脉络膜转移癌的影像学特征  

Imaging characteristics of choroidal metastasis

作　　者：田澍蔚 姚静[1] 王建明[1] 段雪娟 张洁[1] 周爱意[1] TIAN Shuwei;YAO Jing;WANG Jianming;DUAN Xuejuan;ZHANG Jie;ZHOU Aiyi(Department of Ophthalmology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院眼科,陕西西安710004

出　　处：《分子影像学杂志》2021年第2期219-225,共7页Journal of Molecular Imaging

基　　金：陕西省重点研发项目基金(2020SF-270);西安交通大学第二附属医院院基金(YJ[QN]201817)。

摘　　要：目的探讨脉络膜转移癌的临床及影像学检查特征并分析影像学表现之间的关联。方法回顾性分析西安交通大学第二附属医院眼科2012~2019年确诊的脉络膜转移癌患者10例(12只眼),其中男4例,女6例,年龄61±5.8岁。所有患者均行最佳矫正视力、裂隙灯、眼底照相、频域光学相干断层扫描、荧光素眼底血管造影(FFA)、吲哚氰绿血管造影(ICGA)、自发荧光(FAF)检查。部分行B超扫描、MRI和肿瘤标志物检查。结果共10例(12只眼)脉络膜转移癌,原发来自肺癌8例,乳腺癌2例。11眼(91.67%)眼底可见黄色实性隆起,均为孤立性肿物,部分瘤体表面可见色素沉着(50%)。FAF检查示瘤体周边呈点状或环形高自发荧光,内部为斑驳自发荧光表现,且瘤体表面色素沉着的区域FAF呈高自发荧光(100%,P<0.05)。11眼(91.67%)频域光学相干断层扫描表现为脉络膜-RPE层及神经上皮层呈波浪状隆起,视网膜神经上皮层与RPE层间可见大量细颗粒状强反射物质堆积,合并渗出性视网膜脱离。FFA背景期肿物呈低荧光,边界不清,中期其周围出现针尖样高荧光点,晚期呈弥漫性高荧光5眼(41.67%),5眼晚期瘤体中央相对低荧光。ICGA表现为早期肿物大面积低荧光,其后周边缓慢出现斑点状高荧光,随时间缓慢范围扩大并模糊,瘤体大部分仍为低荧光,范围较早期相缩小。B超扫描显示扁平实质性隆起。结论眼底彩照可显示肿瘤的部位、大小、色素及视网膜病变情况;FAF提示视网膜色素上皮状况,肿瘤表面色素与自发荧光表现明显相关;频域OCT可反映视网膜脱离情况及瘤体高度;ICGA与FFA相互补充有助于脉络膜肿瘤的鉴别诊断。Objective To discuss the clinic diagnosis of choroidal metastasis(CM)through the investigation of its clinical and imaging characteristics.Methods The clinical data was collected from 10 patients with CM,in our hospital from 2012 to 2019.There were 4 males and 6 females,with the mean age of 61±5.8 years.The data included detailed medical history,BCVA,slit lamp biomicroscopy,fundus photography,SD-OCT,fundus fluorescein angiography(FFA),fundus autofluorescence(FAF)and type-B ultrasound,MRI and tumor biomarkers.Results Totally 12 eyes of 10 patients with CM were examined,with primary cancer site in the lung in 8 cases and in breast in 2 cases.Yellow isolated bulge lesion was found in 11 eyes(91.67%),while pigmentation being visible on the surface of tumor in 6 eyes(50%).FAF showed high autofluorescence in dots or circles around the tumor,or high autofluorescence in the whole tumor.The inside part demonstrated non-uniform autofluorescence performance.The area of FAF showed high autofluorescence was consistent with the pigment on the tumor surface(100%,P<0.05).SD-OCT was manifested by wavy ridges in the choroid-pigment epithelium layer and the neuroepithelial layer.A large number of fine granular strong reflective materials were observed between the retinal neuroepithelial layer and the RPE layer,combined with exudative retinal detachment.The tumors showed low fluorescence with unclear borders in the early stage,needle-like spotted high fluorescence in the middle stage and diffusive strong fluorescence in the late stage 5 eyes(41.67%),relative low fluorescence in the center of tumors in 5 eyes.ICGA revealed that large areas of tumor show low fluorescence in the early stage,followed by spot-like high fluorescence in the surrounding area and slowly expanding and blurring over time.Most of the tumor body was still low fluorescence,and the diameter was reduced in comparison with the earlier phase.B-type ultrasound scan showed uniform and substantial uplift.Conclusion Color photography of the fundus shows the location,siz

关 键 词：脉络膜肿瘤 肿瘤转移 影像学特征 早期诊断 

分 类 号：R739.7[医药卫生—肿瘤]