眼眶肿瘤的彩色多普勒超声成像诊断分析

目的 探讨彩色多普勒超声成像(color Doppler imaging,CDI)在眼眶肿瘤的诊断和鉴别诊断中的价值.方法 对天津市眼科医院2007年1月至2008年12月117例(117侧眼眶)经术后病理证实的眼眶肿瘤患者的彩色多普勒超声检查结果进行回顾性对比分析.结果 117例眼眶肿瘤中,良性肿瘤96例:28例海绵状血管瘤,其中6例(21.4%)显示内部少量点状m流信号,2例可见动脉频谱;13例淋巴管瘤,其中6例(46.2%)肿瘤内部可见血流信号(4例为血管淋巴管瘤),5例显示动脉频谱;13例泪腺多形性腺瘤,其中9例(69.2%)肿瘤内部可见血流信号;14例神经鞘瘤,其中10例(71.4%)肿瘤内部可见血流信号;21例眼眶囊肿肿瘤内部则未见血流信号.恶性肿瘤21例:其中淋巴瘤12例,泪腺腺样囊性癌4例肿瘤内部均可见丰富血流信号,且为动脉频谱.余5例恶性肿瘤中4例内部均见丰富血流信号,仅1例低分化腺癌未见血流信号.在良性、恶性肿瘤中肿瘤内部显示血流信号比例分别占39.6%和95.2%.统计学分析表明良、恶性肿瘤内部血流收缩期峰值血流速度具有显著差异(P=0.000),阻力指数无明显差异(P＞0.05).结论 彩色多普勒成像对于某些眼眶肿瘤有特征性表现,在眼眶肿瘤的诊断,尤其是良、恶性肿瘤鉴别中有重要价值,同时对手术治疗有一定的指导意义.     

彩色多普勒超声在儿童眼眶肿瘤诊断中的价值

目的探讨彩色多普勒超声（CDI）技术在儿童眼眶肿瘤诊断中的临床价值。方法应用CDI技术对39例儿童眼眶肿瘤患者肿瘤内部回声及彩色血流显像进行检测。结果在39例儿童眼眶肿瘤中,毛细血管瘤8例,横纹肌肉瘤2例,瘤体内CDI均可检测出丰富的动脉血流信号;皮样囊肿12例,淋巴管瘤8例,瘤体内CDI检测均无血流信号;静脉性血管瘤6例中,CDI检测出静脉血流信号3例;3例静脉曲张在颈静脉加压和压力解除过程中示动态血流变。结论CDI技术在儿童眼眶肿瘤的鉴别诊断中有重要的临床价值,联合判断肿瘤特征性内部回声及声像图有助于对肿瘤进行定性诊断。     

眼眶神经源性肿瘤影像学特征及临床意义

目的 探讨超声、CT及MRI对眼眶神经源性肿瘤的诊断价值.方法 收集长征医院眼科2004年1月至2007年11月经手术治疗,具有完整病理资料的眼眶神经源性肿瘤76例,回顾分析超声、CT、MRI检查的影像学表现.结果 各种眼眶肿瘤的影像学表现均有一定的特征性.超声检杳有利于揭示病变内的组织结构.CT利于显示病变的空间位置以及相邻结构的继发改变.MRI即可以显示病变的空间位置、病变蔓延情况.也可以通过显示信号强度提示病变的内部结构.结论 联合应用眼部超声、CT、MRI是发现和诊断眼眶肿瘤的重要检查手段,对大多数肿瘤可以做出明确定性、定位诊断.     

常规超声和超声造影在眼眶肿瘤良恶性诊断中的应用

目的:分析眼眶肿瘤的常规超声和超声造影特点,探讨常规超声和超声造影在眼眶肿瘤良恶性诊断中的应用价值.方法:选取沈阳市第四人民医院2011-05/2014-01期间收治的眼眶肿瘤患者35例作为研究对象,应用常规超声和超声造影分析眼眶肿瘤的形态、内部回声、彩色多普勒特点,应用SonoLiver软件分析超声造影检查资料及超声造影指标.结果:在35例眼眶肿瘤患者中,常规超声和超声造影诊断为良性肿瘤27例,诊断为恶性肿瘤8例,与术后病理结果对比,符合率为91％ (32/35).超声造影参数显示,上升时间(RT)及平均渡越时间(mTT)恶性组低于良性组,差异具有统计学意义(P＜0.05);达峰时间(TTP)在良性及恶性组间差异无统计学意义(P＞0.05).结论:应用超声结合造影可提高眼眶肿瘤的良恶性诊断准确率,有利于眼眶肿瘤的手术前定性诊断.     

