脉络膜转移癌荧光素眼底血管造影特征及其与脉络膜黑色素瘤的鉴别诊断

Fundus fluorescein angiography in metastatic choroidal carcinomas and differentiating metastatic choroidal carcinomas from primary choroidal melanomas

目的 探讨脉络膜转移癌的荧光素眼底血管造影（FFA）特征及其与脉络膜黑色素瘤的鉴别诊断要点.方法 回顾性病例系列研究.对2004年3月至2007年4月就诊的22例（23只眼）脉络膜转移癌患者临床资料和FFA图像进行回顾性分析,以同期行眼球摘除且经病理检查确诊的31例（31只眼）脉络膜黑色素瘤患者的完整临床资料作为对照.患者FFA图像特征比较采用Fisher确切概率法.结果 根据脉络膜转移癌患者的眼底表现,肿瘤可分为孤立扁平型（肿瘤高度＜3 mm）、孤立隆起型（肿瘤高度＞3 mm）、弥漫型3类.3类脉络膜转移癌的FFA图像特征：动脉期肿块呈低荧光,造影过程中逐渐出现高荧光;动静脉期肿块边缘毛细血管扩张,造影早期至晚期肿块边缘针尖样高荧光渗漏,这两种表现主要见于孤立扁平型肿瘤;肿块中可见肿瘤血管,其与视网膜血管呈双循环特征,此种表现主要见于孤立隆起型肿瘤.脉络膜转移癌与脉络膜黑色素瘤的FFA图像特征比较,仅显示肿块边缘针尖样高荧光渗漏发生率明显不同,脉络膜转移癌为73.91%（17/23）,脉络膜黑色素瘤为16.13%（5/31）,两者差异有统计学意义（P=0.0000）.针尖样高荧光渗漏对两种肿瘤鉴别诊断的灵敏度为73.91%,特异度83.87%,准确度79.63%,阳性预测值77.27%,阴性预测值81.25%.结论 FFA有助于脉络膜转移癌的诊断,针尖样高荧光渗漏在脉络膜转移癌与脉络膜黑色素瘤的鉴别诊断中有一定的参考价值.

Objective To investigate the characteristics of fundus fluorescein angiography （FFA）in metastatic choroidal carcinomas and determine the value of FFA in differentiating metastatic choroidal carcinomas from primary choroidal melanomas. Methods It was a retrospective case series. The retrospective analysis of clinical data and FFA findings was performed in 23 eyes of 22 patients with metastatic choroidal carcinomas and 31 eyes of 31 patients with primary choroidal melanomas as the control.Results Ocular fundus findings of metastatic choroidal carcinomas were divided into three types： solitary flat （ tumor thickness less than 3 mm ） , solitary elevated （ tumor thickness more than 3 mm） or diffuse type.FFA of the three types showed hypofluorescence during the arterial phase and progressive hyperfluorescence during the subsequent phases. The border of the lesions revealed retinal capillary dilation during the arteriovenous phase and persistent pinpoint leakage throughout the angiogram. Retinal capillary dilation and pinpoint leakage were more frequently presented in the solitary flat type. Simultaneous visualization of retinal and tumor circulation （the so called double circulation ） was more frequently presented in the solitary elevated type. Pinpoint leakage could be detected in 17 （73.91%） eyes of metastatic choroidal carcinomas and in 5 （ 16. 13% ） eyes of primary choroidal melanomas. The difference between the visibility of pinpoint leakage in metastatic choroidal carcinomas and primary choroidal melanomas was statistically significant （ P =0. 0000）. When pinpoint leakage of FFA was used to differentiate metastatic choroidal carcinomas from primary choroidal melanomas, the sensitivity, specificity, accuracy, positive and negative predictive values were 73. 91%,83. 87%, 79. 63%, 77. 27%, 81. 25% respectively. Conclusions FFA is helpful for the diagnosis of metastatic choroidal carcinomas. Pinpoint leakage on the border of lesions has some value in differentiating metastatic choroidal carcinomas from primary choroidal melanomas.