眼上静脉扩张的影像学诊断意义

目的：探讨超声,CT及MRI检查在眼上静脉扩张及其病因诊断中的意义。方法：对1984－2000年临床资料完善的116例（232只眼）伴眼上静脉扩张患者进行回顾性分析。结果：发现多种疾病均可引起眼上静脉扩张,颈动脉－海绵窦瘘是导致眼上静脉扩张的主要疾病。其中颈动脉－海绵窦瘘92例（包括高和低流瘘）,眼型Graves病14例,眶尖炎症2例,Tolosa-Hunt综合征2例,眼部血管畸形2例,眶炎性假瘤、眶内血肿、海绵窦肿瘤及海绵窦血栓形成各1例。扩张的眼上静脉直径为3．5－7．0mm,各病种眼上静脉管径扩张大小无明显差异,但颈动脉－海绵窦瘘眼上静脉最粗7．0mm。影像学检查同时能发现眼外肌肥大、眶部病变及海绵窦膨大等相关影像学表现。结论：超声、CT及MRI检查均能良好显示眼上静脉扩张,综合其他影像学表现,可确定眼上静脉扩张的病因。     

28例颈动脉海绵窦瘘影像诊断分析

目的探讨超声、CT、MRI和数字减影血管造影(DSA)等各种影像学检查在颈动脉海绵窦瘘(CCF)诊断中的价值。方法收集我院经DSA证实诊断的CCF共28例,所有患者行眼科标准化A／B超声、DSA检查,部分患者行彩色多普勒超声、CT及MRI检查中的一项或多项。结果超声检查可发现眼上静脉增粗与脉搏同周期的搏动等,并能检测血流频谱。CT和MRI检查可发现海绵窦扩大及异常表现。DSA检查显示CCF分为颈内动脉海绵窦段直接供血和颈动脉的供应硬膜的动脉供血,供血动脉包括：颈内动脉海绵窦区细小脑膜分支;颈外动脉来源的脑膜中动脉、副脑膜动脉、咽升动脉、圆孔动脉等;瘘血向眼静脉、岩下窦、海绵问窦、侧裂静脉及皮层引流等。结论超声、CT、MRI等影像学检查对CCF的诊断各有所长,联合应用多可做出正确的临床诊断;DSA是诊断CCF的“金标准”,可明确瘘的大小、瘘血来源及引流方向。（中华眼科杂志,2004,40：674-678)     

首诊眼科的颈动脉海绵窦瘘患者的影像学检查分析

目的分析首诊于眼科的颈动脉海绵窦瘘患者的影像学表现,并讨论其诊断意义。方法对有临床表现11例(12只眼)颈动脉海绵窦瘘患者采用B超、CT和/或MR I检查。结果三种影像学检查均发现眼上静脉扩张、眼外肌肥大、眶内脂肪垫增厚;部分CT或MR I检查还显示扩张的海绵窦。结论医学影像学在颈动脉海绵窦瘘检查中具有特征性的影像表现。对于首诊眼科的此类患者应联合采用多种影像学检查以明确诊断,避免造成误诊。     

硬脑膜海绵窦瘘的临床表现与诊断分析

目的 探讨硬脑膜海绵窦瘘的临床表现，以减少误诊率。方法 对我院1993年9月～2006年6月收治的36例硬脑膜海绵窦瘘的病例进行回顾性分析。结果 硬脑膜海绵窦瘘好发于中年女性，结膜充血水肿、眼球突出、眶周血管杂音是其主要临床表现，三种症状同时存在者占58．33％，且球结膜血管迂曲呈螺丝状，色暗红。CT和MRI检查显示眼上静脉扩张、眼球突出、眼外肌增粗、海绵窦膨大等征象。数字减影血管造影均显示出载瘘动脉。结论 根据眼球突出、眶周血管杂音、结膜水肿及特征性的螺丝状球结膜血管等临床表现和眼上静脉扩张等影像学表现可基本诊断，数字减影血管造影可明确诊断。     

彩色多普勒成象在颈动脉海绵窦瘘诊断和监测的应用

报告应用彩色多普勒成象(color Doppler imaging，CDI)对眼眶和颈动脉联台探查评估9例(10只眼)颈动脉海绵窦瘘。患者均经血管造影确诊。CDI检查均发现患眼眼上静脉扩张伴有反向血流及低阻力动脉化频谱。血流动力学定量测定发现：7例颈内动脉海绵窦瘘眼上静脉高血流量，患侧颈内动脉血流量增加和阻力指数下降；2例硬脑膜动脉海绵窦瘘的眼上静脉低血流量，两侧颈内动脉血流动力学无明显改变。还讨论了CDI在颈动脉海绵窦瘘诊断、分类和监测的价值。     

