脉络膜转移癌荧光素及吲哚青绿血管造影的影像分析

目的了解脉络膜转移癌共焦激光扫描检眼镜同步荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）影像特点，为该疾病的准确诊断提供依据。设计回顾性病例系列。研究对象明确原发灶的脉络膜转移癌患者12例（17眼）。方法经临床诊断、有明确原发恶性肿瘤病灶的患者12例（17眼），散大瞳孔后拍摄彩色眼底像，用海德堡共焦激光扫描检眼镜进行FFA及ICGA同步造影，观察两种影像学检查的异同。主要指标FFA及ICGA各期瘤体荧光表现及差异。结果FFA早期16眼瘤体呈低荧光。ICGA早期17眼瘤体均为低荧光，且低荧光范围略大于FFA；11眼在瘤体边缘见异常脉络膜血管。FFA静脉期显示瘤体表面视网膜血管迂曲、毛细血管扩张及微血管瘤；中晚期渗漏明显，肿瘤边界模糊，色素斑块及出血表现为荧光遮蔽。ICGA中晚期，13眼瘤体边缘见斑驳淡荧光，4眼淡荧光位于瘤体中央，晚期瘤体轮廓较FFA清晰。对于1眼瘤体扁平、面积较小的病灶，ICGA可清晰显示，而FFA表现不典型。结论ICGA对确定肿瘤特别是小而扁平的瘤体的轮廓及脉络膜血管异常有优越性，FFA可显示肿瘤导致的视网膜血管及色素上皮改变。二者结合，有助于脉络膜转移癌的诊断。

Characteristics of FFA and ICGA images in patients with choroidal metastasis

Objective To characterize the staining patterns of indocyanine green angiography （ICGA） and fundus fluorecein angiography （FFA） in choroidal metastasis. Design Retrospective case series. Participants Twelve cases （17 eyes） with choroidal metastasis whose primary cancer site was defined. Methods All patients underwent FFA and ICGA by confocal laser scanning ophthalmoscope. The characteristics of image findings were analyzed. Main Outcome Measures Images recorded from different phase of both FFA and ICGA. Results In the early phase, hypofluorecence was observed in 16 eyes with FFA, while in 17 eyes with ICGA. The diameter of the tumor was slightly larger, and abnormal ehoroidal vessels were present in ICGA. In the retinalvenous phase of FFA, mieroaneurysms and dilation of capillaries were observed from the margin of the tumor with leakage. Diffused and homogenous hyperfluorecence was demonstrated on the tumor in late phase, which obscured the margin of the tumor. As to ICGA, hypofluorecenee was present in the cen- ter of the tumor throughout all stages in 13 eyes with pale fluoreeenee around the tumor in the late phase. The margins of all the tumors were still distinct. Conclusion FFA and ICGA present different features of choroidal metastasis. The combination of both is helpful for distinguishing choroidal metastasis from other choroidal hyperplasia.