泪腺腺样囊性癌CT表现的研究

目的 分析泪腺腺样囊性癌常见的CT图像特征,从而探讨CT(computed tomography)影像对于泪腺腺样囊性癌的诊断价值.方法 病历来源为天津医科大学眼科中心及天津医科大学第二医院,经病理确诊的眼眶腺样囊腺癌39例.其中原发肿瘤20例,复发肿瘤19例,均为单眼发病,所有患者均行眼眶CT检查,获取水平及冠状扫描图像.结果 泪腺腺样囊性癌中原发肿瘤形状多为厚扁平状,贴附于眶壁增长,在体层像上呈锥形者10例、不规则形5例;复发肿瘤形状为不规则型8例、厚扁平状,贴附于眶外上壁向后增长者8例.原发与复发泪腺腺样囊腺癌的好发位置位于眶外上方分别为18例与11例.结论 CT可清晰显示肿瘤的位置,形状,范围、眶骨壁改变,对于泪腺腺样囊性癌的诊断和制定治疗方案具有重要指导意义.     

眼眶腺样囊性癌的影像学研究

目的分析眼眶腺样囊性癌(ACC)的超声、CT及MRI等影像学特征。设计回顾性病例系列。研究对象经病理诊断证实的泪腺腺样囊性癌38例和副鼻窦来源的腺样囊性癌4例。方法分析眼眶腺样囊性癌超声、CT和MRI等各种影像学检查结果,记录图像特征。主要指标标准化A/B超、CT和MRI影像。结果ACC标准化A超表现为前部高波峰,后部低波峰和不规则高低混杂波峰两种类型。B超可显示肿瘤的轮廓,对于瘤内钙化及液化坏死等病变显示优良。CT扫描显示ACC有梭形、扁平形、团块状和不规则形等四种形状,对于肿瘤的边界、空间位置,骨破坏和骨吸收等继发改变显示清晰。ACC在T_1加权像为中信号,T_2加权像有均一的等信号,等、低信号混杂和等、高信号混杂三种,多数不均匀强化。强化MRI有利于显示肿瘤的蔓延途径,泪腺ACC有多种蔓延途径。副鼻窦ACC易累及筛窦和上颌窦。结论各种影像学检查可显示眼眶ACC的不同特性。综合运用和分析各种影像学检查结果可提高诊断水平。(眼科,2007,16:391-394)     

肿瘤干细胞相关标志蛋白在眼眶腺样囊性癌中的表达分析

目的 观察肿瘤干细胞相关标志蛋白CD44、CD133和ABCG2在眼眶腺样囊性癌中的表达,分析其与肿瘤的病理分型、预后之间的关系.方法 实验研究.选取1991年1月至2009年3月间,手术切除后病理证实为眼眶腺样囊性癌的患者中,具有详细随访记录的,首次切除的肿瘤组织石蜡包埋标本33例,复发后切除的肿瘤组织标本5例.ACC-2细胞系建立的裸鼠眼眶移植瘤模型标本6例,以3例正常泪腺组织标本作为对照,采用二步法免疫组织化学法检测CD44、CD133、ABCG2在标本中的表达.分析其与临床病例资料中病理分型、预后的关系.统计学方法采用Fish精确检验,两组间关系比较运用Spearman等级相关检验.结果 CD44表达阳性率为54.5%(18/33).实体型阳性率76.9%(10/13),多呈片状散在分布于肿瘤边缘浸润灶,肿瘤细胞密集处没有着染;筛网型为40.0%(8/20),多分布在肌上皮细胞,二者差异无统计学意义(P=0.072);正常泪腺组织中CD44也有阳性表达.CD133阳性表达率为57.6%(19/33),实体型和筛网型分别为76.9%(10/13)、45.0%(9/20),差异无统计学意义(P=0.087);表达产物定位于细胞膜和细胞质,但部分病例同时表达于胞质和胞核.ABCG2表达阳性率为21.2%(7/33),具有沿血管分布的倾向,实体型和筛网型分别为30.8%(4/13)、15.0%(3/20),差异无统计学意义(P=0.393).CD44、CD133及ABCG2在无复发组的表达阳性率均低于复发组,预后好组低于预后差组,但差异均无统计学意义(P＞0.05).CD44和CD133的阳性表达之间存在正相关(Spearman,rs=0.416,P=0.016).在6例荷瘤裸鼠肿瘤组织标本中,CD44阳性1例,CD133表达阳性1例,ABCG2表达阳性4例.结论 眼眶腺样囊性癌肿瘤组织中存在CD44、CD133及ABCG2阳性细胞,分别表达于腺样囊性癌肿瘤组织的不同部位,其表达随着病程进展而变化,可能会影响预后,但尚不能确定为评估预后的指标.