首诊于眼科的颈动脉海绵窦瘘7例回顾性分析

目的 探讨颈动脉海绵窦瘘眼部表现特点及诊断要点。方法 回顾分析5年中7例首诊于我科的外伤性颈动脉海绵窦瘘者的眼部症状及体征、影像学检查、治疗方法等。所有病例中最常见的眼部表现为搏动性眼球突出、球结膜高度充血水肿、眼压升高等。CT或MRI检查所有病例均显示眼上静脉扩张和海绵窦增宽,数字减影血管造影检查明确诊断。结果 7例行血管内介入栓塞治疗均一次成功,眼部症状和体征得到明显改善。结论 在临床工作中,对于可疑病例,应考虑颈动脉海绵窦瘘的可能,血管造影是该病诊断的金标准,血管内介入栓塞治疗对颈动脉海绵窦瘘是有效的。     

彩色多普勒超声对颈动脉海绵窦瘘的诊断

本文利用彩色多普勒超声技术检测了１３例颈动脉海绵窦瘘患者（颈内动脉海绵窦瘘８例，硬脑膜海绵窦瘘５例）的眼上静脉及双侧颈内动脉的彩色血流显像（ＣＤＦＩ）及脉冲多普勒（ＰＷＤ）频谱，并测定了血流速度及血流量。结果表明：颈动脉海绵窦瘘患者的眼上静脉反向流动，朝向探头，呈红色或红蓝相间；颈内动脉海绵窦瘘患者的眼上静脉的血流速度及血流量均高于硬脑膜海绵窦瘘患者的同类指标，且颈内动脉海绵窦瘘患者患侧颈内动脉的血流速度、血流量均高于健侧的同类指标，而硬脑膜海绵窦瘘的双侧颈内动脉的血流速度及血流量均无明显差异。同时对３例海绵窦栓塞术后患者进行检测，表明眼上静脉及颈内动脉血流动力学恢复正常。由此可以诊断并鉴别诊断颈内动脉海绵窦瘘和硬脑膜海绵窦瘘。与Ｂ超、ＣＴ及ＭＲＩ、ＤＳＡ相比，彩色多普勒超声是一种快速、廉价、无创、无痛的提供二维结构和血流动力学的一种新方法。     

自发性颈动脉海绵窦瘘眼部表现的临床分析

目的:探讨自发性颈动脉海绵窦瘘眼部表现特点及诊断要点,提高对该病的认识,减少临床漏诊、误诊。方法:回顾分析14例就诊于我院的自发性颈动脉海绵窦瘘患者的眼部症状及体征、影像学检查、治疗方法等。结果:所选14例病例中最常见的眼部表现为眼球突出(100%)、结膜及浅层巩膜充血扩张(93%)。行CT或MRI检查的12例病例中,眼上静脉增粗者9例,海绵窦增宽或高信号者6例。4例行栓塞治疗者眼部症状和体征得到明显改善。结论:自发性颈动脉海绵窦瘘的眼部临床谱广泛多样,特征性眼部表现结合影像学检查可有效提高诊断。栓塞治疗对改善眼部表现效果明显。     

颈动脉海绵窦瘘眼眶彩色多普勒超声检查临床意义探讨

目的:探讨颈动脉海绵窦瘘(carotid cavemous fistula,CCF)眼眶彩色多普勒超声显像(color Doppler imaging,CDI)检查的声像表现及其诊断价值。方法:对39例39眼CCF患者的CDI超声表现进行回顾性分析。结果:患者39例均表现为反向动脉化血流的眼上静脉扩张,眼下静脉扩张3例,眼外肌增厚2例。压迫患侧颈总动脉,患侧颈内动脉出现不同程度的倒灌血流。结论:CDI检查可以准确显示CCF眶内扩张的血管及血流动力学状态,对CCF的诊断具有重要临床意义。     

