视盘周围高反射卵圆形团块样结构的影像学特征

Imaging features of peripapillary hyperreflective ovoid mass-like structure

视盘周围高反射卵圆形团块样结构(PHOMS)是近年来在研究视盘玻璃疣(ODD)中新定义的一种新型影像学特征,其在OCT图像上表现为视盘周围Bruch膜上卵圆形高反射信号,自发荧光图像上表现为环形或新月形无荧光,无赤光红外图像上呈视盘周围浅灰色火山样隆起或较平坦的圆周带。目前关于PHOMS是否是ODD的亚型或前体尚无定论,组织病理学上可能是轴突淤积后向视神经方向突出的神经纤维。鉴于组织解剖学上PHOMS与ODD可能存在不同病理性质,两者在多模态影像学图像中存在明显不同的影像学特征,为使ODD的诊断更加准确,国际视盘玻璃疣协会建议将PHOMS与ODD区别开来。PHOMS在OCT上主要与ODD、视盘周围血管相鉴别。可见于ODD、视盘水肿、非动脉炎性前部缺血性视神经病变、多发性硬化症、视网膜中央静脉阻塞、先天性视盘倾斜综合征、孤立性视神经炎及视神经萎缩等多种疾病中,并且是儿童假性视盘水肿的重要原因。本文就PHOMS的起源、影像学特征、鉴别诊断、相关疾病等进行总结,以期增加国内研究者对PHOMS结构的认识,增强其与ODD的鉴别诊断,为临床研究及诊断提供参考。

Peripapillary hyperreflective ovoid mass-like structure(PHOMS)is a novel imaging feature newly defined in recent years in the study of optic disc drusen(ODD).In OCT images,it shows an oval hyper-reflective signal on the Bruch membrane around the optic papilla,ring or crescent non-fluorescence in autofluorescence,and light gray peripapillary elevations around the optic disc in non-red infrared images.There is no conclusive evidence as to whether PHOMS is a subtype or precursor of ODD.Histopathologically,PHOMS might correspond to the lateral bulging or herniation of distended axons into the peripapillary retina.Since there may be different pathological properties between PHOMS and ODD in histology,there are different imaging features in multimodal imaging.To make the diagnosis of ODD more accurate,the Optic Disc Drusen Studies Consortium recommends that PHOMS be distinguished from ODD.PHOMS is mainly differentiated from ODD and perioptic vessels on OCT.It can be seen in many diseases such as ODD,optic papilledema,non-arteritis anterior ischemic optic neuropathy,multiple sclerosis,central retinal vein occlusion,pediatric tilted disc syndrome,isolated optic neuritis and optic atrophy,and is an important cause of pseudopapilloedema in children.This article summarizes the origin,imaging features,differential diagnosis and related diseases of PHOMS,to increase domestic researchers'understanding of the structure of PHOMS,enhance the differential diagnosis between PHOMS and ODD,and provide a reference for clinical research and diagnosis.