Abstract：

Objective To observe the expression and distribution of CD44,CD133,and ABCG2 in orbital adenoid cystic carcinoma (ACC) and investigate their correlations with pathological type and prognosis. Method Two steps method of immunohistochemical staining was employed in 33 cases of paraffin embedded surgical specimens of human orbital ACC,5 cases of recurrence samples,3 cases of an excised lacrimal gland caused by neither inflammation nor tumor diseases,and 6 cases of xenograft tumors in nude mice. A retrospective analysis was performed on the clinical material of these patients,which were collected from Jan. 1991 to Mar. 2009. Results The positive rate of CD44 was 54. 5% ( 18/33),with 76. 9% (10/13) in solid type and 40. 0% (8/20) in adeno-tubiform type. There was no statistically significant difference between them (P = 0. 072). In solid type the positive expression cells were often located at the marginal part of the cancer nest. In the adeno-tubiform type,positive cells were often located at the outer layer of the tubiform structure ( myoepithelial cells). CD44 was also expressed in normal tissues.The positive rate of CD133 was 57.6% (19/33),with 76. 9% (10/13) in solid type and 45.0% (9/20)in adeno-tubiform type. There was no significant difference between them (P =0. 087). CD133 antigen was expressed in either the cytoplasm or nucleus,or expressed in both the cytoplasm and nucleus. The positive rate of ABCG2 was 21.2% (7/33),with 30. 77% (4/13) in solid type and 15.0% (3/20) in adenotubiform type. There was no significant difference between them ( P = 0. 393 ) . Many positive cells surrounded the vessels in tumor tissues. There were no significant differences between different prognosis groups of these surface phenotypes. The correlative analysis results of three surface phenotypes showed that CD44 + cells have positive correlation with CD133 + cells ( Spearman,rs = 0. 416,P = 0. 016 ). In six transplanted tumors of nude mice,the number of positive cases for CD44 +,CD133 + and ABCG2 + was 1,1 and 4 cases,respectively. Conclusions The expression of CD44,CD133 and ABCG2 in ACC may influence the progress of ACC. However,they cannot be used as the markers for the evaluation of the prognosis of this tumor.     

眶区皮样囊肿的CT表现

目的 分析眶区皮样囊肿及表皮样囊肿的CT表现,揭示该病的特殊性CT征,作为诊断依据.方法 复习经手术及病理组织学证实的皮样及表皮样囊肿CT片共55例,分析其所在位置、范围、形状、边界、密度、CT值及继发改变.结果 55例病变均被CT发现,53例提示病理组织学诊断,2例眶缘有瘘管者缺乏特征性CT表现.病变位于眶内者44例:内上象限2例、外上象限36例、内下象限3例、外下象限3例;按所在间隙分析,中央间隙(肌锥内)1例、周围间隙9例、骨膜下间隙24例、眶骨壁内10例.眶缘者5例均位于眶上缘.颞窝者6例均位于颞肌下.囊肿密度不均,CT值-158.67Hu～+62.00Hu.典型的骨壁改变45例.结论 CT能够在术前对皮样囊肿作准确定性、定位诊断,对制定手术方案有很大帮助.

Abstract：

Objective To study the findings of the orbit dermoid and epidermoid cyst on CT, then to reveal the CT characteristics of the disease for diagnosis. Methods To reviewing the CT image of 55 cases, all had proved by histopathology or operation. And to analyze its position, extent, shape, boundary, density, CT value and subsequent changes. Results CT could discover all the lesions. Fifty-three CT findings indicated its histopathology diagnosis and 2 patients with orbit margin fistula lacked CT characteristics. There were 44 cases in the orbit, 2 in the upper inner quadrant, 36 in the upper outer quadrant, 3 in the lower inner quadrant, 3 in the lower outer quadrant, 1 in the muscle cone, 9 in the space between muscle cone and periosteum, 24 in the subperiosteal space, 10 in the bone wall. There were 5 cases in the margo supraorbitalis, 6 under the temporalis.The density of the cysts was heterogeneity, and the CT value was from -158.67Hu to +62.00 Hu. Forty-five cases with typical boll wall changes were found. Conclusions Orbital CT scanning is the effective way in the preoperative diagnosis of orbital dermoid and epidermoid cysts for determining its nature and location. It is helpful to formulating the procedures of operation.     

