CT和MRI检查在视神经鞘脑膜瘤诊断中的价值

目的探讨CT和MRI检查在诊断视神经鞘脑膜瘤中的价值。方法本研究15例视神经鞘脑膜瘤均经手术及病理检查确诊,并均于术前行CT和MRI检查。结果15例视神经鞘脑膜瘤患者中,增强CT仅显示2例颅内蔓延;平扫MRI显示2例颅内蔓延;而增强MRI显示9例颅内有肿瘤。结论增强MRI在诊断视神经鞘脑膜瘤颅内蔓延中非常有价值,可显示增强CT和MRI平扫未显示的病变,应将其作为视神经鞘脑膜瘤术前、术后常规检查。     

眼眶神经鞘瘤的MRI影像研究

目的评价磁共振成像（megnetic resoance imaging,MRI）影像对于眼眶神经鞘瘤的诊断价值,并提出常见的MRI图像特征。方法收集我院病理确诊的眼眶神经鞘瘤62例,均为单眼发病,所有患者均行眼眶MRI检查,获取T1和T2加权像。注射钆喷酸葡胺后获取强化T1加权像。回顾性分析并比较所有MRI图像。结果眼眶神经鞘瘤常见的肿瘤形状为圆锥形（16例）、哑铃形（10例）、椭圆形（9例）和圆形（8例）。神经鞘瘤的好发部位为眶上部（17例）、眶内上方（12例）和眶尖部（12例）。在T1加权像,53例显示均一的等信号或伴小片状低信号区。强化T1加权像的图像特征与T2加权像具有相关性,增强类型可分为5类。最常见的增强类型是环形强化征,有18例。均匀增强和不均匀增强各为16例和26例。结论MRI对于眼眶神经鞘瘤具有重要的诊断价值,尤其是在使用造影剂后。MRI可清晰显示肿瘤的形状和位置。T1加权像无明显特异性。T2和增强的T1加权像可提供肿瘤的组织学信息。环形强化征可作为神经鞘瘤的靶特征。     

原发性眼眶脑膜瘤临床及影像诊断分析

目的：探讨原发性眼眶脑膜瘤的临床表现，影像学特征，诊断及治疗原则，方法：1979－1998年间诊治的原发性眼眶脑膜瘤115例进行回顾性分析，详细复习了全部病例的临床，病理资料及X线，B超，彩色多普勒超声，CT和（或）MRI的图像并进行比较，结果：原发性眼眶脑膜瘤可起源于视神经鞘和眶骨膜，多发生于中年女性，眼球突出，视神经萎缩，视力丧失和视睫状静脉为视神经鞘脑膜瘤的四联征，起源于眶骨膜的脑膜早期出现眼球突出和移位，视力减退出现较晚，X线，B超，CT和MRI有特征性表现，CT可以同时显示视神经增粗，眶内软组织肿块和眶骨改变，MRI可以更好地观察视神经管内及颅内蔓延状况，治疗原则主要为手术切除，结论：原发性眼眶脑膜瘤是种较为常见的眼眶肿瘤，影像学检查有助于诊断和鉴别诊断，一旦确诊，应早期手术治疗。     

眶尖部及视神经肿瘤的早期诊断

目的探讨眶尖部及视神经肿瘤在眼球突出前的临床表现、影像学检查特征及临床诊断要点。方法回顾性分析22例无明显眼球突出单侧眼眶肿瘤患者的病历资料,包括主要症状、首发表现、临床诊治过程及影像学检查结果。结果22例肿瘤患者中,海绵状血管瘤6例,神经鞘瘤、视神经鞘脑膜瘤、鼻窦及鼻咽腔恶性肿瘤眶内蔓延各4例,后组筛窦黏液囊肿2例,神经纤维瘤和视神经胶质瘤各1例。以视力下降为首发症状者17例,视力下降合并复视者3例。全部患者均在CT或MRI检查后确诊。肿瘤位于眶尖部或起源于视神经。结论眶尖部及视神经肿瘤的早期症状是视功能障碍,无眼球突出表现。视力呈缓慢进行性下降,按视神经炎治疗效果差。CT或MRI检查对早期诊断起重要作用。     

