脉络膜转移癌的影像学特征

目的探讨脉络膜转移癌的临床及影像学检查特征并分析影像学表现之间的关联。方法回顾性分析西安交通大学第二附属医院眼科2012~2019年确诊的脉络膜转移癌患者10例(12只眼)，其中男4例，女6例，年龄61±5.8岁。所有患者均行最佳矫正视力、裂隙灯、眼底照相、频域光学相干断层扫描、荧光素眼底血管造影(FFA)、吲哚氰绿血管造影(ICGA)、自发荧光(FAF)检查。部分行B超扫描、MRI和肿瘤标志物检查。结果共10例(12只眼)脉络膜转移癌，原发来自肺癌8例，乳腺癌2例。11眼(91.67%)眼底可见黄色实性隆起，均为孤立性肿物，部分瘤体表面可见色素沉着(50%)。FAF检查示瘤体周边呈点状或环形高自发荧光，内部为斑驳自发荧光表现，且瘤体表面色素沉着的区域FAF呈高自发荧光(100%，P < 0.05)。11眼(91.67%)频域光学相干断层扫描表现为脉络膜-RPE层及神经上皮层呈波浪状隆起，视网膜神经上皮层与RPE层间可见大量细颗粒状强反射物质堆积，合并渗出性视网膜脱离。FFA背景期肿物呈低荧光，边界不清，中期其周围出现针尖样高荧光点，晚期呈弥漫性高荧光5眼(41.67%)，5眼晚期瘤体中央相对低荧光。ICGA表现为早期肿物大面积低荧光，其后周边缓慢出现斑点状高荧光，随时间缓慢范围扩大并模糊，瘤体大部分仍为低荧光，范围较早期相缩小。B超扫描显示扁平实质性隆起。结论眼底彩照可显示肿瘤的部位、大小、色素及视网膜病变情况；FAF提示视网膜色素上皮状况，肿瘤表面色素与自发荧光表现明显相关；频域OCT可反映视网膜脱离情况及瘤体高度；ICGA与FFA相互补充有助于脉络膜肿瘤的鉴别诊断。      

超声和荧光素眼底血管造影在葡萄膜转移癌诊断中的价值研究

目的：研究葡萄膜转移癌的超声和荧光素眼底血管造影的影像学特点并分析其诊断价值。方法：回顾性分析2014年1月1日至2019年2月1日我院收治的25例葡萄膜转移癌患者的临床资料,其中21例23只眼为脉络膜转移癌,4例5只眼为虹膜转移癌。25例患者均常规检查视力、散瞳、眼压、眼底,行腹部B超和胸部CT;另外行B型超声或(和)彩色多普勒超声检查21例23只眼,荧光素眼底血管造影检查17例19只眼,UBM检查4例5只眼,分析患者的临床特征和影像学特点。结果：25例28只眼中,B超检查脉络膜转移癌21例23只眼,可见视盘周围、眼球后极部或颞上方实质性占位病变,呈现扁平、半球形或不规则波浪形隆起的回声光团;FFA检查脉络膜转移癌17例19只眼,早期表现为无脉络膜背景萤光的暗部,动静脉期呈斑点状荧光或斑片状强荧光,静脉期呈高荧光斑点。晚期呈高斑驳状荧光;UBM检查虹膜转移癌4例5只眼,可见虹膜内瞳孔缘存在实性隆起、回声较均匀的肿物,虹膜根部厚度增加。结论：葡萄膜转移癌多以脉络膜转移癌最为多见,多发生于单个眼单个病灶,B超或彩超检查颞上方或极部不规则实质性占位,基底血流丰富;荧光素眼底血管造影早期萤光较低,中期呈现点状或斑片状高荧光,晚期呈斑驳状持续高萤光。     

