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。     

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。     

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)     

眼球缺血综合征临床特点观察

目的探讨眼球缺血综合征(OcularischemicsyndromeOIS)患者眼部表现、眼底荧光血管造影临床特点及血流动力学改变。方法OIS患者眼部检查、眼底荧光素血管造影检查,彩色多谱勒超声检查对比研究OIS患者组和正常对照组颈总动脉、颈内动脉、眼动脉、视网膜中央动脉收缩期血流峰速(PSV)值。结果①共观察OIS患者22例22眼。21例(95%)患者以不同程度的视力下降为主要表现。6眼(27%)出现虹膜新生血管。眼底改变:16眼(73%)视网膜静脉扩张,20眼(90%)有中周部视网膜点状出血。2眼(9%)见到视网膜动脉搏动。②眼底荧光素血管造影臂-视网膜循环时间、视网膜动-静脉循环时间延长,15例(68%)视网膜血管着染,有2只眼发现视网膜动-静脉交通支形成。③OIS患者患侧眼动脉、视网膜中央动脉PSV降低。结论①眼球缺血综合征临床表现复杂,FFA及彩色多谱勒超声检查是诊断该病的重要手段。     

眼眶动静脉畸形致眼上静脉扩张的影像学表现

目的探讨眼眶动静脉畸形(AVM)致眼上静脉(SOV)扩张的影像学及血管造影表现。设计回顾性病例系列。研究对象6例临床表现与硬脑膜海绵窦瘘(CCF)相似的眼眶AVM患者。方法总结分析所有患者的影像学检查结果,如CT、MRI和选择性脑血管造影。主要指标影像学征象及血流动力学。结果CT和MRI均可显示所有患者的SOV扩张。另外,尚存在眼球突出、AVM畸形血管团等征象。所有6例AVM均位于眼眶内,1例尚合并颅内AVM。所有患者的主要引流静脉均为SOV,动脉包括脑膜中动脉、上颌动脉和眼动脉。结论眼眶AVM可引起与CCF相似的临床和影像学征象,但AVM通常不引起海绵窦膨大,血管造影仍是确诊的必需手段,而无创技术是辅助血管造影进行明确诊断的重要手段。(眼科,2007,16:395-398)     

彩色多普勒成像技术检测视网膜静脉阻塞眼血流动力学的变化

目的探讨视网膜静脉阻塞(retinal vein occlusion,RVO)患者视网膜中央动脉(central retinal artery,CRA)和视网膜中央静脉(central retinal vein,CRV)血流动力学特征及其意义。方法使用ATL-HDI3000彩色多普勒诊断仪，检测RVO患者患眼48只、对侧临床健康眼39只及正常对照眼40只的CRA收缩期峰值血流速度(peak systolic velocity,PSV)、舒张末期血流速度(end diastolic velocity,EDV)和血管搏动指数(pulsatility index,PI)，CRV最大血流速度(maximun velocity，Vmax)。结果RVO患眼、对侧临床健康眼CRA的PSV和EDV均显著低于正常对照眼，RVO患眼PI显著高于正常对照眼；RVO患眼CRA的PSV显著低于RVO对侧临床健康眼，RVO患眼PI显著高于RVO对侧临床健康眼；RVO患眼、对侧临床健康眼CRV的Vmax均显著低于正常对照眼。结论RVO患眼和对侧临床健康眼血流动力学异常。彩色多普勒成像技术可作为其早期诊断的重要手段。(中华眼底病杂志,1998,14:111-113)     

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。     

颈内动脉狭窄与缺血性眼部疾病的相关关系探究

目的：：探讨颈内动脉狭窄与缺血性眼部疾病的关系。方法：收集2010-11/2014-05入住我院的30例37眼缺血性眼部疾病患者的临床资料,对其行眼底荧光素血管造影(FFA)、眼部血管经颅多普勒超声(TCD)、颈部血管彩色超声多普勒血流成像( CDFI)、颈部CT血管造影( CTA)及颈动脉数字减影血管造影( DSA)等检查,然后对缺血性眼部疾病患者眼部症状、眼部表现、FFA检查结果进行分析;比较眼动脉收缩期峰值血流速度( peak systolic velocity, PSV)和阻力指数( resistance index,RI)、视网膜中央动脉PSV及RI;患侧颈动脉内中膜厚度( IMT )与眼动脉、视网膜中央动脉PSV及RI的相关性;患侧颈内动脉斑块性质与眼动脉PSV及RI的相关性;患侧颈内动脉斑块性质与视网膜中央动脉的PSV及RI相关性。结果：眼部症状：一过性黑矇、视力降低、眼前闪光、眼部及周围疼痛发生率分别为75.7%,83.8%,51.4%及32.4%;眼部体征：以视网膜静脉扩张、视网膜点片状出血、动脉狭窄及棉絮斑等为主要体征;患侧与健侧眼动脉PSV及RI值差异均具有统计学意义(P<0.05);患侧与健侧视网膜中央动脉PSV及RI值差异均具有统计学意义( P<0.05);患侧IMT与眼动脉、视网膜中央动脉PSV及RI值无相关性( P>0.05);患侧颈内动脉斑块性质与眼动脉PSV及RI值无相关性(P>0.05);患侧颈内动脉斑块性质与视网膜中央动脉的PSV及RI值无相关性( P>0.05)。结论：缺血性眼部疾病的发病与颈内动脉狭窄具有非常紧密的关联性,临床上可将颈内动脉狭窄程度作为眼部疾病诊疗的重要依据。     

