨其对于眼眶淋巴瘤诊断和鉴别诊断的价值.方法 对53例56只眼眼眶淋巴瘤进行回顾性分析.结果 眼眶淋巴瘤可累及眼眶内不同区域,大部分眼眶淋巴瘤表现为眶区肿物,眼球运动受限,部分表现为眼睑、结膜水肿及眼球突出等.53例(56只眼)行B超探查,42只眼显示为形状不规则,42只眼内回声少,31只眼内回声不均匀,11只眼显示眼球受压变形.40例(43只眼)行CDI探查,19只眼显示病变内血流信号丰富,14只眼仅见少许血流信号.49例(52只眼)行cT扫描,41只眼显示病变形状不规则,34只眼显示病变边界清楚,29只眼内密度均匀,25只眼显示病变与眼球呈"铸造样",3只眼可见骨破坏.15例(15只眼)行MRI检查,11只眼显示为T1WI中等信号强度,T2WI中等偏高信号强度,6只眼行强化MRI检查均可被中度强化.结论 临床表现以及影像学检查对于眼眶淋巴瘤的诊断和鉴别诊断具有重要价值.     

眼眶淋巴瘤临床及影像学分析

目的 通过分析眼眶淋巴瘤的临床表现以及B超、CDI、CT、MRI等影像学表现,探讨其对于眼眶淋巴瘤诊断和鉴别诊断的价值.方法 对53例56只眼眼眶淋巴瘤进行回顾性分析.结果 眼眶淋巴瘤可累及眼眶内不同区域,大部分眼眶淋巴瘤表现为眶区肿物,眼球运动受限,部分表现为眼睑、结膜水肿及眼球突出等.53例(56只眼)行B超探查,42只眼显示为形状不规则,42只眼内回声少,31只眼内回声不均匀,11只眼显示眼球受压变形.40例(43只眼)行CDI探查,19只眼显示病变内血流信号丰富,14只眼仅见少许血流信号.49例(52只眼)行cT扫描,41只眼显示病变形状不规则,34只眼显示病变边界清楚,29只眼内密度均匀,25只眼显示病变与眼球呈"铸造样",3只眼可见骨破坏.15例(15只眼)行MRI检查,11只眼显示为T1WI中等信号强度,T2WI中等偏高信号强度,6只眼行强化MRI检查均可被中度强化.结论 临床表现以及影像学检查对于眼眶淋巴瘤的诊断和鉴别诊断具有重要价值.     

眼眶淋巴瘤临床及影像学分析

目的 通过分析眼眶淋巴瘤的临床表现以及B超、CDI、CT、MRI等影像学表现,探讨其对于眼眶淋巴瘤诊断和鉴别诊断的价值.方法 对53例56只眼眼眶淋巴瘤进行回顾性分析.结果 眼眶淋巴瘤可累及眼眶内不同区域,大部分眼眶淋巴瘤表现为眶区肿物,眼球运动受限,部分表现为眼睑、结膜水肿及眼球突出等.53例(56只眼)行B超探查,42只眼显示为形状不规则,42只眼内回声少,31只眼内回声不均匀,11只眼显示眼球受压变形.40例(43只眼)行CDI探查,19只眼显示病变内血流信号丰富,14只眼仅见少许血流信号.49例(52只眼)行cT扫描,41只眼显示病变形状不规则,34只眼显示病变边界清楚,29只眼内密度均匀,25只眼显示病变与眼球呈"铸造样",3只眼可见骨破坏.15例(15只眼)行MRI检查,11只眼显示为T1WI中等信号强度,T2WI中等偏高信号强度,6只眼行强化MRI检查均可被中度强化.结论 临床表现以及影像学检查对于眼眶淋巴瘤的诊断和鉴别诊断具有重要价值.     

眼眶神经鞘瘤的影像学表现

目的 分析眼眶神经鞘瘤的计算机体层摄影(computed tomography,CT)和磁共振成像(magnetic resonance imaging,MRI)表现,并探讨其在诊断和鉴别诊断中的价值.方法 回顾性分析经手术和病理证实34例眼眶神经鞘瘤,其中CT扫描26例,MRI检查4例,CT加MRI检查4例.结果 27例肿块位于肌锥内,7例位于肌锥外,多呈椭圆形和类圆形.CT平扫为等密度,多数密度均匀,增强后不均匀强化.MRI表现为肿瘤T1WI呈等或略低信号,T2WI呈中高信号,肿瘤囊变区T1WI呈低信号,T2WI呈高信号,增强后瘤体实质部分呈均匀强化,而囊变部分不强化.结论 CT与MRI均能显示眼眶内的肿块,MRI对神经鞘瘤诊断及鉴别诊断的准确性优于CT.(中国眼耳鼻喉科杂志,2006,6360～361)     