眼眶神经鞘瘤的影像学表现

目的 分析眼眶神经鞘瘤的计算机体层摄影(computed tomography,CT)和磁共振成像(magnetic resonance imaging,MRI)表现,并探讨其在诊断和鉴别诊断中的价值.方法 回顾性分析经手术和病理证实34例眼眶神经鞘瘤,其中CT扫描26例,MRI检查4例,CT加MRI检查4例.结果 27例肿块位于肌锥内,7例位于肌锥外,多呈椭圆形和类圆形.CT平扫为等密度,多数密度均匀,增强后不均匀强化.MRI表现为肿瘤T1WI呈等或略低信号,T2WI呈中高信号,肿瘤囊变区T1WI呈低信号,T2WI呈高信号,增强后瘤体实质部分呈均匀强化,而囊变部分不强化.结论 CT与MRI均能显示眼眶内的肿块,MRI对神经鞘瘤诊断及鉴别诊断的准确性优于CT.(中国眼耳鼻喉科杂志,2006,6360～361)     

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。     

38例眼眶神经鞘瘤的诊治分析

目的探讨眼眶神经鞘瘤的临床诊断和手术治疗方法。方法对1999年8月至2003年12月在北京武警总医院眼眶病研究所治疗的38例眼眶神经鞘瘤患者进行回顾性分析。结果38例中男性15例,女性23例,年龄9—65岁,平均22岁。其中行标准化A／B超检查者37例,CT扫描38例,MRI成像33例。手术入路的选择有外侧开眶（包括改良外侧开眶）26例,内外联合开眶2例,前路开眶4例,内侧开眶2例。其中肿瘤囊内切除21例,肿瘤整体切除15例,部分切除联合术后放射治疗2例。随访时间平均为23个月,手术并发症包括视力丧失1例,上睑下垂2例,眼球运动障碍2例。结论现代影像学检查方法尤其是MRI对眼眶神经鞘瘤的术前定性、定位诊断及对手术入路的选择提供可靠依据,熟练的手术方法和技巧可提高治愈率,减少手术并发症。     

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。     

眼眶肿瘤的手术治疗探讨

目的 探讨眼眶肿瘤的种类、手术进路、治疗效果及并发症.方法 对我院2004～2005年收治的眼眶肿瘤45例（45眼）的临床表现、影像检查和治疗方法进行分析.结果 45例眼眶肿瘤中囊肿12例,海绵状血管瘤10例,静脉性血管瘤6例,泪腺多形性腺瘤5例,神经鞘瘤、非霍奇金淋巴瘤各3例,泪腺腺样囊性癌2例.视神经胶质瘤、视神经鞘脑膜瘤、神经纤维瘤及眼眶骨瘤各1例.45例均进行手术摘除,其中前路开眶32例,外侧开眶9例,经筛窦内侧开眶2例,外侧结合内侧开眶1例,经颅开眶1例.术后6个月复查上睑下垂2例,瞳孔改变3例,眼球运动受限2例.结论 眼眶肿瘤的临床表现具有多样性;大多因眼球突出而就诊;影像学检查显示多种形状的占位性病变,治疗方法以手术为主,注意手术技巧和术式的选择可以防止复发和出现并发症.     