糖尿病患者球后血管血流动力学变化分析

目的:观察糖尿病视网膜病变(diabetic retinopathy,DR)患者球后血管血流动力学的变化情况。方法:利用彩色多普勒超声诊断仪(color Doppler imagi-ning,CDI)测定61例(122眼)糖尿病视网膜病变患者球后血流状态,其中糖尿病无视网膜病变(NDR)48眼,糖尿病视网膜病变非增殖期(NPDR)40眼,糖尿病视网膜病变增殖期(PDR)34眼,并与正常人32例(64眼)进行对照。检测指标包括视网膜中央动脉、视网膜中央静脉、眼动脉血管的最大收缩期血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)和阻力指数(RI)。结果:NDR组与正常对照组相比,视网膜中央动脉、视网膜中央静脉、眼动脉血管的最大收缩期血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)和阻力指数(RI)无统计学差异,NPDR组、PDR组分别与正常对照组相比,视网膜中央动脉、视网膜中央静脉、眼动脉血管的最大收缩期血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)和阻力指数(RI)均有变化,各检测指标比较有统计学意义(P<0.05)。NPDR组与PDR组之间比较,视网膜中央动脉、视网膜中央静脉、眼动脉血管的最大收缩期血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)和阻力指数(RI)均有变化,各检测指标比较有统计学意义(P<0.05)。结论:CDI对DR患者球后血管血流动力学变化的检测有一定临床应用价值,对2型DM患者的治疗监测及预后评估有重要意义。     

永存性原始玻璃体增殖症的彩色多普勒成像特征

目的:探讨永存性原始玻璃体增殖症(Persistent Hyperlastic Primary Vitreous,PHPV)的彩色多普勒成像(Color Doppler Imaging,CDI)的影像特征。方法:采用高频率(7.5MHz)CDI对3例4眼PHPV进行检查,在二维影像的基础上分析其显示的血管血流特征。结果:CDI显示在玻璃体腔内呈条索状回声影内显示血管血流,由视乳头向晶体后延伸,频谱分析为动脉血流。结论:CDI显示PHPV的影像特征是与PHPV增殖膜内残留玻璃体动脉的病理组织特征相一致;再结合小眼球、无钙化斑可能是PHPV的特有表现,有助于其诊断及与其他白瞳症及机化膜的鉴别。眼科学报1997;13:56～58。     

Stereotactic gamma surgery combined with endovascular surgery for treatment of a spontaneous carotid cavernous sinus fistula

A Barrow type D carotid cavernous sinus fistula (CCF) with varices proved unamenable to endovascular surgery. Follow-up angiography showed a persistent CCF fed by a recurrent meningeal branching of the ophthalmic artery division with drainage into the ophthalmic vein, resulting in a secondary glaucoma and central retinal thrombosis. Stereotactic gamma surgery was successfully performed, and aggravation of the visual symptoms was prevented. The CCF disappeared and intraocular pressure normalized one month after the radiosurgery. Stereotactic radiosurgery is thus an appropriate treatment for cavernous sinus dural arteriovenous fistulas resistant to endovascular treatment, especially with small, slow flow target residual fistulas.     