中心性晕轮状视网膜脉络膜萎缩的荧光素眼底血管造影

目的：探讨中心性晕轮状视网膜脉络膜萎缩（central areolar retinochoroidal atrophy,CARCA）的荧光素眼底血管造影（fundus fluorescein angiography,FFA)的特征。方法：回顾分析32例CACA患者59只患眼的FFA检查资料。结果：FFA可见视网膜色素上皮及脉络膜毛细血管萎缩灶，早期呈弱荧光，晚期呈透见荧光；病灶内有色素沉着者可见斑点状遮蔽荧光；萎缩灶边缘染色呈强荧光，荧光范围不扩大。病灶内可透见粗大的脉络膜血管。后期萎缩区巩膜染色呈强荧光。其中25只眼有视盘周围环形脉络膜萎缩区，周边视网膜及视网膜血管正常。双眼发病且FFA表现对称者27例，单眼发病者5例。26例47只眼病灶范围在1－2．5个PD之间，6例12只眼病灶范围大于3个PD或小于1个PD。28 51只眼病灶呈圆形或椭圆形，边缘规则清楚；4例8只眼病灶边缘不规则，边界欠清晰。2例3只眼黄斑未受累。结论：CACA的FFA特征表现为萎缩区病灶边缘染色清楚的强荧光环，病灶内可呈现斑点状透见荧光、可透见粗大的脉络膜血管。后期萎缩区巩膜染色呈强荧光。     

眼球钝挫伤112例眼底荧光血管造影特点分析

目的探讨眼挫伤眼底荧光素眼底血管造影的特点。方法对112例（130眼）眼球钝挫伤患者进行眼底荧光素眼底造影检查。结果视网膜震荡80只眼表现黄斑拱环血管稍迂曲36眼,局限性高荧光16眼或透见荧光24眼,未见异常荧光40眼;视网膜出血26眼表现为视网膜前出血遮蔽脉络膜视网膜荧光,均遮挡血管,视网膜下出血遮蔽脉络膜荧光。脉络膜裂伤14眼,血管水平下一条或数条条状或弧形弱荧光,晚期增强,呈现高荧光;黄斑裂孔黄斑区圆形或椭圆形透见荧光;视神经损伤早期后极部点状荧光渗漏,晚期呈雾状荧光渗漏、出血为遮蔽荧光。结论眼钝挫伤眼底损伤的临床表现复杂,尽早进行荧光素眼底血管造影检查,可以及时、彻底、全面、系统地了解眼底损伤部位及损害程度。     

脉络膜骨瘤的CT影像学与眼科临床各种检查方法比较分析

目的：研究脉络膜骨瘤CT诊断价值。方法：对3例患者、4只单眼进行CT平扫及眼底镜、萤光血管造影、三面镜及B超等一系列检查，将检查结果进行对比，并提出与眼内其他钙化性疾病鉴别诊断要点。结果：CT检查具有准确、快捷、直观、无损伤的优点，其他方法均有一定的局限性。结论：脉络膜骨瘤的诊断应以CT作为首选。     

多灶性脉络膜炎合并脉络膜新生血管的分析

目的：探讨多灶性脉络膜炎(multifocal choroiditis，MFC)合并脉络膜新生血管(choroidal neovascularization，CNV)的临床特点和治疗方法的选择。方法：对2002～2004年诊断的MFC合并CNVl9例20只眼的临床资料和荧光素眼底血管造影(fundus fluorescein angiography，FFA)图像进行回顾性研究。结果：患眼眼底后极部可见视网膜下4个至近百个圆形病灶，呈灰黄色或黄白色，直径50～500μm。FFA显示活动性病灶造影早期呈高荧光或低荧光，后期渗漏；非活动性病灶呈透见荧光。CNV大多为1个，平均直径884．31／zm。1例1只眼用糖皮质激素和光动力疗法(photodynamic therapy，PDT)治疗，视力明显提高，CNV缩小。结论：MFC是导致CNV的病因之一。FFA可用于诊断病灶和CNV。糖皮质激素可能有助于控制炎症、减缓CNV的生长。对MFC合并黄斑中心凹下CNV，可选择PDT治疗。     

吲哚菁绿血管造影和荧光素眼底血管造影同步检查的护理配合

荧光素眼底造影(fundus fluorescein angiographg，FFA)是用于眼底视网膜疾病的诊断及鉴别诊断。吲哚菁绿血管造影(indocyanine green．ICGA)主要用于脉络膜及视网膜色素上皮疾患、黄斑下新生血管膜以及某些视网膜疾病的诊断和鉴别诊断。由于脉络膜血管荧光干扰对视网膜毛细血管和小动脉及小静脉的观察，目前ICGA的图像清晰度难以与FFA图像相比，不能取代FFA来观察视网膜血管的循环情况。     

