眼上静脉扩张的影像学诊断与逆向栓塞治疗颈动脉海绵窦瘘

Imaging diagnosis of dilated superior ophthalmic vein

目的 探讨超声波 (包括彩色超声Doppler)、CT、MRI在显示眼上静脉 (SOV)扩张及病因诊断中的作用 ,分析导致SOV扩张的机理及通过增粗的SOV逆向栓塞治疗颈动脉海绵窦瘘 (CCF)。方法 对 116例伴有SOV扩张疾病的影像学表现进行形态和病因分析 ,对其中 7例CCF患者进行SOV逆行插管 ,用弹簧圈或可脱球囊堵塞瘘口。结果 发现多种疾病均可引起SOV扩张 ,CCF是导致SOV扩张的主要疾病。本组病例中CCF 92例 (包括高流瘘及低流瘘 ) ;眼型Graves病 14例 ;眶尖炎症 2例 ;Tolosa Hunt综合征 2例 ;眶部血管畸形2例 ;眶炎性假瘤、眶内血肿、海绵窦肿瘤及海绵窦血栓形成各 1例。扩张静脉直径 3.5～ 7.0mm ,各病种管径扩张大小无明显差异。管径最粗者为CCF ,影像检查同时能发现眼外肌肥大、眶部病变和海绵窦膨大等相关表现。结论 超声波 (包括彩色超声Doppler)、CT、MRI均能良好显示SOV扩张 ,结合MRI、CT和超声波检查的其他表现 ,可对导致SOV扩张的病因作出诊断 ,对伴有SOV扩张的CCF患者行SOV逆行插管栓塞瘘口可达到良好效果。

Objective To evaluate the diagnostic value of CT,MRI and Doppler ultrasound in dilatation of superior ophthalmic vein(SOV)and its etiologies. Methods 116 cases of dilated SOV were analyzed with regard to imaging techniques. Seven patients with CCF were successfully cured by retrograde embolization via the enlarged SOV . Results SOV enlargement was noted to occur in carotid cavernous fistula, ophthalmic Graves' disease, Tolosa Hunt syndrome, inflammation at the apex of the orbit, orbital pseudotumor and thrombosis of cavernous sinus. The dilated vein appeared as signal void tubular shadows on both T1 and T2 weighted images. The diameter of the enlarged vein was 3.5～7.0mm. Extraocular muscle enlargement, orbital lesions, enlarged cavernous sinus etc, were also revealed by MRI,CT and Doppler ultrasound scanning. Conclusion The dilated SOV may well be demonstrated by MRI,CT and ultrasound scanning. The etiologic diagnosis of enlarged SOV could also be made in combination with the associated findings.The authors suggest that some CCF cases can be occluded by retrograde embolization via the SOV route.