眶尖部肿瘤的诊断与治疗

本文回顾性分析了我院诊治的眶尖部肿瘤２９例。病理检查为海绵状血管瘤１０例，神经鞘瘤８例（其中复发性神经鞘瘤３例），视神经鞘脑膜瘤７例，继发肿瘤及转移瘤３例。眶尖肿瘤主要表现早期视力障碍，轻度眼球突出，眼底视盘水肿或萎缩，早期易误诊。ＣＴ及ＭＲＩ显示眶尖部肿瘤，手术难度较大，合并症多。本文讨论了几种常见眶尖肿瘤的临床诊断特点、手术治疗原则及注意事项     

眼附属器淋巴瘤的影像学表现及其临床意义

目的 了解眼附属器淋巴瘤的CT和MRI表现.方法 回顾性分析经手术或活检病理证实的50例眼附属器淋巴瘤的影像学表现,其中31例行CT扫描,8例MRI扫描,11例行CT和MRI扫描.结果 侵犯眼睑或结膜18例,泪腺6例,肌锥内外11例,肌锥外8例,肌锥内2例,眼外肌受累16例,视神经受累13例.7例肿瘤呈铸造样包裹整个眼球.结论 眼附属器淋巴瘤的影像学表现有一定特征性,MRIH脂肪抑制技术有助于了解肿瘤范围.     

Advances in imaging in oculoplastics

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.     

Neuroimaging in neuro-ophthalmology

Computed tomographic scanning is an excellent modality for evaluation of most orbital and intracranial tumors and strokes. However, MR scanning is definitely superior to CT when evaluating for multiple sclerosis, posterior fossa lesions (evaluation of gaze palsies, internuclear ophthalmoplegia, and downbeat nystagmus), or when assessing an area where sagittal scanning is important (chiasmal lesions). Magnetic resonance has increased specificity when the CT is equivocal. Although MR and CT may be complementary in the information they provide, many clinical studies have shown MR to be superior to CT in evaluating cerebral infarctions, hematomas, the intracanalicular optic nerve, optic chiasm, sella turcica, and the cavernous sinus. Magnetic resonance generally has replaced metrizamide CT cisternography as the procedure of choice for evaluating the suprasellar cistern and posterior fossa. Computed tomography is still preferable for major trauma, especially involving acute fractures and hematomas, although MR is more sensitive to the more subtle intracerebral lesions, such as shear injuries and subdural hematomas, that may provide prognostic information. Computed tomography also is preferred in situations where detecting small amounts of calcification is important for the differential diagnosis. As the development of MR imaging continues with faster scan times, finer spatial resolution, the use of paramagnetic contrast agents, and with increased availability and decreased cost, MR imaging may become preferable to CT as the imaging modality of choice for the CNS and orbit.     

眼外蔓延的脉络膜黑色素瘤的临床观察

目的 总结眼外蔓延的脉络膜黑色素瘤的诊断方法和治疗经验.方法 回顾性系列病例研究.收集12例经病理学确诊的眼外蔓延期脉络膜黑色素瘤患者临床资料,总结病史特点、临床表现及影像学征象、治疗与随访结果.结果 4例既往有误诊为青光眼的病史;4例既往确诊者,其中3例接受肿瘤局部切除术.常见体征包括:视力下降,眼球突出,上睑下垂,眼球运动受限,结膜充血,眼压或眶压升高等,特异性体征为巩膜表面隆起性肿物.眼B超检查6例,典型表现为眼球壁结构中断,眼内、外肿瘤连续,眼外肿瘤呈低回声,或呈中、低回声混杂.CT检查6例,表现为肌锥内团块状肿瘤与球内肿瘤相连续,边清,均质,包绕眼球或视神经生长.所有患者行MRI T1和T2加权像检查,球内、外的肿瘤有4种类型的信号特征,肿瘤在T1加权像呈高信号,T2加权像呈低信号为典型表现.球外肿瘤的最大直径超过4 mm者有9例.MRI检查可显示球外多灶蔓延及远处转移,且有助于显示微小的球外蔓延灶,最小直径3 mm.11例患者行眶内容物剜除术,1例行眼球及球外瘤体摘除术.病理学检查显示肿瘤以上皮细胞型最为多见,有3种向眼外蔓延的途径.有随访记录者8例,术后联合化疗、放疗或干扰素治疗,随访1～5年,6例无眼部复发,全身情况良好,1例死亡,1例转移.结论 脉络膜黑色素瘤发展至眼外蔓延期的主要原因可能是延误治疗,临床缺少特异表现,确诊多需结合多种影像学检查.手术联合辅助治疗有助于减少局部复发和全身转移.