眼眶嗜酸性粒细胞增生性淋巴肉芽肿的临床病理学观察

目的 探讨眼眶嗜酸性粒细胞增生性淋巴肉芽肿(Kimura病)的临床病理学特点.方法 回顾性系列病例研究.对天津市眼科医院病理科从1976年至2008年间诊断的9例Kimura病患者的临床和病理学特点进行总结,分析CD20、CD79a、CD3、CD45Ro、CD34、Ki67及IgE等抗体免疫组织化学染色特点.结果 9例中,男性7例,女性2例,发病年龄13～62岁,年龄中位数为25岁;7例为单眼眶内病变,2例为双眼眶内病变.病变均发生在眼眶上方或颞上方,多数病例侵及眶内深部组织,6例累及泪腺,5例累及外直肌.其中1例伴有左侧颌下3个肿大的淋巴结和双侧肘部各1个皮下肿块.临床主要表现为眼睑红肿、眼球突出和眶内肿物,发病时间为6个月～15年.3例患者外周血检查显示嗜酸性粒细胞数量增高(11%-14%).病理学特点为大量分化成熟的淋巴细胞增殖,其间有大小不一的淋巴滤泡、大量嗜酸性粒细胞浸润和增生的毛细血管.免疫组织化学染色显示淋巴滤泡内的细胞表达B细胞抗原,滤泡间的淋巴细胞多数表达T细胞抗原.结论 Kimura病是一种很少见的眶内淋巴组织增生病变,伴有大量嗜酸性粒细胞浸润和毛细血管增生,好发于眼眶外上方,容易累及泪腺和外直肌.

Abstract：

Objective To improve the knowledge of the clinicopathologic features of eosinophilic hyperplastic lymphogranuloma (Kimura disease) in the orbit. Methods It was a retrospective case series study. The clinical and pathological characteristic of 9 cases of Kimura disease from the pathology department of Tianjin Eye Hospital were reviewed, immunohistochemical staining was performed, including for CD20, D79a, CD3, CD45Ro, CD34, Ki67 and IgE. Results In the 9 cases, 7 cases were male, 2 cases were female; the age of onset were from 13 to 62 years, medium age was 25 years; 7 cases were simple, 2 case were bilateral orbit. These lesions occurred in the superior or superotemporal quadrant of the orbit and the majority of cases extended into deep orbital tissues, 6 cases involved the lacrimal gland, 5 case involved the lateral rectus muscle. The clinical features mainly included lid swelling, eye redness, proptosis and palpable mass, and the disease course ranged from 6 months to 15 years. 3 lymph node enlargements in the submandibular regions and 1 subcutaneous nodule on the bilateral elbow were found in one case. The documentation of peripheral-blood eosinophilia (11% - 14%) was found in 3 cases. The pathological characteristics of Kimura disease were lymphoid tissue hyperplasia with prominent lymphoid follicles, conspicuous eosinophils infiltration and capillary proliferation. Immunohistochemical study in our cases revealed B cells in lymphoid follicles and mostly T cells in the interfollicular regions. Conclusion Kimura disease of orbit is an uncommon lymphoid hyperplasia with prominent eosinophils infiltration and capillary vessels, which commonly occur superotemporal quadrant of the orbit, easy to involve lacrimal gland and lateral rectus muscle.     