超声造影联合荧光血管造影在脉络膜肿瘤中的诊断价值

【】 目的 探讨超声造影及荧光血管造影在脉络膜肿瘤中的诊断价值。方法 对75例经手术病理或临床综合诊断及随访证实的脉络膜肿瘤的超声造影及荧光血管造影检查资料进行回顾性分析。结果 脉络膜血管瘤、脉络膜黑色素瘤与脉络膜转移癌在IMAX、RT、TTP、mTT均有明显统计学差异(P<0.05)。脉络膜血管瘤荧光造影通常表现为早期显影,瘤体呈现不规则丛状或斑状的强荧光,中期逐渐荧光增强,晚期有不同程度的荧光渗漏及瘤体染色。脉络膜黑色素瘤荧光造影表现为早期呈现弱荧光或低荧光,中期逐渐荧光增强,晚期瘤体多呈斑状高荧光伴不同程度的荧光渗漏。脉络膜转移癌荧光造影表现为造影早期瘤体呈现斑驳样的弱荧光,中期逐渐转变为强荧光,晚期增强呈斑驳样荧光。结论 超声造影检查及荧光血管造影检查在脉络膜肿瘤的诊断和鉴别诊断中具有重要价值。     

缺血性视神经病变的荧光造影和视野改变分析

目的探讨眼底荧光造影（FFA）和视野检查对前部缺血性视神经病变的诊断作用。方法对56例（62眼）确诊为前部缺血性视神经病变患者的眼底荧光血管造影和视野等检查结果进行回顾性分析。结果62眼（100％）在造影早期视盘缺血区荧光充盈延缓或缺损,可见局限性的弱荧光区,晚期视盘呈强荧光或强弱不对称的特征;46眼（82．1％）的FFA图像与视野缺损呈基本对应关系。结论FFA及视野检查对诊断前部缺血眭视神经病变具有重要临床意义。     

吲哚青绿眼底脉络膜血管造影的观察与护理

吲哚青绿脉络膜血管造影（ICGA）是眼底造影检查的一种，它弥补了荧光素血管造影（FFA）的缺点。由于吲哚青绿的分子量大不易从窗孔型的脉络膜毛细血管渗漏，并且其荧光光谱可穿透视网膜色素上皮、黄斑区叶黄素、出血及浆液性渗出等．从而能很好的对脉络膜血管显影。如果说FFA对视网膜病变有较高的诊断价值，那么ICGA则对脉络膜病变，特别脉络膜新生血管性疾病具有独特的诊断价值．两种检查配合使用为眼底疾病的诊断提供了更有效、可靠的手段。     

Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review

This report describes a patient who had acute lymphocytic leukemia with exudative retinal detachment (RD), which mimicked Vogt–Koyanagi–Harada disease (VKH). A 61-year-old woman presented with painless loss of vision in the left eye. Fundus examination revealed RD in her left eye. B-scan ultrasonography confirmed localized RD and choroidal thickening. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence in the upper macula. One week later, reduced visual acuity was noted in the right eye. B-scan ultrasonography and optical coherence tomography revealed serous RD in both eyes. A provisional diagnosis of VKH was made. However, subsequent hematologic analysis detected an extremely high leukocyte count. Elevated numbers of leukocytes and tumor cells were found in cerebrospinal fluid. Bone marrow biopsy revealed 77% primary atypical blood cells, 89% of which were immature lymphocytes. The patient was subsequently diagnosed with acute lymphocytic leukemia and transferred to the Department of Hematology. However, the patient and her family refused chemotherapy; she eventually died. Our findings suggest that exudative RD, similar to VKH, could be a sign of leukemia. Pinpoint hyperfluorescence leakage is important for differential diagnosis, particularly with respect to VKH.     

螺旋CT在女性盆腔病变的诊断价值

目的:探讨螺旋CT扫描技术在女性盆腔病变诊断价值。方法:分析57例女性盆腔病变CT表现,并与手术病理结果对照。结果:病变检出率100%,手术符合率88%。卵巢癌与囊腺瘤的鉴别要点是:实性组织在肿物中所占的比例和软组织结节形态和在动、静脉期的强化特点。动脉期“双环征”及静脉期、延迟扫描持续强化是卵巢脓肿的特征。子宫内膜癌及绒癌在动脉期与正常子宫平滑肌比较有相反的CT特征。直肠左右明显移位是后腹膜病变定位可靠的CT征象。结论:螺旋CT双期扫描能显示各种女性盆腔病变更多CT特征,对提高女性盆腔病变术前诊断有意义,经验不足是造成误诊主要原因。     

Choroidal osteoma: Acoustic shadowing and reduplication echoes

A 27-year-old woman had a curious choroidal mass of 12 years duration in her right eye. Interesting ultrasonic findings of a choroidal osteoma, including acoustic shadowing and reduplication echoes on A-scan and B-scan are presented. Ophthalmic nurses can assist in performing ophthalmic examinations and in reinforcing regular follow-up examinations for these patients.     