Vascular Studies of the Orbital Cavity

The orbital cavity is a dynamic region filled with pulsatile vascular structures. Newly developed ultrasonic-imaging equipment enables the physician to study the in-vivo motion of orbital tissues and their blood vessels to obtain pertinent diagnostic information relating to orbital diseases. Evidence of enhanced vascular activity is observed in endocrine ophthalmopathy and other orbital inflammatory conditions. Blood vessels within tumors help to localize the abnormalities and give clues relating to an accurate tissue diagnosis. These examinations are performed repeatedly and noninvasively in a clinical environment.     

彩色多普勒超声在眼眶病诊断中的价值

目的 探讨彩色超声多普勒（color Doppler imaging,CDI）在眼眶病诊断及鉴别诊断中的应用价值。方法 应用CDI技术对288例眼眶病患者眼眶病病变内部的彩色血流显像和脉冲多普勒频谱进行检测。结果 288例眼眶病中,恶性肿瘤38例,炎性假瘤23例,泪腺混合瘤（血流信号不丰富）18例,神经鞘瘤22例,脑膜瘤7例,良性血管内皮瘤及血管外皮瘤各2例,视神经胶质瘤及神经纤维瘤各1例,瘤体内CDI均可检测出血流信号;海绵状血管瘤62便,皮样囊肿16例及脂肪瘤1例瘤体内CDI检测均无血流信号;静脉性血管瘤29例中,CDI检测出静脉血流信号16例;动静脉血管瘤3例CDI检测出动脉血流信号;静脉曲张15例在颈静脉加压和压力解除过程中示动态血流变化;婴儿性血管瘤6例应用糖皮质激素治疗后内部血流信号明显减少;颈动脉海绵窦瘘13例,其中颈内动脉海绵窦瘘（internal carotid cavernous sinus fistula,CCF)8例和硬脑膜海绵窦瘘（dural cavernous sinus fistula,DCF）5例CDI检测均显示眼上静脉扩张动脉化,同时CCF的眼上静脉的血流速度和每分血流量高于DCF,而阻力指数低于DCF。1例眼上静脉血栓性静脉炎显示眼上静脉扩张但无血流信号。结论 CDI对于多血管性肿瘤和眼眶血管性疾病有其特征性的表现。CDI检测在协助B超、CT或MRI检查眼眶病确定疾病的诊断和鉴别诊断中的重要意义。     

The role of vascular factors in the development of traumatic optic neuropathy in course of closed head injury

PURPOSE: This study was undertaken to assess the pathogenesis of traumatic optic neuropathy as a consequence of closed head injury. MATERIAL AND METHODS: The clinical material comprised 34 patients (4 women and 30 men, age 14-70 years), who developed clinical symptoms of optic neuropathy after head trauma. A full ophthalmologic survey and colour Doppler examination of the orbital vessels were performed in all patients. RESULTS: Full blindness of the affected eye, persisting since the injury, was noted in 20 patients. Orbital fracture was diagnosed in 15 person, but 4 patients among them had fracture of the optic canal bones. In 16 cases a retrobulbar hematoma was present. In 8 patients, who displayed no light perception after trauma, no flow was observed in the central retinal artery. In 18 other persons there was decreased of blood flow parameters. Only 6 patients had the normal flow in the orbital vessels. CONCLUSION: The reason of the development of optic neuropathy after head injury is not clear. Our results of the blood flow measurement in the orbital vessels suggest, that disturbance of circulation within the optic nerve is very serious factor in the pathogenesis of traumatic optic neuropathy.     