超声、CT、MRI对泪腺腺样囊性癌诊断价值比较

目的：探讨泪腺腺样囊性癌X线、超声、CT及MRI的影像学特征,以及各种检查方法对疾病诊断价值的比较。方法：回顾性分析1977－1999年经病理组织学确诊的泪腺腺样囊性癌46例,对X线（8例）、B超（39例）、CDI（7例）、CT（37例）、MRI（4例）的特征进行比较。结果：X线可以发现眼眶密度增高及眶骨破坏;B超可以发现眶内占位病变,且对病变内部的钙斑、液化腔等组织结构的显示良好;CDI可以提供肿瘤内部血液供应情况;CT可以揭示病变范围、生长方式、肿物与眶内正常结构的关系、眶骨及眶周结构的改变;MRI对于显示肿瘤颅内和颞凹蔓延,优于以上检查方法。结论：联合应用多种影像学检查方法,可以提高术前诊断率。     

泪腺肿瘤38例临床分析

目的：分析泪腺肿瘤的临床特点和治疗结果。方法：回顾性研究38例45眼泪腺肿瘤。结果38例45眼中，男17例17眼，女21例28眼；年龄5～63岁，平均40．6岁；其中泪腺癌5眼，腺样囊性癌5眼。恶性泪腺混合瘤5眼，良性泪腺混合瘤14眼，炎性假瘤13眼，慢性泪腺炎2眼，泪腺潴留性囊肿1眼。42眼行前路或侧壁开眶肿瘤摘除术，恶性肿瘤中4眼行眶内容物剜除。恶性肿瘤患者全部于术后1个月接受放疗。术后随访观察3个月～8年。术后症状完全缓解35眼，好转5眼，复发5眼。结论：泪腺肿瘤为眼眶常见肿瘤，结合病史，临床表现和影像学检查。绝大部分可以作出术前定性诊断，良性泪腺混合瘤预后较好，但易复发。恶性泪腺混合瘤及腺样囊性癌复发率、死亡率较高，应联合眶内容物剜除，放疗及化疗。     

Primary Chronic Angle-closure Glaucoma in Chinese——A Clinical Exploration of Its Pathogenesis And Natural Course

Fourty-three cases (86 eyes) of primary chronic angle-closure glaucoma were randomly selected. An additional 44 cases (77 eyes) of primary acute angle-closure glaucoma and 30 normal subjects (34 eyes) were also randomly enrolled as control groups for comparison in the clinical study. Ultrasonic biometric measurements of the anterior chamber depth, lens thickness and axial length of the eyeball were performed. Using an potic microgauge attached to the slit-lamp, the entrance of anterior chamber angle was also calculated. The clinical manifestations and the natural course, including the characteristic appearance of anterior chamber angle, the form of peripheral anterior synechia as well as the facility of outflow, were carefully investigated. There were significant differences in the biometric parameters of the anterior segment of eye among above three groups. The facts reveal that the anatomic features of eyeball, especially in the anterior segment differentiate from those of primary acute angle-closure     

原发性结膜肿瘤728例临床病理分析

目的 了解眼部原发性结膜肿瘤的组织病理学特征及发病率.方法 收集第三军医大学附属西南眼科医院2003年1月至2009年12月期间门诊及住院治疗的728例原发性结膜肿瘤的临床病理资料进行回顾性分析.结果 良性结膜肿瘤570例(78.3%),其构成位于前10位的依次为:色素痣、结膜囊肿、乳头状瘤、血管瘤、迷芽瘤(皮样瘤、皮样脂肪瘤、畸胎样瘤)、脂肪瘤及纤维脂肪瘤、反应性淋巴增生、黑变病、非典型性增生、皮脂腺瘤.恶性结膜肿瘤158例(21.7%),其构成位于前5位的分别是:鳞状细胞癌(含黏液表皮样癌)、恶性淋巴瘤、恶性黑色素瘤、浆细胞瘤、原位癌.对结膜鳞状细胞性肿物及黑色素性病变的临床、病理特征及鉴别诊断进行了总结分析.结论 结膜肿瘤临床及病理分类繁多,对病变进行临床及病理分析有助于正确的诊断及治疗.

Abstract：

Objective To investigate the histopathologic features and incidence of primary conjunctival neoplasms. Methods The histopathologic data of 728 primary conjunctival neoplasms in Southwest Eye Hospital from January of 2003 to December of 2009 were collected and analyzed retrospectively. Results Benign conjunctival neoplasms were 570(78.3%), the top ten in the ranking in turn were pigmented nevus, conjunctival cyst, papilloma, hemangioma, Choristoma, lipoma and lipofibroma, Reactive Lymphoid Hyperplasia,melanosis, atypical hyperplasia, sebaceous adenoma. Malignant conjunctival neoplasms were 158(21.7%), the top five in the ranking in turn were squamous cell carcinoma, malignant lymphoma, plasmocytoma, carcinoma in situ. The clinical, pathological and differential diagnosis of conjunctival squamous cell neoplasms and melanin lesions were summarized. Conclusions The classification of conjunctival neoplasms are various, the clinical and pathological analysis of primary conjunctival neoplasms is helpful to the diagnosis and therapy.     