B超诊断颈动脉海绵窦瘘的探讨

目的探讨B型超声诊断颈动脉海绵窦瘘(carotid-cavernoussinusFistulaCCF)的临床价值及声像学特征。方法利用眼A/B型超声诊断仪对8例颈动脉海绵窦瘘患者进行眼部超声检查,观察眼上静脉有无扩张。结果8例患者均可探及扩张的眼上静脉,超声特点表现为:探头置于眼睑向上轴位扫描时可探及视神经和上直肌之间扩张的眼上静脉呈园形无回声腔,边界清楚锐利。变换探测方向,可获得眼上静脉的声学横断面,呈椭圆形或管状无回声腔,探头中等压力压迫眼球时扩张的眼上静脉消失。结论B超扫描可清晰地显示CCF患者扩张的眼上静脉且经济、简捷、有效、安全,可重复。为CCF早期诊断、治疗提供可靠依据,减少该病的漏诊或误诊。     

Transvenous embolization of carotid cavernous fistulas via the superior ophthalmic vein

BACKGROUND: Treatment of choice for symptomatic carotid-cavernous and cavernous-dural fistulas is neuroradiologic intervention via the femoral artery. Owing to the location of the fistula and/or to anatomic variations, a direct surgical approach via the superior ophthalmic vein may be necessary for embolization. METHODS: Three patients presented with exophthalmos, episcleral venous congestion, chemosis, restricted eye movement, and secondary glaucoma. One patient had visual impairment and scotoma due to compression of the optic nerve by the fistula. The tentative diagnosis of an arteriovenous fistula was confirmed in two cases by color Doppler imaging and in all three cases with cerebral arterial angiography (two carotid-cavernous fistulas, one cavernous-dural fistula). After an unsuccessful transarterial attempt, embolization via the superior ophthalmic vein was chosen. RESULTS: In all three patients the preparation of the superior ophthalmic vein was performed without any complications. In two cases the fistula could be embolized completely with platinum coils. In one patient the placement of the microcatheter was impossible, because of an abnormal vascular pattern. Later on the fistula was successfully embolized by an approach via the femoral vein. All three patients had complete resolution of symptoms. There were no recurrences. CONCLUSION: Embolization of carotid-cavernous and cavernous-dural fistulas by a surgical approach via the superior ophthalmic vein represents safe and effective treatment when standard transarterial access is impossible. The cooperation of an orbital surgeon and an invasive neuroradiologist can be of benefit for this rare group of patients.     

Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein

A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.     

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。     

Endovascular treatment of sinus dural fistulas using vein catheterism

PURPOSE: We report two techniques for treatment of dural arteriovenous fistulas using femoral vein catheterism and direct surgery via the superior ophthalmic vein. We will attempt to show the advantages of these new techniques instead of using the arterial pathway, which is currently the reference procedure. Subjects and method: Mrs G, 75 years old was sent by her ophthalmologist because of a suspected orbital tumor. Visual acuity: right eye: 3/10, exophthalmia, chemosis, with no thrill or murmur. The fundus examination was normal. The ultrasound exam with color Doppler imaging showed an arterialization of the superior ophthalmic vein compatible with an arteriovenous sinus dural fistula. Angio-MRI revealed a large left cavernous sinus, confirming the diagnosis. Considering the type of the fistula and the weak physical condition of the patient, we decided to attempt an endovascular embolization with coil placement, using femoral vein catheterism. Exophthalmia regressed within days. The fistula remains sealed 1 year after the procedure. Mr D, 40 years old, showed a similar clinical aspect of sinus dural fistula. We attempted an embolization with the femoral vein, which failed. We decided to embolize the cavernous sinus via the direct surgical pathway of the superior ophthalmic vein. Coils were placed and the fistula was sealed. CONCLUSION: These clinical cases show two less invasive alternatives giving better results than arterial embolization, the reference method (Brooks 1930; Spearmann 1964; Parkinson 1965), endovascular trapping, or surgery.     

The Case of IgG4-Related Ophthalmic Disease with Perivascular Lesions of Superior Ophthalmic Vein Associated with Optic Nerve Disturbance

A 61-year-old man with hyperthyroidism had exophthalmos with dilated conjunctival vessels in both eyes. Magnetic resonance imaging showed that the superior ophthalmic veins had a funicular-like appearance. Cerebral angiography showed no blood flow from both internal carotid arteries to the cavernous sinus, thus excluding a carotid-cavernous fistula. Blood tests showed an elevation of IgG4 (281 mg/dl), and a IgG4-related ophthalmic disease was considered. Steroid pulse therapy was performed, and all of the abnormal findings were improved. We concluded that this was a rare case of IgG4-related ophthalmic disease with perivascular lesions of the superior ophthalmic vein associated with optic nerve disturbance.