超声引导下眶内肿瘤穿刺活检术临床应用

眼球后占位病变病情复杂,常引起眼球突出,视功能受损,严重者可导致失明。随着医学影像学的发展,对球后组织的病变部位、形状、大小及与周围组织的关系能作出较为确切的诊断。然而球后组织结构复杂,占位病变的种类繁多,定性诊断还有一定的困难。我院从1988年7月至1998年2月在超声引导下穿刺球后占位性病变45例,全部穿刺活检成功,无并发症,全部病例获得病理组织学进一步诊断。1　资料与方法本组45例,男28例,女17例,年龄1～72岁,平均年龄4352岁。眼球突出38例,视力下降40例,失明3例。穿刺时所使用超声诊断仪为ＡＬＯＫＡＳＳＤ190,ＡＬＯＫＡＳ…     

眶内肿瘤彩色超声引导穿刺活检术的临床应用

眶内组织结构复杂,占位病变的种类繁多,定性诊断有一定的困难.我院1988年9月～2007年12月在高频彩色超声引导下对眶内占位性病变进行穿刺活检,报告如下.     

眼眶肿瘤磁共振成像80例分析

磁共振成像是近年应用于眼病诊断的新影像技术。由于成像参数多，软组织对比分辨力强，定性和定位诊断优于超声和ＣＴ。本文分析眶内占位性病变８０例的ＭＲ图像，发现眶内占位病变８０例，其中正确分辨出良性病变５９例，恶性病变１０例，定位正确和显示病变远全者７９例。对ＭＲＩ基本概念，各种病变的信号强度和ＭＲＩ适应证进行讨论。     

B型超声显像对眼内异物的诊断评价

目的评价B型超声对眼内异物的诊断价值.方法回顾性分析50例经手术证实眼内异物病例的临床资料,对照B超与X线、CT的检查结果,根据术中所见异物的位置分析B超对眼内异物位置判断的准确性.结果B超对眼内异物位置的判断准确性达80%,对于异物与球壁关系的判断准确性达81.5%,高于X线,与CT接近.结论B超对眼内异物尤其是球壁异物的诊断有重要的参考价值,联合应用B超和其它辅助检查手段有助于提高眼内异物诊断率.     

MRI对泪腺占位性病变的诊治价值

目的 探讨分析MRI在泪腺占位性病变诊断治疗中的价值.方法 回顾性分析36例泪腺占位性病变患者的MRI表现.主要观察指标为:病变范围、病变形态、病变边界、内部信号特点(T1及T2加权像)、病变强化显像的情况以及临近骨组织的改变.结果 36例泪腺病变的患者中,泪腺炎4例,炎性假瘤9例,淋巴瘤8例,泪腺多形性腺瘤7例,泪腺腺样囊性癌8例.泪腺炎多为双侧发病,MRI可见病变累及眶内及眼睑,形状不规则边界不清,T1加权像为中等信号,T2加权像为低信号.炎性假瘤和淋巴瘤多累及眶内,形状不规则边界不清与眼球呈铸造型,在T1和T2加权像均为中信号.泪腺多形性腺瘤可见病变累及眶内为圆形或椭圆形边界清楚,可伴有骨质增生,在T1加权像为中信号和T2加权像为高信号.泪腺腺样囊性癌多为形状不规则的病变,多伴有骨破坏,在T1加权像为中信号和T2加权像为高信号.以上泪腺病变的MRI强化显像均为中等强化.结论 MRI对于泪腺占位性病变的鉴别诊断具有一定意义,尤其有助于区别炎性病变和实体性肿瘤以及良性肿瘤和恶性肿瘤,并且结合MRI强化显像技术可以对手术切除病变的范围起到一定的指导作用.     

儿童眼眶占位性病变的临床及病理组织学分析

目的：探讨儿童眼眶占位性病变的病理组织学分类及发病情况,为儿童眼眶占位性病变的诊断提供参考。
　　方法：回顾性分析天津医科大学第二医院1998-01/2012-12收治并经病理学证实的儿童眼眶占位性病变290例病例资料。
　　结果：选取的290例儿童眼眶占位性病变中以静脉性血管瘤最为常见,共58例(20.0%),其它常见病变依次为血管淋巴管瘤、皮样囊肿、神经纤维瘤、视神经胶质瘤、横纹肌肉瘤等。毛细血管瘤、静脉性血管瘤、视神经胶质瘤等有明显年龄倾向;视神经胶质瘤、静脉性血管瘤、横纹肌肉瘤等有明显性别倾向。
　　结论：儿童眼眶占位性病变以先天性和胚胎性为主,其中以静脉性血管瘤最为多见,某些病变具有明显的年龄及性别倾向。     