DOPPLER ULTRASOUND OF ORBITAL VESSELS

The techniques of doppler ultrasound have been applied to blood vessels within the orbit. The doppler frequency shifts of ultrasonic pulses scattered from blood cells moving within orbital vessels are a measure of velocities rather than the amount of blood flow. The doppler signal from the ophthalmic artery behind the globe is responsive to changes in ocular blood flow. Blood flow can also be detected at the optic nerve head, and from the coats of the eye adjacent to the nerve head. Flow rate in the ophthalmic artery is reduced following retrobulbar anaesthesia. The source of the pulsatile retrograde flow signal which can be detected in some cases of internal carotid stenosis is located in the region of the ophthalmic artery.     

Doppler ultrasound of orbital vessels

The techniques of doppler ultrasound have been applied to blood vessels within the orbit. The doppler frequency shifts of ultrasonic pulses scattered from blood cells moving within orbital vessels are a measure of velocities rather than the amount of blood flow. The doppler signal from the ophthalmic artery behind the globe is responsive to changes in ocular blood flow. Blood flow can also be detected at the optic nerve head, and from the coats of the eye adjacent to the nerve head. Flow rate in the ophthalmic artery is reduced following retrobulbar anaesthesia. The source of the pulsatile retrograde flow signal which can be detected in some cases of internal carotid stenosis is located in the region of the ophthalmic artery.     

Retinoblastoma manifesting as orbital cellulitis

Five children with previously undiagnosed retinoblastoma had signs of unilateral orbital cellulitis and were treated with systemic antibiotics, corticosteroids, or both. When retinoblastoma was finally diagnosed clinically, radiologists believed in every case that, on the basis of the soft-tissue swelling seen with computed tomography, there was orbital extension of the tumor. However, intraoperative and histopathologic observations disclosed no demonstrable orbital tumor involvement. The affected eyes all had neovascular glaucoma, and all harbored highly necrotic tumors that were contained within the eye. We concluded that orbital inflammation can occur with retinoblastoma confined to the eye and that signs of orbital cellulitis do not necessarily imply orbital extension of the tumor.     

Blood flow parameters in the arteries of the eye in premature children

PURPOSE: of the study was to evaluate blood flow in the arteries of the eye in preterm neonates. MATERIAL AND METHODS: Color Doppler imaging (CDI) of ophthalmic artery, central retinal artery and posterior ciliary arteries was performed in 36 preterm infants and 19 full-term infants. Maximal systolic velocity, end-diastolic velocity, resistance index--RI and pulsatility index--PI were assessed for the studied vessels. RESULTS: There were no significant differences in ophthalmic artery blood flow between preterm and normal newborns. End-diastolic velocity in central retinal artery and posterior ciliary arteries in preterm infants was significantly lower and resistent index and pulsatility index was higher. The Doppler color ultrasonography is a non-invasive technique which can be useful for the estimation of the hemodynamic parameters in the arteries of the eye in the prematures. CONCLUSIONS: The recorded changes in the ultrasound measurements of the blood flow in the eye arteries in premature children comparing to the normal newborns, can be the evidence for the immaturity of the vessel system in the preterm born neonates.     

Orbital optic nerve gliomas in children with neurofibromatosis type 1

PURPOSE: To describe the clinical course and treatment of symptomatic orbital optic nerve gliomas in children with neurofibromatosis type-1 (NF-1). METHODS: A retrospective review of the records of patients with NF-1 and symptomatic orbital optic nerve gliomas seen in a large multidisciplinary NF-1 clinic of a tertiary care children's hospital. The main outcome measures included presenting symptoms and signs, ophthalmologic examination at diagnosis, the presence of progressive disease following diagnosis, type of therapy, and the reasons therapy was instituted. RESULTS: Twelve patients with symptomatic orbital optic nerve gliomas, all of which led to proptosis (eight girls, four boys), were identified. The mean age of diagnosis of NF-1 was 20 months; the mean age of diagnosis of the orbital optic nerve glioma was 26 months. At the time of diagnosis of the tumor, 10 of 12 patients (83%) had decreased visual acuity in the affected eye. Three patients underwent optic nerve resection; eight received chemotherapy, and one was observed without therapy. Of the eight children who received chemotherapy, progressive disease prior to treatment could be documented in only three; none of these eight children had a reproducible improvement in vision following chemotherapy. There was no demonstrable improvement in vision in any treated patient with NF-1-associated orbital optic nerve gliomas. CONCLUSIONS: Although not definitively proven, our data and previous studies suggest that NF-1-associated orbital optic nerve gliomas should not be treated unless there is clear evidence of either ophthalmologic or radiographic progression. Surgical excision of tumors which have led to proptotic eyes without functional vision should be reserved for cosmetic purposes or to treat complications of exposed globes.     