Delayed enhancement of hepatocellular carcinoma on dynamic CT: sign of extrahepatic collaterals after transcatheter arterial chemoembolization or transcatheter arterial chemoinfusion

BACKGROUND: We examined the factors of delayed enhancement of hepatocellular carcinoma (HCC) on dynamic computed tomography (CT). METHODS: Dynamic CT and angiography were compared in 113 patients who had undergone transcatheter arterial chemoembolization or transcatheter arterial chemoinfusion and were suspected of developing new HCCs. RESULTS: Eight of 113 patients had HCC nodules that enhanced gradually from the arterial phase to the portal venous phase on dynamic CT and were fed by extrahepatic arteries on angiography. The feeding artery was an omental branch of the splenic artery in one lesion, an omental branch of the gastroduodenal artery in five, and the intercostal artery in two. CONCLUSION: We believe that the recurrence of HCCs delayed enhancement on dynamic CT because the hepatic artery was hidden and long narrow extrahepatic collaterals fed the tumor.     

眼内期眼球肿瘤的CT诊断与鉴别诊断

目的：探讨CT检查在眼球肿瘤定位及定性诊断中的价值。材料与方法：回顾性分析48例经手术病理和临床证实的各种眼内期眼球肿瘤的CT表现与鉴别诊断。结果：48例中视网膜母细胞瘤28例占58．3％;脉络膜黑色素瘤12例占25％;脉络膜骨瘤4例占8．3％;转移瘤及血管瘤各2例,各占4．2％。结论：薄层CT扫描对各种类型球内肿瘤的疗效、定性诊断、鉴别诊断及治疗、预后具有十分重要的价值。     

CT与磁共振成像对肝内胆管细胞癌的诊断价值

目的:探讨CT与磁共振成像(MRI)对肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的诊断价值。方法:经手术或活检病理证实的ICC患者29例,其中15例行多层螺旋CT平扫和动态增强扫描,16例行MRI平扫和动态增强扫描。回顾分析肿瘤的形态学特征、CT及MRI影像学表现特征以及附属征象。结果:29例ICC,共检出32个病灶,肝左、右叶均见分布。CT共检出17个病灶,平扫仅1个病灶表现为混杂密度,其余均呈低密度;增强扫描动脉期显示10个病灶呈边缘强化,6个病灶呈轻度不均匀强化,1个病灶未见强化,门脉期显示12个病灶呈渐进性强化,5个病灶强化减退。MRI共检出17个病灶,T1WI、T2WI主要表现为混杂的异常信号;动态增强扫描动脉期显示16个病灶呈边缘环形或不规则强化,1个病灶无明显强化,门脉期和延迟期显示15个病灶瘤内实性部分的信号呈渐进性增强,强化程度更加明显,1个病灶瘤体边缘保持厚环状明显强化,1个病灶强化减弱。附属征象包括胆管扩张15例,局部肝包膜凹陷2例,肝叶萎缩1例,门静脉癌栓4例。结论:ICC的CT和MRI表现具有一定的特征性,动态增强扫描是其诊断和鉴别诊断的重要方法,术前详尽的影像学检查是及早发现ICC的重要途径。     

Superficial venous aneurysm: reports of 3 cases and literature review.

OBJECTIVE: The purpose of this series is to describe the ultrasonographic and computed tomographic (CT) findings of superficial venous aneurysms sometimes misdiagnosed as subcutaneous soft tissue tumors. METHODS: Two of the patients had an asymptomatic subcutaneous mass that gradually increased in size; the third patient had a superficial mass in the right antecubital fossa associated with pain and occasional edema. All of the patients were examined with ultrasonography, and 2 had CT scans. RESULTS: In all cases, ultrasound examinations showed a well-defined heterogeneous echoic lesion that was contiguous with the adjacent superficial vein and easily compressed by the probe, whereas a Doppler study indicated a venous spectral wave without pulsation. Dynamic enhanced CT showed homogeneous enhancement in the late phase, with contiguity with the adjacent vein. Only the third patient had an internal, floating, heterogeneous, echoic mass-like lesion, suggesting a chronic thrombus in the lesion on ultrasonography. This patient underwent aneurysmectomy with end-to-end anastomosis. CONCLUSIONS: Venous aneurysm should be included in the differential diagnosis of a subcutaneous mass, and an accurate understanding of the differences between superficial and deep venous aneurysms may help in diagnosis and treatment.