眼眶孤立性纤维瘤12例临床影像学分析

目的：探讨眼眶孤立性纤维瘤(SFT)的彩色多普勒超声及磁共振成像(MRI)特点。

方法：回顾性病例研究。收集2013-04/2018-08天津医科大学眼科医院收治的12例眼眶SFT患者的临床资料,均行彩色多普勒超声和MRI平扫、增强及动态增强检查,分析其临床影像学特点。

结果：纳入的12例患者中男7例,女5例,病程3mo～20a(平均3.2±5.2a),6例为首次发病,6例为复发病例; 均为单眼发病,其中左眶8例,右眶4例。肿瘤位于眼球后肌锥间隙内5例,肌锥间隙外3例,跨肌锥间隙内、外4例; 肿瘤形状呈卵形9例,不规则形3例,边界均清晰。超声表现为低回声10例,不均匀回声2例; 12例彩色多普勒血流显像(CDFI)均可见血流信号,阻力指数(RI)平均值0.70,PW均测得动脉频谱。MRI表现在T1WI均呈等信号; T2WI呈低信号 5例,等信号3例,中高信号4例,内部信号均匀9例,不均匀3例; 增强后12例均呈显著强化,10例均匀强化,2例不均匀强化。动态增强扫描的时间-信号强度曲线(TIC)7例为速升平台型,5例为速升速降型。

结论：眼眶SFT在彩超显示低回声、富血供的实体瘤,MRI提示T1WI呈等信号,T2WI信号混杂,增强后显著强化,动态增强TIC曲线以速升型为主的特征性表现对诊断具有重要意义。     

非特异性炎症致眶尖综合征临床特征分析

目的 总结眶尖非特异炎症导致眶尖综合征患者的临床特征。设计 回顾性病例系列。研究对象 2016年6月至2019年5月北京同仁医院神经眼科及北京市普仁医院眼科眼眶非特异性炎症致眶尖综合征15例（16眼）。方法 回顾患者的临床症状、体征、化验及影像学检查、激素治疗效果及病情转归。主要指标 临床表现、眼眶及头颅CT、MRI表现。结果 15例中男性8例,平均年龄（53±16）岁。14/15例单眼发病。病灶均局限于眶尖区,7例同时累及海绵窦。首先出现患侧眼眶疼痛,相继出现眶尖综合征表现。眼眶MRI均显示眶尖部条片状不规则实性病灶,呈等T1WI、等T2WI信号,均匀强化。经全身或眼球局部糖皮质激素治疗后14眼（87.5%）眼痛完全消失,13眼（81.3%）上睑下垂改善,11眼（68.8%）眼球运动及复视症状改善。3个月后复查眼眶MRI病灶均缩小。仅一半患者治疗后视力提高,其余8眼（50.0%）视力无改善。随访过程中2例（12.5%）病变复发。结论 局限于眶尖的非特异炎症可导致严重的眶尖综合征。早期无眼红肿等炎症表现,眼球突出亦不明显,表现为眶周疼痛、眼球运动障碍,继而视力进行性损伤,易被误诊。临床表现和神经影像学是诊断主要依据。糖皮质激素治疗能有效改善眼球运动障碍和疼痛,但视力恢复困难,且病变有复发可能。（眼科,2021,30： 56-61）     

眼附属器淋巴瘤的影像学表现及其临床意义

目的 了解眼附属器淋巴瘤的CT和MRI表现.方法 回顾性分析经手术或活检病理证实的50例眼附属器淋巴瘤的影像学表现,其中31例行CT扫描,8例MRI扫描,11例行CT和MRI扫描.结果 侵犯眼睑或结膜18例,泪腺6例,肌锥内外11例,肌锥外8例,肌锥内2例,眼外肌受累16例,视神经受累13例.7例肿瘤呈铸造样包裹整个眼球.结论 眼附属器淋巴瘤的影像学表现有一定特征性,MRIH脂肪抑制技术有助于了解肿瘤范围.     

Magnetic Resonance Imaging and DWI Features of Orbital Rhabdomyosarcoma

 Purpose: To describe the magnetic resonance imaging (MRI) features of orbital rhabdomyosarcoma (RMS). Methods: Thirty-nine patients with histopathologically confirmed orbital RMS were retrospectively reviewed. All patients underwent orbital conventional MRI, including axial, sagittal, and coronal T1-weighted, T2-weighted, and postcontrast T1-weighted sequences. The location, shape, margin, and MRI signal of the 39 lesions were reviewed. DWI in 15 patients and susceptibility weighted imaging (SWI) in 2 patients were also analyzed. Results: Orbital MRI was available in 39 patients and revealed a soft tissue mass in the orbital region in all cases. Of the 39 patients, the primary tumor sites were limited to the orbital proper in 31 cases, while 28 cases had extraocular muscle invasion and 8 cases had extraorbital invasion. All lesions were unilateral. Thirty-three cases were well-defined soft tissue masses and 6 cases appeared as less well-defined soft-tissue masses. Thirty-four cases showed homogeneous isointense or slightly hypointense signals on T1-weighted imaging (T1WI) and hyperintense signal on T2-weighted imaging (T2WI) compared with extraocular muscles. Five cases had heterogeneous signals with focal areas of increased signal on T1WI or decreased signal on T2WI, including 1 case with hypointense signal on SWI. The mean apparent diffusion coefficient (ADC) value of the viable part of tumors was (0.925±0.09)×10-3 mm2/s. All cases showed moderate to marked enhancement after contrast administration. Conclusion:Several MRI features—including homogeneous isointense or slightly hypointense signal on T1WI and slightly hyperintense signal on T2WI, relative low ADC values, and moderate to marked enhancement, extraocular muscles invasion, and extraorbital extension—are helpful in the diagnosis of orbital RMS.     

