多模式检查在视盘黑色素细胞瘤中的应用  

Application of multi-mode detection onmelanocytoma of the optic disk

作　　者：史煜 刘洋[2] 许译丹 曹鎏[2] 陈春生 SHI Yu;LIU Yang;XU Yidan;CAO Liu;CHEN Chunsheng(Department of Ophthalmology,Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Ophthalmology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京大学医学院附属鼓楼医院眼科,江苏南京210008 [2]南京医科大学附属南京医院眼科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2022年第5期456-458,共3页Chinese Journal of Surgical Oncology

摘　　要：目的探讨多模式检查在视盘黑色素细胞瘤(MCOD)中的应用。方法收集2017年4月至2022年2月于南京大学医学院附属鼓楼医院经多模式影像检查确诊为MCOD的20例患者的临床资料。分析其眼底检查、荧光素眼底血管造影(FFA)、频域光学相干断层扫描(SD-OCT)、B超及磁共振成像(MRI)检查的特征并与恶性视盘黑色素瘤进行鉴别。结果眼前节检查有2例(2/20)伴有角膜水肿及葡萄膜炎改变,其余患者未见明显异常;眼底检查可见5例(5/20)患眼瘤体位于视盘表面,边界清晰,呈棕黑色,15例(15/20)患眼瘤体位于视盘旁,呈深黑色边缘不规则;B超显示所有患眼视盘前局限性高回声隆起,内部回声均匀,与周围组织间境界清晰,其中1例(1/20)患眼伴中度玻璃体混浊;FFA示造影早期所有瘤体均呈低荧光,晚期无明显荧光渗漏,其中2例(2/20)患眼中晚期视盘呈强荧光渗漏,提示患眼合并视盘水肿或缺血性视神经病变可能;SD-OCT检查可见视盘不同程度隆起,表面反射增强呈带状高反射,信号强度接近于色素上皮层,其下深层反射减弱为低反射。结论多模式检查可以客观地评价肿瘤的生长及变化情况,为MCOD提供可靠的诊断和鉴别诊断依据。Objective To explore the effect of multi-mode detection on the diagnosis of the melanocytoma of the optic disk(MCOD).Methods From April 2017 to February 2022,20 patients(20 eyes)diagnosed as MCOD in Nanjing Drum Tower Hospital were included in this study.The characteristics of fundus examination,fundus fluorescein angiography(FFA),spectral-domain optical coherence tomography(SD-OCT),B-mode ultrasonography and magnetic resonance imaging(MRI)examination were analyzed for the differential diagnosis of malignant optic disc melanoma.Results There were 2 cases(10%)with corneal edema and uveitis.No abnormality was found in the rest of the patients in the anterior segment examination.Fundus examination showed that the tumor in 5 cases(25%)was located on the surface of the optic disc with a clear boundary and brown-black color.The tumor in 15 cases(75%)was located beside the optic disc with dark black and irregular margins.B-ultrasound examination showed a localized hyperechoic bulge with a uniform internal echo and a clear realm between the surrounding tissues in front of the optic disc in all eyes.Moderate vitreous opacity was found in one case(5%).FFA examination showed that all tumors were hypofluorescence in the early stage,and there was no obvious fluorescence leakage in the late stage.2 patients(10%)showed hyperfluorescence leakage in the middle and late stage of the optic disc,which suggests that the eyes were combined with papilloedema or ischemic optic neuropathy.SD-OCT examination showed that the optic disc was bulge in different degrees,and the surface reflection was enhanced to form a band-shaped high reflection.The signal intensity was close to retinal pigment epithelial(RPE)layer,and the reflection of the deep layers is weakened to low reflection.Conclusions Multi-modal imaging is conducive to confirm the diagnosis and differential diagnosis of MCOD.

关 键 词：视盘黑色素细胞瘤 多模式检查 鉴别诊断 眼底肿瘤 

分 类 号：R739.7[医药卫生—肿瘤]