眼眶动静脉畸形致眼上静脉扩张的影像学表现

Imaging diagnosis of superior ophthalmic vein enlargement associated with orbital arteriovenous malformation

目的探讨眼眶动静脉畸形(AVM)致眼上静脉(SOV)扩张的影像学及血管造影表现。设计回顾性病例系列。研究对象6例临床表现与硬脑膜海绵窦瘘(CCF)相似的眼眶AVM患者。方法总结分析所有患者的影像学检查结果,如CT、MRI和选择性脑血管造影。主要指标影像学征象及血流动力学。结果CT和MRI均可显示所有患者的SOV扩张。另外,尚存在眼球突出、AVM畸形血管团等征象。所有6例AVM均位于眼眶内,1例尚合并颅内AVM。所有患者的主要引流静脉均为SOV,动脉包括脑膜中动脉、上颌动脉和眼动脉。结论眼眶AVM可引起与CCF相似的临床和影像学征象,但AVM通常不引起海绵窦膨大,血管造影仍是确诊的必需手段,而无创技术是辅助血管造影进行明确诊断的重要手段。(眼科,2007,16:395-398)

Objective To investigate the radiologic and angiographic findings of dilated superior ophthalmic vein （SOV） associated with orbital arteriovenous malformations （AVM）. Design Retrospective case series. Participants Six cases of orbital AVM patients, with clinical symptoms and signs mimicking a carotid cavernous fistula （CCF）. Methods Examinations of the six cases, such as CT, MRI, and selective cerebral angiography, were summarized and analyzed. Main Outcome Measures Images findings and bemodynamics. Results All patients were found with dilated SOV on CT and MRI. Additional radiographic findings included proptosis and AVM. All six AVM were located at the orbit, and one of them was also found with AVM in brain. The main draining vein was SOV in all cases. The branches contributing to the fistula＇s blood supply were the middle meningeal artery, the internal maxillary artery, and the ophthalmic artery. Conclusions Orbital AVM can cause similar clinical signs and radiologic features to those associated with a CCF. However, the bulging cavernous sinus cannot be found in most AVM. Angiography is necessary for definitive management, non-invasive techniques have an important role in pre-angiographic diagnostic decisions. （Ophthalmol CHN, 2007, 16： 395-398）