泪腺上皮性肿瘤的外科治疗探讨

目的 探讨泪腺上皮性肿瘤的现代治疗方法。方法 对34例泪腺上皮性肿瘤进行分析。其中20例泪腺良性多形性腺瘤（复发性7例），11例腺样囊性癌（复发性９例），２例恶性多形性腺瘤（复发性2例）和1例黏液表皮癌。结果 前路开眶15例，改良外侧开眶15例，眶内容摘除术2例，内侧开眶1例，术后放射治疗17例（恶性14例，良性3例），随访28例，时间半年至1.5年，良性肿瘤16例均无复发，恶性肿瘤12例中2例复发。结论 泪腺上皮性肿瘤是常见的眶内肿瘤，复发率较高。改良外侧开眶是切除泪腺上皮性肿瘤最好的方法。     

原发于眼眶脑膜瘤的CT图像分析

目的分析原发于眼眶脑膜瘤的常见CT图像特征,探讨CT影像对原发于眼眶脑膜瘤的诊断价值。方法回顾性分析51例经病理确诊的原发于眼眶脑膜瘤患者的临床资料和CT图像表现。探讨CT对脑膜瘤的诊断及鉴别诊断价值。结果 51例原发于眼眶脑膜瘤患者中视神经鞘脑膜瘤43例,眶骨膜脑膜瘤8例。视神经鞘脑膜瘤43例中肿瘤形状呈管状20例,块状12例,其他形状11例;呈现车轨征16例,钙化斑6例。8例眶骨膜脑膜瘤均有蝶骨大翼和(或)小翼骨膜增厚及眶外壁骨质增生,其中视神经向内移位6例。所有病例中肿瘤蔓延者8例,双眼眶发病2例。结论 CT图像可清晰显示肿瘤的位置、形状、范围,尤其是眶骨壁改变,对于原发于眼眶脑膜瘤的诊断及治疗具有重要的临床指导意义。     

眼眶纤维组织细胞瘤临床分析

目的 探讨眼眶纤维组织细胞瘤的临床诊断及治疗方法.方法 对1989年1月至2009年1月收治的21例经病理证实的眼眶纤维组织细胞瘤患者的临床特征及影像学特点进行分析.结果 21例(15例初发,6例复发)均有不同程度的眼眶占位性病变体征;16例眼球突出移位;16例有视力下降;15例有眼球运动障碍;15例可触及眶缘肿块;9例结膜充血水肿;9例出现复视;6例眼睑肿胀.B超显示占位性病变,良性者,边界清,类圆形或椭圆形,内回声少,声衰减显著;恶性者,形状不规则、边界不清,内回声中等或不均匀,声衰减显著,不可压缩.彩色多普勒超声显示肿物内有丰富或中等量血流信号,呈动脉血流频谱.CT显示眶内呈椭圆形或不规则形、边清均质的软组织密度影,或伴有骨破坏,可强化.MRI显示肿物内T1WI呈中或低信号,T2WI呈中或高信号,可强化.所有患者均行手术治疗,6例患者行眶内容剜除术;15例患者行局部肿瘤切除术,其中4例术后随访中复发再次手术.术后病理,21例患者中良性纤维组织细胞瘤10例,中间型2例,恶性者9例.结论 影像学检查只能提供定位诊断,最终仍需病理确诊.治疗以手术切除为主,常复发,可辅以放疗或化疗.