Abstract：

Objective To evaluate the clinical features, diagnostic methods and treatment of extraocular extension of choroidal melanoma. Methods It was a retrospective case series study. The records of 12 consecutive cases with extraocular extension of choroidal melanoma confirmed by pathologic examination were analyzed with special attention to the case histories, clinical manifestations, imaging findings, treatment and follow up results. Results Four patients were misdiagnosed as glaucoma. Another 4 patients were confirmed the diagnosis of melanoma and 3 of them received the operations of transscleral local resection. The common clinical manifestations included: impaired vision, exophthalmos,blephroptosis, limited ocular motility, conjunctival hyperemia, and increased ocular or orbital pressure, etc.Characteristic sign was raised mass on the surface of sclera. All cases underwent orbital MRI preoperatively,6 underwent ocular B-scan echography, and 6 underwent orbital CT scanning to evaluate for extraocular extension of tumor. Typical ultrasonography revealed the discontinued ocular wall and an intraocular mass with a continuous hypoechoic extraocular mass. In some cases the extraocular mass showed hypoechoic with medium echo area. CT scan showed a well-defined homogeneous intraconal mass connecting with intraocular lesion in 6 cases, which could infiltrate eye or optic nerve. The MR signal features of intraocular tumors with extraocular extension showed 4 patterns in all patients. The typical pattern was the tumor showed hyperintensity on T1 and hypointensity on T2-weighted image. The maximum diameter of extraocular tumor was measured over 4 mm in 9 cases. MRI was useful for demonstrating multiple extraocular lesions, remote metastatic lesion or micro extraocular tumor, of which minimal diameter was 3 mm in our cases. Orbital exenteration was performed in 11 cases and ocular enucleation with excision of extraocular tumor was in 1 cases. Microscopic examination showed the epithelioid-cell-type tumors were the most common. The tumor extended out of the eye by three types of way in our cases. Follow-up ranged from 1 to 5 years in 8 cases,who underwent chemotherapy, radiotherapy or interferon. Six cases had no recurrences and general health.Death and metastasis was respectively recorded in one case. Conclusions Delayed treatment could induce the growth of choroidal melanoma to the stage of extraocular extension, which has few specific clinical manifestations. The combination of multiple imaging examinations was helpful for the correct diagnosis.Surgical operation with adjunctive therapies could partly reduce recurrence and metastasis of melanoma.     

Magnetic Resonance Imaging and DWI Features of Orbital Rhabdomyosarcoma

 Purpose: To describe the magnetic resonance imaging (MRI) features of orbital rhabdomyosarcoma (RMS). Methods: Thirty-nine patients with histopathologically confirmed orbital RMS were retrospectively reviewed. All patients underwent orbital conventional MRI, including axial, sagittal, and coronal T1-weighted, T2-weighted, and postcontrast T1-weighted sequences. The location, shape, margin, and MRI signal of the 39 lesions were reviewed. DWI in 15 patients and susceptibility weighted imaging (SWI) in 2 patients were also analyzed. Results: Orbital MRI was available in 39 patients and revealed a soft tissue mass in the orbital region in all cases. Of the 39 patients, the primary tumor sites were limited to the orbital proper in 31 cases, while 28 cases had extraocular muscle invasion and 8 cases had extraorbital invasion. All lesions were unilateral. Thirty-three cases were well-defined soft tissue masses and 6 cases appeared as less well-defined soft-tissue masses. Thirty-four cases showed homogeneous isointense or slightly hypointense signals on T1-weighted imaging (T1WI) and hyperintense signal on T2-weighted imaging (T2WI) compared with extraocular muscles. Five cases had heterogeneous signals with focal areas of increased signal on T1WI or decreased signal on T2WI, including 1 case with hypointense signal on SWI. The mean apparent diffusion coefficient (ADC) value of the viable part of tumors was (0.925±0.09)×10-3 mm2/s. All cases showed moderate to marked enhancement after contrast administration. Conclusion:Several MRI features—including homogeneous isointense or slightly hypointense signal on T1WI and slightly hyperintense signal on T2WI, relative low ADC values, and moderate to marked enhancement, extraocular muscles invasion, and extraorbital extension—are helpful in the diagnosis of orbital RMS.     