眼眶囊尾蚴病11例临床分析

目的探讨眼眶囊尾蚴病的临床诊断和治疗方法。方法对我院自1982年6月至2007年3月收治的11例眼眶囊尾蚴病,回顾性分析其临床、实验室和影像学检查以及治疗方法。结果11例眼眶囊尾蚴病均有反复眶内炎症史及占位性病变体征,如眼睑及结膜充血水肿,眼球突出,眼球运动受限;3例有视力下降及视乳头水肿,扪及肿块1例。B超示眶内占位性病变,内有液性暗区及自由运动光斑。CT扫描示眶内高密度块影中央有低密度区。11例眼眶囊尾蚴病经手术摘出囊尾蚴9例,1例经穿刺抽吸等治疗,位于眶前部的1例破溃后自行排出囊尾蚴。11例均痊愈,眶内炎症消退,眼球运动恢复正常,眼球突出度恢复至正常,CT扫描及B超检查均示眶内无占位性病变影像。结论影像学检查有助本病的诊断,尤其是定位性诊断可提供选择手术进路的依据。本病的治疗以手术切除囊尾蚴为主。     

眼眶内球后占位病变的CT表现

1998～ 2 0 0 1年我科共对 82例眼眶内球后占位病变 CT表现进行分析 ,现报告如下。1　临床资料1.1　一般资料　本组共 82例患者 ,男 50例 ,女 3 2例。年龄 1～ 78岁 ,平均4 2 .1岁。单侧突眼者 79例 ,双侧 3例。突眼时间 1～ 2 0 a。其中 78例经手术证实 ,4例经穿刺活检证实。1.2　方法　器械为 TOSH IBA TCT - 3 0 0 EZ型 ,距阵 512× 512。 82例中 ,全部做横断扫描 ,除 4例外 ,都做平扫加增强。层厚及间隔均为 5m m。疑为血管瘤患者均有增强延迟扫描。2　结果82例眼眶内球后占位病变患者 CT结果见表 1。术前 CT诊断与术后病理检查…     

泪囊区占位病变13例临床分析

目的 探讨泪囊区占位病变的临床诊断及治疗方法。方法 对10年间诊治的13例泪囊区占位病变的临床表现、影像学特征和治疗进行分析。结果 13例病变中，根据病变特点分囊肿性病变7例、实体性病变6例。临床上以溢泪、泪囊区肿物、血性分泌物、疼痛等为主要特征，B超及CT检查提示病变的形态、性质。结论 泪囊区占位病变根据临床表现及影像学检查，可早期明确诊断。治疗以手术切除为主，酌情辅以放、化疗，预后良好。     

轴性近视致单侧眼球突出

单侧眼球突出是眼眶疾患中最常见的征象。病变可来自眶内(包括眼球内外)、眶外,也可继发于颅内、副鼻窦、鼻咽部的病变,其原因除占位性病变之外,尚有因水肿、出血、感染等原因所致的球后组织肿胀及内分泌性突眼等。本文介绍2例因轴性近视引起之单侧眼球突出。     

B-scan ultrasonography in Graves' Orbitopathy

Diagnosing and monitoring of Graves' Orbitopathy (GO) can be supported by use of Ultrasonography (USG) and Computerized Tomography (CT); they provide supplementary information. In this retrospective study we describe 107 clinical GO patients evaluated by B-scan USG and 27 clinical GO patients evaluated by CT scan. Analysis of 236 B-scan USG included measurements of medial, inferior and lateral rectus muscles. The presence of muscle enlargement and increased orbital fat were noted by the radiologist on 27 CT scans. Sensitivity of both B-scan USG and CT scan were calculated. We suggest that B-scan USG has a high sensitivity, which is equal or better than CT scan sensitivity in diagnosing GO. Furthermore USG A and B scan combination is an effective, accurate tool in diagnosing GO, and optic neuropathy, but it also provides essential information about the GO disease activity.     