Abstract：

Objective To explore the clinical diagnosis and management approach of the orbital fibrous histiocytomas. Methods The clinical and imaging features of 21 patients from Second Hospital of Tianjin Medical University were collected from January 1989 to January 1999. They were all diagnosed for fibrous histiocytoma by histopathology. Results There were orbital occupying lesion in all 21 patients, but 16 patients demonstrated the exophthalmos and displacement, 16 patients with decreased vision, 15 patients with the ocular movement disturbance, 15 patients with the mass of orbital margin. 9 patients with the diplopia. 9 patients with the conjunctival congestion and edema and 6 patients with the eyelid swelling. Type-B ultrasound showed space occupying lesions. Benign tumors demonstrated the well-defined and nearly round mass, the moderate or few inner echo and the obvious attenuation of sound. But malignant tumors showed the ill-defined and irregular mass. Color doppler flowing image (CDFI) discovered that there was abundant or moderate blood flow, accompanied with arterial frequency spectrum. Computed tomography (CT) revealed an oval-shape or irregular, well-defined or ill-defined and homogeneous soft tissue mass in the orbital cavity, sometimes with bone destruction. The masses were enhanced. Magnetic resonance imaging (MRI) demonstrated a intermediate or low signal on T1 weight imaging, but a intermediate or high signal on T2 weight imaging in the tumor. All the patients were managed by surgery. Six patients were performed by orbital exenteration and 15 patients were performed only surgical resection. But 4 patients recurred postoperatively and underwent another surgery. There were 10 benign tumors, 2 locally aggressive tumors and 9 malignant tumors postoperatively. Conclusions Surgery is the mainstay of therapy. Imaging examination may provide the level diagnosis, but the final diagnosis is made by histopathology. The tumors often recur and adjuvant therapy is utilized.     

泪腺腺样囊腺癌的MRI特征分析

目的 探讨泪腺腺样囊腺癌（adenoid cystic carcinoma,ACC）的MRI特征,为临床早期诊断提供依据。设计 回顾性病例系列。研究对象 北京同仁医院经手术证实ACC患者26例,术前均行MRI扫描。方法 所有ACC患者常规MRI扫描;同时对动态增强磁共振成像（DCE-MRI）及磁共振扩散加权成像（DWI）图像进行后处理获得相应量化指标。主要指标 ACC动态增强的峰值强化指数（CIpeak）、峰值强化时间（Tpeak）、最大强化指数（CImax）、强化指数曲线（I型为持续上升型,II型为平台型,III型为流出型）、肿瘤平均表观扩散系数（ADC）值。结果  26例均起自泪腺眶部,20例形态不规则,14例边界不清,12例边界清晰,6例累及颅内,9例出现骨质破坏。T1WI呈等或略低信号,其中3例内部出现高信号区;T2WI呈等或稍高信号为主,增强后仅1例强化均匀,25例呈不均匀强化,其中16例伴有内部囊变、坏死区。泪腺ACC峰值强化指数（CIpeak）为0.9±0.41,峰值强化时间（Tpeak）为（109.3±58.5）s, 最大强化指数（CImax）为0.95±0.45。22例时间强化指数曲线中2例为I型,14例为II型,6例为III型。平均ADC值为（1.25±0.30×10-3）mm2·s－1。结论 MRI可以清晰显示泪腺ACC的部位、形态、范围、边界及骨质侵犯,DCE-MRI及DWI为肿瘤的诊断及鉴别诊断提供辅助量化特征。（眼科,2013, 22： 314-319）     

高分辨弥散张量示踪用于鞍区肿瘤患者前视路的形态学研究

目的：探讨鞍区肿瘤患者前视路高分辨弥散张量纤维束示踪（DTT）的影像特点及其与视觉功能、预后的关系。方法：系列病例研究。选取2015年11月至2017年6月在福建医科大学福总临床医学院经手术切除的鞍区肿瘤患者21例，在术前1周及术后4个月行前视路高分辨弥散张量成像（DTI）扫描， 并通过DTT重建白质纤维束，观察纤维束走行及完整性情况。采用视觉功能障碍（VIS）评分进行视 觉功能的评估。采用Ｍann-Whitney U检验、Fisher精确概率法对数据进行统计学分析。结果：DTT 可清晰观察21例鞍区肿瘤患者前视路白质纤维束的中断或完整现象，稀疏或饱满情况，也可以显现 前视路白质纤维束与鞍区肿瘤之间的空间位置关系（中断型8例，连续型13例）。术前前视路白质纤 维束不同形态患者的VIS评分差异无统计学意义（Z=-0.679，P=0.497），连续型和中断型与视觉功能预后相关，前视路白质纤维束形态完整型的患者术前视觉功能状态及术后4个月时的预后均优于中断型（P=0.014）。结论：高分辨DTT能直观显示前视路白质纤维束的形态，并对鞍区肿瘤患者视觉功 能的预后判断具有参考价值。     

