应与视神经炎鉴别诊断的视神经肿瘤的临床和影像学特征  

Clinical and imaging characteristics of optic nerve tumors as the differencial diagnosis of optic neuritis

作　　者：孙传宾[1] 姜波 刘庚昊 肖庆[1] Sun Chuanbin;Jiang Bo;Liu Genghao;Xiao Qing(Eye Center,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Ophthalmology,First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009 [2]浙江大学医学院附属第一医院眼科,杭州310009

出　　处：《中华眼科杂志》2023年第5期367-375,共9页Chinese Journal of Ophthalmology

摘　　要：目的探讨需与视神经炎鉴别诊断的视神经肿瘤的临床和影像学特征。方法回顾性病例系列研究。收集2017年1月至2021年12月在浙江大学医学院附属第二医院确诊的视神经肿瘤患者的临床资料,选取眼部和影像检查表现类似视神经炎或视神经周围炎的患者29例(39只眼)纳入本研究。其中视神经鞘脑膜瘤(ONSM)15例(17只眼)、视神经胶质瘤(ONG)4例(5只眼)、浸润性视神经病变(ION)10例(17只眼)。患者均接受最佳矫正视力(BCVA)、眼前节和眼底、视野、眼眶或颅脑MRI检查。观察并分析患者的眼部和影像学检查资料,记录患者治疗和随访情况,与视神经炎或视神经周围炎对比,总结其临床表现和影像学特征。结果29例视神经肿瘤患者中,男性10例,女性19例;年龄为(43.3±13.8)岁,范围为11~72岁;随访时间为6.8(2.0,11.0)个月,范围为1~33个月。16例(21只眼)患者曾被误诊为急性视神经炎,且均对激素治疗反应不佳,包括9例(11只眼)ONSM患者、4例(6只眼)ION患者、3例(4只眼)ONG患者。患者诊断延误时间为7.1(1.5,12.0)个月,范围为1~24个月。全部患眼的主要临床症状包括视力急性下降(23只眼)、视力缓慢下降(5只眼)、反复一过性黑矇(4只眼)、无明显视觉症状(7只眼)。全部患眼最佳矫正视力(BCVA)中位数为0.1,范围为无光感至1.0。眼底检查结果显示,39只视神经肿瘤患眼中,视盘水肿34只眼、视盘正常5只眼。共27例(33只眼)患者完成视野检查,其中生理盲点扩大11只眼,视野向心性收缩或管状视野8只眼,弥漫性光敏感度降低7只眼,弓形暗点4只眼,视野正常3只眼。全部患眼均完成眼眶或颅脑MRI检查,结果显示视神经轻度增粗22只眼,明显增粗6只眼,高度增粗伴扭曲5只眼,视神经无明显增粗6只眼。MRI造影剂增强T1加权成像(T1WI)检查结果显示,视神经实质增粗5只眼,均为ONG,其中2只眼伴有视神经实质强化;视神经鞘膜增厚、强Objective To investigate the clinical and imaging features of optic nerve tumors that require differential diagnosis from optic neuritis.Methods A retrospective case series study was conducted.Clinical data of patients diagnosed with optic nerve tumors from January 2017 to December 2021 at the Second Affiliated Hospital of Zhejiang University School of Medicine were collected.A total of 29 patients(39 eyes)with clinical and magnetic resonance imaging(MRI)findings similar to optic neuritis or optic neuropathy were included.There were 15 cases of optic nerve sheath meningioma(ONSM)(17 eyes),4 cases of optic nerve glioma(ONG)(5 eyes),and 10 cases of infiltrative optic nerve lesions(ION)(17 eyes).All patients underwent best-corrected visual acuity(BCVA),anterior and posterior segment examinations,visual field examination,and orbital or cranial MRI examination.Patient data were observed and analyzed,treatment and follow-up information were recorded,and clinical and imaging features were summarized and compared with those of optic neuritis or optic neuropathy.Results Among the 29 patients with optic nerve tumors,10 were male and 19 were female,with an average age of(43.3±13.8)years and a range of 11 to 72 years.The follow-up time was 6.8(2.0,11.0)months,with a range of 1 to 33 months.Sixteen patients(21 eyes)with optic nerve tumors were initially misdiagnosed as having acute optic neuritis and showed poor response to steroid treatment.Of these,9 cases(11 eyes)were ONSM,4 cases(6 eyes)were ION,and 3 cases(4 eyes)were ONG.The diagnostic delay time was 7.1(1.5,12.0)months,with a range of 1 to 24 months.The main clinical symptoms of all affected eyes were acute vision loss in 23 eyes,slow vision loss in 5 eyes,transient blackouts in 4 eyes,and no obvious visual symptoms in 7 eyes.The median BCVA of all affected eyes was 0.1,ranging from light perception to 1.0.Fundus examination results showed optic disc edema in 34 eyes and normal optic disc in 5 eyes among the 39 eyes with optic nerve tumors.A total of 27 patients(33 ey

关 键 词：视神经肿瘤 脑膜瘤 视神经胶质瘤 视神经炎 视神经疾病 磁共振成像 诊断 鉴别 

分 类 号：R774.6[医药卫生—眼科] R739.7[医药卫生—临床医学]