The role of ultrasound examinations in diagnosis of massive suprachoroidal hemorrhage occurring as a postoperative complication of intraocular surgery

This article presents importance of the ultrasound examinations (standard A- and B-scan ultrasonography, Colour Doppler and Power Doppler ultrasonography) in early and late diagnosis of massive intraoperative suprachoroidal hemorrhage. Standardized echography can help establish an accurate diagnosis. Echography can determine the location and extent of expulsive hemorrhage, as well as determine the status of the retina and vitreous. Furthermore, differentiation between hemorrhagic choroidal detachment and serous choroidal effusion can be made only by A- and B-scans. Colour and Power Doppler imagings of orbital vessels are relatively new sonography methods of ocular diagnosis. Using them, we can evaluate all blood flow disturbance, which occur in eye with massive suprachoroidal hemorrhage. These methods are also useful in differentiation of retina from other tissues, especially in the presence of opaque media.     

Ultrasound examination methods in diagnostics of ischemic lesions of the eye

One hundred and thirty-eight patients, aged 35 to 70, with acute ischemic neuroopticopathy (54 patients), occlusion of the central retinal artery (CRA--40 patients), chronic neuroopticopathy (21 patients) and chronic ischemic retinopathy (23 patients) underwent ultrasound examinations of the orbital artery (OA), CRA and internal carotid artery (ICA). A more pronouncedly impaired blood flow was registered in OA and CRA in cases of acute clinical forms of ischemic ocular lesions, i.e. a lack of blood circulation in CRA or a significantly diminished blood flow in it; a 2-fold decrease of the maximum systolic blood velocity; a 5-fold decrease of the terminal diastolic blood-flow velocity; and a 1.5 fold increase of the resistance index versus the normal value. Duplex scanning of the carotid arteries enables a timely diagnosis of a hemodynamically valuable ICA stenosis in different clinical forms of ischemic lesions of the eye.     

Choristoma of visual organ in children

PURPOSE: The aim of this study was to present the clinical and histopathological characteristics of choristoma tumors of the eye in children and to estimate the surgical treatment. MATERIAL AND METHODS: The study comprised 23 children with choristoma of visual organ including 10 girls (43.5%) and 13 boys (56.5%) in age between 2 months and 16 years, hospitalized in Department of Pediatrics Ophthalmology between 1999 and 2005. Complete ophtalmological examination and ultrasonography of eyeballs and orbital cavity was performed. In each case surgical procedure was implemented and the operated neoplastic changes were verified histopathologically. RESULTS: The tumors were placed within the eyeball in 10 children (43.5%) including corneal limbus placement in 4 children (40%), epibulbar placement with orbital cavity penetration in 5 children (50%) and one patient was diagnosed with lacrimal caruncule tumor (10%). Periorbital choristoma was diagnosed in 13 children (56.5%), while in 9 of them (69.2%), the tumor was placed within the upper lid and in case of 3 (23.1%), the tumor crossed orbital cavity septum and in one patient (7.6%) penetrated towards temporal cranial fossa. The eyeball tumors were entirely removed in 6 children (60%). In 4 children (40%) the surgical procedure was limited to excision of anterior parts of the changes protruding to the orbital cavity. The excision of palpebral, palpebral-orbital and palpebral-cranial tumors was complete (100%). Histopathological examination showed dermoids in 17 children (73.9%), including epidermal cyst in 13 patients (76.5%) and dermoid cyst in 4 patients (23.5%). Additionally, dermolipoma tumors were diagnosed in 6 children (26.1%). CONCLUSIONS: Choristoma tumors are characteristically placed within the organ of vision and have characteristic clinical picture. Both therapeutic and cosmetic results of surgical treatment of choristoma in children were satisfactory.     