Abnormal ophthalmic veins: differential diagnosis and management using color Doppler imaging

Objective: To evaluate the role of color Doppler imaging (CDI) in the diagnosis and management of patients with abnormal ophthalmic veins. Design: Records from patients with suspected abnormalities of ophthalmic veins who had been studied with color Doppler imaging were reviewed. Patients and methods: Twenty-three patients had abnormalities of their superior ophthalmic vein (SOV) due to anomalous SOV enlargement, carotid cavernous fistula (CCF), dural shunt, tumor, or Graves’ disease. Color Doppler imaging of the orbits was obtained initially and as needed during the course of each case. Abnormalities of superior ophthalmic vein included velocity greater than 8.26 cm/sec, anteriorly directed blood flow, and/or pulsatile waveform. Results: Incidental enlargement of SOV was associated with normal waveform velocity on CDI. Of three patients with CCF, two showed high velocity in one or both SOVs which resolved after embolization. One patient with a dural shunt had high SOV velocity. Four patients with clinical and CDI findings typical of dural shunt improved spontaneously and did not need angiography. Two patients with orbital tumors and one with intracranial tumor had evidence of increased venous outflow through the SOV. Two patients with Graves’ disease showed mild to moderate increase in SOV velocities. Conclusions: CDI is especially helpful in the diagnosis of incidental SOV enlargement and in management of low flow dural shunts.     

Carotid artery fistula after cataract surgery

To determine carotid cavernous fistula associated with choroidal detachment after cataract surgery. A 77-year-old woman underwent cataract surgery in both eyes. Postoperatively, proptosis and dilation of episcleral vessels in her left eye occurred and gradually increased. One month later, choroidal detachment developed in her left eye. Computed tomography showed an enlarged superior ophthalmic vein. Selected cerebral angiography showed fistulas between the megingeal branches of both the internal and external carotid arteries and the cavernous sinus. After the neurosurgical treatment, these symptoms disappeared. The development of carotid cavernous fistula after cataract surgery, as demonstrated in our patient, may be uncommon. [Ophthalmic Surg Lasers 1998;30:160-162.] Carotid cavernous fistula (CCF) is an abnormal communication between the internal carotid artery and the cavernous sinus. Ocular manifestation of the fistula includes proptosis, pulsation of the globe, orbital bruit, episcleral vein dilation, and chemosis. CCF is divided into spontaneous or traumatic by cause and direct or dural by angiographic findings. To our knowledge, CCF development after cataract surgery may be uncommon. We recently examined a patient with such a condition.     

外科治疗对合并缺血性眼病的颈动脉狭窄患者眼动脉血流动力学的影响及疗效评价

目的：:利用彩色多普勒超声仪（CDFI）对伴有缺血性眼病的颈动脉狭窄患者行颈动脉内膜切除术（CEA）或颈动脉支架成形术（CAS）前、后颈部血管及眼部血管的血流动力学检查,以探讨外科手术治疗对眼动脉血流动力学的影响,并比较CEA和CAS这2种不同的外科手术治疗方法对缺血性眼病的疗效。方法：:前瞻性临床研究。收集2017年...     

Three cases of carotid cavernous sinus fistulas where the main ocular manifestation was restricted ocular motility]

BACKGROUND: Some cases of carotid cavernous sinus fistulas (CCFs) have few ocular congestive signs and symptoms. These cases need to be accurately diagnosed as having CCFs. CASES: Three patients with CCFs without ocular congestive signs or symptoms developed unilateral abducens restriction and visited our clinic. FINDINGS: Color Doppler imaging revealed retrograde flow of the superior ophthalmic veins bilaterally in the three cases. The diagnose of CCF was confirmed by cerebral angiography. CONCLUSION: It is sometimes difficult to diagnose CCF, when a patient without ocular congestive signs or symptoms shows disturbed ocular motility as the only ocular manifestation. In such cases, color Doppler imaging may show the presence of CCF.     

颈动脉海绵窦瘘的眼部表现与血管内治疗

目的 分析颈动脉海绵窦瘘的临床特点。评价血管内治疗的效果。方法 回顾分析１２例经全盘离血管造影证实为颈内动态海绵窦瘘患者的病史、眼部表现、临床检查的特点及进行可脱性球囊栓塞的疗效。结果 １２例患者１次栓塞成功者１０例（８３．３％）,２例行２次栓塞,术后无并发症,１例术前失明,术后１ｗｋ视力恢复至眼前手动。１０例视力较术前提高１～４行（Ｓｎｅｌｌｅｎ表）。术后眼部瘀血肿胀、眼球突出度均明显减轻或消失。眼球运动恢复正常,复视消失,视网膜出血吸收,眼部血管杂音全部消失。术后全脑血管造影复查,瘘口均封闭。结论 对于颈内动脉海绵窦瘘应及时治疗,尽快恢复视功能。彩色多普勒超声、ＣＴ、ＤＳＡ是诊断本病的常用手段。血管内栓塞是目前治疗颈动脉海绵窦瘘最为理想的方法。