医学影像学在诊断以眼部为首发表现的全身病中的作用

Medical imaging for the diagnosis of systemic disease with ocular problem as the first symptom

现代医学影像技术在诊断眼部疾病中发挥着重要作用,同时亦能通过眼部影像学表现推测病变是否源于颅内或是全身系统性疾病。良性颅内压增高多以视力损害为首发症状,眼眶或颅脑MRI征象中包括空蝶鞍(79%)、视神经周围蛛网膜下腔增宽(74%)、视乳头隆起(56%)等。MRI和CT检查可以及时发现视网膜母细胞瘤球外侵犯以及远处转移的病变,为临床治疗提供依据。MRI能够发现动眼神经麻痹的大多数(71%)病因,且病变位置均在核团所在脑干及动眼神经在颅内走行行程中,少数位于颅眶沟通的眶上裂区。以眼部表现为首发症状的IgG4相关性疾病具有双侧泪腺肿胀及多发眼外肌增粗等特征性的影像表现,治疗前后生长抑素受体SPECT/CT显像在判断疾病的活动性及疗效评价的定量研究中具有较大应用价值。

Modem medical imaging technology plays an increasingly important role in diagnosis of ocular diseases, and can assist in speculating the origin of lesions originated from intracranial part or systemic disease. In patients with benign intracranial hyperten- sion usually presenting with ocular symptoms as a chief complaint, the orbit or eraniocerebral MRI image could disclose empty sella in 79% of cases; distension of the perioptic subarachnoid space in 74% of cases, and papiIledema in 56%. MRI and CT could find metastatic tumor of retinoblastoma and provide basis for clinical treatment. MRI is useful to find the causes of most oeulomotor nerve palsy. Most lesions locate at the nuclei in brain stem and oculomotor nerve trunk and the surroundings, the minority in the supraorbital fissure. The characteristic imaging findings of IgC,4-related disease （IgG4-RD） with primary ocular symptom were diffuse enlargement of bilateral lacrimal glands and extraoeular muscles. Somatostatin receptor scintigraphy of SPECT/CT has a good prospect for evaluating activity and treatment effect of IgG4-RD.