Clinical applications of color Doppler imaging in the management of orbital lesions

PURPOSE: To present the clinical applications of color Doppler imaging (CDI) as an adjunctive study in the diagnosis and treatment of orbital lesions. METHODS: Retrospective noncomparative case series. Medical records of 17 patients with orbital lesions who underwent orbital CDI were reviewed, and their orbital CDI results, diagnosis, and treatment were studied. The main outcome measures were detection of abnormal orbital vascular flow and presence or absence of blood flow within orbital lesions by CDI. RESULTS: Absence of intralesional flow was associated with an orbital lesion considered benign. Tumors in which flow was present were more frequently malignant or had malignant potential. Reversal of flow in the superior ophthalmic vein was observed in patients with carotid-cavernous fistula and orbital varix. CONCLUSIONS: CDI is a useful adjunctive imaging study for evaluating the vascularity of orbital tumors. The absence or presence of intratumoral blood flow as demonstrated by CDI can help determine the nature of the orbital mass and can assist with surgical planning.     

Zweij?hriger Patient mit akutem Exophthalmus

Hemorrhage into an orbital lymphangioma can cause acute proptosis. A lymphangioma must be distinguished from acute threatening causes of rapidly developing proptosis in childhood, such as orbital cellulitis or malignant tumors (rhabdomyosarcoma). Imaging (magnetic resonance imaging, ultrasound, computed tomography) and histopathological evaluation are required for the final diagnosis. Immunohistochemical staining of lymphatic vessels with podoplanin can be useful for confirmation of the diagnosis.     

A 2-year-old patient with acute proptosis

Hemorrhage into an orbital lymphangioma can cause acute proptosis. A lymphangioma must be distinguished from acute threatening causes of rapidly developing proptosis in childhood, such as orbital cellulitis or malignant tumors (rhabdomyosarcoma). Imaging (magnetic resonance imaging, ultrasound, computed tomography) and histopathological evaluation are required for the final diagnosis. Immunohistochemical staining of lymphatic vessels with podoplanin can be useful for confirmation of the diagnosis.     

眼眶及眼附属器淋巴瘤的彩色多普勒超声显像特征分析

目的 探讨眼眶及眼附属器淋巴瘤的彩色多普勒超声显像(CDI)特征.方法 回顾性研究30例经病理证实为眼眶及眼附属器淋巴瘤的CDI,结合临床表现和好发部位分析其特征.结果 淋巴瘤发生部位有眼眶、结膜、泪腺和泪囊;瘤体大多数长径在1cm以上,形态不规则,边界不清,内回声不均匀,以低回声为主,但多可见高回声分隔;14例声衰减中等,16例声衰减不明显;多数肿瘤有轻度可压缩性;可见较明显占位效应.彩色多普勒血流显像(CDFI)显示多数肿瘤内部可见Ⅲ级或Ⅳ级血流信号,均为动脉频谱,峰值流速和阻力指数较高;部分瘤体周围可见血流信号.结论 眼眶及眼附属器淋巴瘤的CDI具有一定特征,结合好发部位及临床表现有助于临床判断.     

Comparison of colour Doppler imaging of orbital vessels in elderly compared with young adult patients.

PURPOSE: Colour Doppler imaging provides an estimate of the velocity of blood flow in vessels supplying the eye. METHODS: To assess changes in orbital blood flow with age, we used a method to study peak systolic velocity in 20 young normal patients, mean age 25.2+/-2.4 years and 30 elderly normal patients, mean age 69.5+/-7.9 years. RESULTS: Peak systolic velocity was significantly higher in the central retinal artery and the temporal division of the posterior ciliary artery in elderly patients. There was greater variation in the peak systolic velocity readings in the distal part of the ophthalmic artery in the elderly than in the younger group. There was greater variation in the pulsatility index in the central retinal artery in young subjects. CONCLUSIONS: Though not large, these differences suggest changes in the orbital blood vessels with age which could affect the development of disease processes in elderly patients. These changes should be taken into account when assessing blood flow in elderly patients.