Bilateral optic nerve sheath meningioma (ONSM) --diagnostic and therapeutic problems

The authors describe the case of bilateral optic nerve sheath meningioma /ONSM/ in 14 years old girl. When being hospitalized at the Neurology Clinic with paresis n.VII, the patient was examined by ophthalmologist. The diagnosis was made on the basis of clinical and characteristic changes revealed by USG, CT and MRI. The very first ophthalmologic examination confirmed a visual acuity 5/5 OD and hand movements OS, associated with papilloedema OD and edematous optic atrophy OS. The use of USG, CT and MRI revealed bilateral tubular thickening of the optic nerves (8mm), with calcification. After the period of one year, clinical progression was observed. The intracranial tumor extended. It was shown in diagnostic imaging. The patient was operated on by neurosurgeons with histopathology verification. In the later stage she underwent radiotherapy. The case has been described because of its diagnostic and therapeutic difficulties.     

首诊眼科的颅内病变诊断分析

目的 分析颅内病变的眼部表现及诊断方法。方法 分析２２例首诊于眼科的颅内病变的眼部表现及辅助检查，初诊与确诊对照分析。结果 本组中，有视力下降占８１．８％，视野改变占８９．５％，视盘水肿占４０．９％，视神经萎缩占５０％，瞳孔改变占２２．７％，眼肌麻痹占１８．２％，初诊误诊率较高。头颅ＣＴ或ＭＲＩ有助于早期诊断，但较难发现较小病灶。结论 颅内病变可以通过影响视路、瞳孔光反射路及眼运动神经而表现各种眼     

Myocysticercosis: experience with imaging and therapy

OBJECTIVE: To compare computed tomography (CT) and B-scan ultrasonography (USG) in the diagnosis and to study the efficacy of a combination of oral albendazole and prednisolone in the management of myocysticercosis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-six consecutive patients with myocysticercosis. INTERVENTION: Diagnostic imaging was performed by CT scan and USG in 24 and 22 patients, respectively; serial USG was obtained in 7 patients receiving treatment. All patients received oral albendazole (15 mg/kg body weight per day) and prednisolone (1.5 mg/kg body weight per day) for 4 weeks. MAIN OUTCOME MEASURES: Presence of scolex on CT scan compared to USG and clinical response to medical therapy were the main outcome measures. Recovery was defined as complete resolution of the scolex or of the main presenting clinical feature. RESULTS: Presence of scolex on CT scan (11 of 24) and USG (11 of 22) was not different (P = 1.0; chi-square test). Recovery was seen in 24 (92%) of 26 patients receiving medical treatment. On serial USG of patients receiving treatment (n = 7), cysts with scolex were seen to progress to a cyst without scolex before final resolution. Time to recovery on treatment (0.5-35 months) correlated with the duration of symptoms at presentation (correlation coefficient r = 0.56, P = 0.003, linear regression analysis), but not with positive serum enzyme-linked immunosorbent assay for anticysticercal antibodies (P = 0.57, log-rank test) or the presence of scolex (P = 0.52, log-rank test). CONCLUSIONS: Treatment with a combination of oral albendazole and prednisolone is effective in the management of myocysticercosis. Imaging methods CT and USG are equally effective in identifying the cyst and the scolex; serial USG is useful in studying the temporal sequence of therapeutic response. The longer recovery time correlating with the duration of symptoms may indicate the chronicity of the inflammatory changes requiring longer time for recovery.     

Lens subluxation as a sign of medulloepithelioma in 13 years boy--case report

The paper presents the case of the 13 years old boy with the deterioration of vision acuity of the right eye, caused by lens subluxation. The condition was caused by tumour of ciliary body. Additional tests: USG, UBM, CT did not resolve diagnostic doubts. After the biopsy medulloephitelioma was diagnosed and the decision of the eye enucleation was made. Histopathological examination confirmed the diagnosis.     

眼眶CT显示钙斑的临床意义

目的 探讨眼眶病患者CT影像中钙斑图像的临床意义。方法 回顾性审读2181例眼眶病患者的眼眶CT片,其中129例CT片有钙斑,分析影像中眼眶钙斑在诊断标准、发生机制及诊断与鉴别诊断中的作用。结果 2181例眼眶CT片中129例有钙斑存在,其中眼内视网膜母细胞瘤40例(31％),眼内脉络膜骨瘤3例(1％);眼眶血管性病变58例(45％),眼眶其他良性病变19例(15％),眼眶恶性病变9例(8％)。结论 确诊眼眶钙斑和其形状、数量及位置可能有助于眼眶病患者的临床定性诊断和鉴别诊断。     

