相干光断层扫描在眼内肿瘤诊断中的临床应用

Value of optical coherence tomography in diagnosis of intraocular tumors

目的 研究相干光断层扫描（OCT）在多种眼内肿瘤诊断中的临床价值.设计回顾性系列病例.研究对象 49例（52眼）未行治疗的多种眼内肿瘤的OCT图像.方法 收集2006～2009年在北京同仁医院进行OCT检查（Zeiss StratusOCT Model 3000）的49例（52眼）未行治疗的眼内肿瘤的临床资料,对各种肿瘤的OCT图像进行分析.肿瘤诊断根据患者的典型症状、病史、跟底镜下表现并综合眼底血管造影、眼彩色多普勒超声检查、眼眶CT和MRI结果.其中14例脉络膜黑色素瘤及3例睫状体肿瘤在局部切除后病理检查确诊 2例脉络膜转移癌有明确原发恶性肿瘤.主要指标OCT图像表现.结果 42眼脉络膜肿瘤（脉络膜黑色素瘤27眼、脉络膜转移癌2眼、脉络膜血管瘤5眼、脉络膜骨瘤8眼）的OCT表现为瘤体处视网膜及色素上皮层（RPE）光带隆起,伴不同程度的反射强度改变及层次紊乱,光带后瘤体为暗区 瘤体局部（27眼）和黄斑部（27眼）可见视网膜神经上皮层脱离.视网膜内（下）高反射点仅见于脉络膜黑色素瘤,脉络膜骨瘤的RPE光带反射显著增强且极不规则.7眼视网膜肿瘤（视网膜星形细胞错构瘤2眼、视网膜血管瘤5眼）的OCT表现为视网膜光带隆起,反射强度不均匀,RPE光带不能显示 3眼可见黄斑区视网膜神经上皮层水肿、脱离.其中视网膜星形细胞错构瘤隆起的视网膜光带可见特殊的虫蚀样外观.3眼睫状体肿瘤（黑色素瘤1眼、无色素上皮腺瘤2眼）OCT未能扫描到瘤体,2眼黄斑部OCT正常,1眼黄斑部视网膜水肿伴神经上皮层浅脱离.结论 OCT可显示肿瘤继发性的瘤体局部和邻近的视网膜及黄斑部改变,在一定程度上提示肿瘤的性质帮助诊断.

Objective To investigate the value of optical coherence tomography in diagnosis of intraocular tumors. Design Retrospective case series. Participants 49 cases （52 eyes） with untreated intraoeular tumors. Methods The characteristics of the OCT images of tbe intraocular tumors were analyzed. Main Outcome Measures The characteristics of the OCT image. Results In 42 eyes with choroidal tumor （27 melanomas, 2 metastasis, 5 anginma, 8 osteomas） OCT revealed the elevation of the retina and the retinal pigment epithelium （RPE） with the changes of the reflectance and the loss of the normal retinal architeehture, while the tumor revealed as the dark area behind RPE. Low-reflectance region corresponding to neurosensory retinal detachment overlying the tumor （27 eyes） and maeular （27 eyes） was revealed. Remarkable intraretinal and/or subretinal highly reflective points were uniquely found in melanomas, and particularly significant irregularity of RPE were noticed in osteomas. In the 7 eyes with retina tumor （2 astroeytic harmartomas, 5 hemangiomas） OCT revealed the elevation of the retina with the changes of the reflectance and the loss of normal architeehture, while the RPE was invisible; 3 eyes combined with macular detachment as well. Astrocytie harmartomas demonstrated characteristic moth-eaten appearance. All the 3 ciliary tumors （1 melanoma, 2 adenomas of nonpigmented epithelium） were not well captured by OCT, scan of the maeular revealed the shallow retinal detachment of the melanoma and the normal appearance was observed in the 2 adenomas. Conclusion OCT mainly reveals the secondary changes in overlying and adjacent retina of the intraoeular tumors, and also the maeular changes.