Hydroxyapatite orbital implant vascularization assessed by magnetic resonance imaging

PURPOSE: To report hydroxyapatite (HA) implant enhancement patterns on magnetic resonance (MR) images at varying time intervals after implantation. METHODS: We retrospectively reviewed the records of 45 consecutive patients(from one author's practice) who underwent an MR imaging study 2 to 157 months after HA orbital implant placement. Implant fibrovascular ingrowth was assessed by analyzing the extent of implant enhancement seen on MR imaging.RESULTS Of 21 patients undergoing gadolinium-DTPA T1-weighted MR imaging 2 to 7 weeks after HA placement, 15 had enhancement limited to the implant rim (Grade I or less). Five patients had peripheral foci of enhancement (Grade II), and one patient had foci of enhancement extending to the center of the implant (Grade III). MR images obtained 9 to 15 weeks after HA insertion in all 14 patients had some degree of central enhancement (Grade III) and 11 had homogeneous enhancement throughout the implant (Grade IV or V). Seven patients in the homogeneous group were believed to have particularly intense enhancement patterns (Grade V). Of the 10 patients undergoing MR imaging from 31 to 69 weeks after surgery, 5 had Grade III enhancement and 5 had Grade IV enhancement. CONCLUSIONS: This study demonstrated consistent central HA orbital implant enhancement on MR imaging in the 9- to 15-week group and the >31-week postoperative group. HA orbital implant drilling and peg placement should be performed after central vascularization of the spherical implant has occurred. The results of this study support the principle of performing orbital implant drilling and peg placement at least 5 to 6 months after HA implant insertion.     

眼眶猪囊尾蚴的临床分析

探讨眼眶猪囊尾蚴的临床诊断及治疗方法。方法对１９７３年７月至１９９７年８月收治的２３例眼眶猪囊尾蚴患者的临床特征,实验室检查及影像学特点进行分析。     

Imaging characteristics and surgical management of orbital neurilemmomas

AIM: To review imaging characteristics and surgical outcomes of orbital neurilemmoma. METHODS: Retrospective review of 21 patients with orbital neurilemmoma managed at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2005 to December 2016. All patients underwent surgical excision following preoperative imaging including ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: Among these patients, 11 were male and 10 were female, with age ranging from 12 to 75y (average, 40.3y). Ultrasound of the orbit showed a roundish well-demarcated orbital mass with low or middle internal reflectivity in each case. Dark inner liquid fields were detected in 28.6% of these cases. Doppler ultrasound demonstrated blood flow signals in these masses. CT showed that the tumors were either homogeneous or heterogeneous. MRI of T1WI revealed isointense or hypointense tumors, while the T2WI indicated heterogeneous hyperintense lesions. Gd contrast MRI demonstrated heterogenous or homogeneous enhancement initiating from the wide area of the lesion. Six patients underwent lateral orbitotomy and 15 anterior orbitotomy. All tumors were completely removed. After a mean follow-up of 1.8y, 3 patients experienced reduced vision while the remaining 10 patients showed improved vision after surgery. One patient experienced a mild limitation of upward motility. No recurrence occurred. CONCLUSION: Orbital neurilemmoma is a relatively rare, benign orbital tumor. Effective diagnosis requires a combination of ultrasonography, CT and/or MRI. These imaging techniques are also vital to differentiate neurilemmomas from other orbital masses like that of cavernous hemangiomas and meningiomas. Successful treatment requires complete resection of the neurilemmomas as performed either by lateral or anterior orbitotomy. Recurrence is rare after complete removal.     

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。