Ultrasonological characteristics of extraocular cysticercosis

Cysticercosis is a common ophthalmic parasitosis wherein humans are the intermediate hosts in the life cycle of the tape worm Taenia solium. While intraocular cysticercosis is more common and is more readily diagnosed clinically, recognition of extraocular cysticercosis needs supplementary imaging. Computed tomography (CT) and magnetic resonance imaging (MRI) have been extensively used to diagnose and characterize neurocysticercosis. Since the orbit is easily accessible to ultrasonography (USG), we evaluated its role in the diagnosis and management of extraocular cysticercosis. Serial A- and B- scan ultrasonograms from 24 patients with extraocular cysticercosis were analyzed to determine features at various stages of evolution of the lesion and an attempt was made to classify the lesion on this basis. Of 24 patients, 23 had a cyst clearly demonstrable by USG: 22 within or attached to an extraocular muscle (with or without myositis) and one free in the orbit. One patient had an optic nerve cyst not detected by USG but by CT scan. Cysts at various stages of evolution were found - viable, degenerating and inactive. The therapeutic response of the cyst to treatment with oral albendazole could be effectively studied and monitored by sequential USG. Orbital ultrasound is a practical, precise and cost-effective imaging modality to diagnose, manage and monitor extraocular cysticercosis, although it can not completely replace CT and MRI.     

Ultrasonological characteristics of extraocular cysticercosis

Cysticercosis is a common ophthalmic parasitosis wherein humans are the intermediate hosts in the life cycle of the tape worm Taenia solium . While intraocular cysticercosis is more common and is more readily diagnosed clinically, recognition of extraocular cysticercosis needs supplementary imaging. Computed tomography (CT) and magnetic resonance imaging (MRI) have been extensively used to diagnose and characterize neurocysticercosis. Since the orbit is easily accessible to ultrasonography (USG), we evaluated its role in the diagnosis and management of extraocular cysticercosis. Serial A- and B- scan ultrasonograms from 24 patients with extraocular cysticercosis were analyzed to determine features at various stages of evolution of the lesion and an attempt was made to classify the lesion on this basis. Of 24 patients, 23 had a cyst clearly demonstrable by USG: 22 within or attached to an extraocular muscle (with or without myositis) and one free in the orbit. One patient had an optic nerve cyst not detected by USG but by CT scan. Cysts at various stages of evolution were found – viable, degenerating and inactive. The therapeutic response of the cyst to treatment with oral albendazole could be effectively studied and monitored by sequential USG. Orbital ultrasound is a practical, precise and cost-effective imaging modality to diagnose, manage and monitor extraocular cysticercosis, although it can not completely replace CT and MRI.     

角膜深板层内皮移植的三年临床观察

目的:探讨用微型自动角膜板层刀进行深板层角膜内皮移植术(microkeratomeassociateddeeplamellarendothelialkeratoplasty,MDLEK)的临床效果和不良反应。方法:对于2002年1月～2002年3月期间,用MDLEK治疗的6例大泡性角膜病变患者进行随访观察。结果:术后3个月5例患者最佳校正视力较术前明显提高,最高者可达0.7,并在以后的随访中保持稳定;术后3个月患者平均散光为(2.04±1.19)D,以后进一步减退;角膜中央厚度于术后3个月已接近正常水平,此后无显著变化;术后角膜内皮密度逐步下降,其下降速率与穿透性角膜移植相仿;共焦显微镜观察发现术后1a,创面附近的角膜基质细胞已趋于正常,且角膜中央视轴区无明显瘢痕。随访期内未发现角膜深层缝线导致新生血管或引起排异反应。结论:MDLEK用以治疗角膜内皮失代偿安全、实用;术后恢复视力时间短;术后散光小;术后板层创面愈合快,光学性能满意。     

Blow-in fracture of the orbital roof presenting as a case of non-resolving choroidal effusion

A 34-year-old male patient was referred to us as a case of non-resolving suprachoroidal hemorrhage. History revealed decrease in right eye vision following trauma to forehead. B scan ultrasonography (USG) of the right eye showed a high-reflective structure indenting the globe. It turned out to be an inferiorly displaced fracture fragment from the orbital roof on computerized tomography (CT) scan. The choroidal elevation disappeared after open reduction of the fracture fragment and patient had good recovery of vision. USG and CT scan were helpful in the diagnosis and management of this case.