Expression patterns of sialylated epitope recognized by KL-6 monoclonal antibody in ocular surface epithelium of normals and dry eye patients

PURPOSE: To determine the association of the KL-6 epitope (sugar moiety) with MUC1 and its distribution on the ocular surface of human non-dry and dry eyes. METHODS: The human ocular surface was examined immunohistochemically and immunoelectron microscopically using monoclonal antibody (mAb) KL-6, which recognize a carbohydrate epitope of MUC1. The expression patterns of KL-6 epitope in corneal and conjunctival cells were examined by impression cytology from 24 non-dry eye volunteers and 43 dry-eye patients. RESULTS: In the cornea, bulbar conjunctiva, and limbus epithelium, mAb KL-6 reacted to the apical cell membrane of superficial cells and the intercellular space of superficial and wing cells. No immune reactivity of mAb KL-6 was observed in the basal plasma membrane of basal epithelial cells. Results of impression cytology indicated that the corneal epithelium of 13 of 24 non-dry eyes was weakly stained by mAb KL-6, whereas 42 of 43 dry eyes showed a mosaic pattern. In non-dry eyes, 19 of 24 bulbar conjunctival epithelia expressed the KL-6 epitope in a honeycomb pattern. In mild (17/19) and moderate (17/17) dry eye conjunctiva, the KL-6 epitope showed a mosaic pattern. However, the expression of KL-6 epitope decreased in severe dry eyes, showing a mosaic pattern in three of seven patients and labeling a few cells weakly in four of seven patients. CONCLUSIONS: These findings suggest that there is an upregulation of the sialylated KL-6 epitope of MUC1 by apical corneal and conjunctival cells in mild and moderate dry eyes. This upregulation may in part alleviate the consequences caused by goblet cell mucin dysfunction in dry eyes. It is noteworthy that the KL-6 epitope is downregulated in the conjunctiva of severe dry eyes, a phenomenon that may be explained in part by the malfunction of conjunctival epithelial cells.     

羟基磷灰石义眼台植入术临床应用

目的探讨眼球摘除或眼内容剜除羟基磷灰石义眼台植入术临床应用。方法眼内容剜除,后巩膜开窗,羟基磷灰石义眼台植入巩膜腔或肌锥内,分层紧密缝合巩膜、筋膜及结膜。结果2例2眼义眼台轻度外露,观察随访半年无发展,后行羊膜移植后愈合,其余21例21眼均无结膜裂开及义眼台外露,取得了满意的效果。结论眼内容剜除后一期植入义眼台于巩膜腔或肌锥内,术中充分降低巩膜、筋膜及结膜的张力,并紧密分层缝合是降低和预防结膜裂开,义眼台外露、脱出的关键。     

Distribution of conjunctival HLA-DR expression and the pathogenesis of damage in early dry eyes

PURPOSE: To examine the expression of HLA-DR, a marker of inflammation, in the early stages of dry eye disease and to locate the appearance of this marker on specific areas of the bulbar conjunctiva. METHODS: Dry eye patients were identified and their condition classified as mild (n = 16) or moderate (n = 16) based on Schirmer testing, vital staining, tear break-up time, and symptom questionnaire scores. Brush cytology was used to collect epithelial cells from the nasal, temporal, and superior conjunctivae of patients and age-matched controls. HLA-DR positive cells were detected by immunohistochemical staining and quantified. RESULTS: Patients with moderate dry eye had the highest rate of conjunctival HLA-DR-positive cells, with significantly higher rates than controls regardless of which region of the conjunctiva was sampled (P < 0.01). The mild dry eye group had similar rates of HLA-DR-positive cells in the superior conjunctival region compared with controls. However, in the nasal and temporal regions, they displayed a significantly higher rate of HLA-DR-positive cells than controls (P < 0.01) and the nasal region showed a significant difference (P < 0.01) when compared with the temporal one. Some of these mild dry eyes had no vital staining. CONCLUSIONS: The HLA-DR expression pattern in mild and moderate dry eyes appears to reflect disease progression. Overexpression of HLA-DR in mild dry eyes showing no vital staining suggests that inflammation may be a primary cause of ocular surface damage. These data support the use of immunomodulatory drugs in the treatment of dry eye disease.