眼眶CT视神经增粗征的临床分析

目的 探讨CT检查出现视神经增粗征的临床意义。方法 回顾1424例眼眶肿瘤CT资料，选择出现视神经增粗征的病例，将其按病因及形状分类。结果 在1424例眼眶肿瘤CT中，有111例出现视神经增粗征。按病因分为原发性和继发性；按形状分为管状、梭形或椭圆形、锥形、局部膨大、块状。结论 在眼眶CT影像中，视神经增粗征可见于多种疾病，有助于眼眶肿瘤的诊断和鉴别诊断。     

眼眶神经鞘瘤的影像学研究

目的 探讨眼眶神经鞘瘤的CT和MRI的影像学表现及诊断价值。方法 42例眼眶神经鞘瘤均经手术及病理证实。结果 42例中CT显示（1）球后视神经上方20例，视神经外侧9例（2例位于眶尖），视神经下方11例和内侧2例。（2）椭圆形和类圆形27例，分叶状或S形9例，哑铃形6例（其中5例经眶上裂向颅内蔓延）。（3）平扫显示肿瘤内均质高密度28例，不均质14例，其中5例肿瘤内有较大片状低密度区（囊变区）。37例MRI扫描中等T1、长T24例；等T1、短等长T2混杂信号29例；等T1等T24例。在37例MRI检查中35例行Gd-DTPA增强，3l例呈不均匀增强；4例均匀增强。显示肿瘤颅内蔓延5例。结论 CT和MRI能显示肿瘤的位置、形状和病变内部特征，可明确诊断，为手术治疗提供重要依据；而MRI在肿瘤的定性和定位诊断方面明显优于CT。     

Combined positron emission tomography/computed tomography for evaluation of presumed choroidal metastases

BACKGROUND: Choroidal metastases are the most common intraocular malignancy and are the first sign of systemic malignancy in approximately one-third of patients. Of patients with no previous diagnosis of cancer, oncological evaluation fails to find the primary lesion in approximately 50% of cases. Newer imaging modalities such as combined positron emission tomography/computed tomography (PET/CT) may improve the yield of the systemic work-up. METHODS: Consecutive patients presenting with presumed choroidal metastases were evaluated with whole body combined PET/CT scanning. RESULTS: Four patients presenting to a tertiary referral hospital with choroidal metastases as the first sign of systemic malignancy were evaluated. In all four cases, PET/CT demonstrated the ocular lesion, and the primary malignancy which was confirmed by tissue biopsy. False-negative results were seen in two cases of cerebral metastases. PET/CT demonstrated lesions not visible on CT or magnetic resonance imaging in two cases. CONCLUSIONS: Combined PET/CT is a useful addition to the work-up of patients with choroidal metastases. It provides the opportunity to detect lesions not visible with other imaging modalities and the ability to image patients with contraindications to magnetic resonance imaging. It is essential to correlate PET images with clinical information and the results of other imaging modalities and tissue biopsy remains the gold standard in the diagnosis of malignancy. False positives and negatives can occur with PET/CT, and further research is needed before this promising technology becomes a routine part of the evaluation of patients with choroidal metastases.     

Space-occupying lesions of the lacrimal gland at one tertiary eye center in China: a retrospective clinical study of 95 patients

AIM: To investigate the treatment status and prognosis of space-occupying lacrimal gland lesions at one tertiary eye center in China. METHODS: A retrospective clinical study was performed on 95 patients with space-occupying lesions of the lacrimal gland surgically treated at the Eye & ENT Hospital of Fudan University from 2003 to 2007. The reviewed clinical data included age, gender, side of the lesion, duration of signs and symptoms, histopathological diagnosis, treatment modality, recurrence (local, regional, and distant metastasis) and survival. RESULTS: Of the 95 cases (99 eyes), pleomorphic adenomas were the most common lesions (43 cases), followed by lymphoid disorders (14), inflammatory pseudotumors (11), carcinoma ex-pleomorphic adenomas (11), and adenoid cystic carcinomas (ACC, 6). There were 8 patients with relapsed pleomorphic adenomas. Five of these 8 cases had malignant pathological changes. All patients with ACC had metastasis and three of them died during their follow-up. CONCLUSION: Our study indicated that the most common lacrimal gland lesions were pleomorphic adenomas. Multiple recurrence and surgical procedures may increase the risk of tumor progression. ACC had a high incidence of tumor metastasis and a poor prognosis.