中华眼底病杂志

中华眼底病杂志

视网膜大动脉瘤光相干断层扫描血管成像影像特征观察

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目的 观察视网膜大动脉瘤(RAM)的光相干断层扫描血管成像(OCTA)影像特征。 方法 回顾性研究。临床确诊为RAM的19例患者19只眼纳入研究。其中,男性1例1只眼,女性18例18只眼;年龄62~85岁,平均年龄71.3岁。患眼经眼底彩色照相检查发现瘤体均位于动脉第1~3级分支,呈局灶性纺锤状或梭形血管瘤样扩张;经荧光素眼底血管造影检查发现瘤体早期均匀一致充盈,晚期活动期瘤体表现为强荧光素渗漏。参照文献并依据眼底表现将RAM分为渗出型及出血型。19只眼中,渗出型RAM 8只眼,出血型RAM 11只眼。所有患眼均行OCTA检查,常规采集黄斑区3 mm×3 mm直径范围视网膜血流图像, 观察患眼的OCTA影像特征。 结果 OCTA检查发现,所有患眼视网膜浅层RAM呈强反射信号,并与视网膜动脉血管相连。B扫描(B-scan)像上,对应病灶处可见较小的瘤体在管腔内呈小片状强反射膨隆扩张,较大的瘤体呈山峰样高度隆起,深层反射减弱、消失,瘤体内部血流信号丰富。横断面(en-face)像可清晰显示瘤体的立体形态,伴有渗出或多层次出血者可清晰显示出血范围及边界,对应病灶处可见视网膜血管内有小团状膨隆改变。结合多彩透视功能可明确显示瘤体呈现与浅层视网膜血管相一致的白色信号。血流密度模式中亦可清晰显示立体的瘤体形态。 结论 RAM在视网膜浅层呈强反射信号,并与视网膜动脉血管相连;B-scan像上可见较小瘤体呈小片状强反射膨隆扩张,较大瘤体呈山峰样高度隆起,瘤体内部血流信号丰富;en-face像可清晰显示瘤体的立体形态。

Objective To observe the imaging features of the optical coherence tomography angiography (OCTA) of complex retinal arterial macroaneurysm (RAM). Methods Nineteen eyes of 19 patients with RAM were enrolled in this retrospective study. There were 1 male (1 eye) and 18 females (18 eyes). The patients aged from 62 to 85 years, with the mean age of 71.3 years. The fundus photography examination revealed the tumors were located in the 1 - 3 branch of the artery, which showed focal spindle-shaped or fusiform angiomatous dilatation. The fundus fluorescein angiography revealed the early uniform fluorescence of the tumor, and the tumor was a high-fluorescence leak in the late period. RAM was divided into exudative type and hemorrhagic type according to the literature and based on the ocular fundus appearance. In 19 eyes, 8 eyes were exudative RAM and 11 eyes were hemorrhagic RAM. All eyes were examined by OCTA, and the retinal blood flow images of 3 mm ×3 mm diameter were routinely collected to observe the OCTA imaging features. Results OCTA examination showed that the superficial RAM of all eyes had strong reflection signal connected with retinal artery. B-scan image showed smaller tumors in the lumen with strong reflection of expansion, or large tumor with peak-like uplift and the blood flow signals in the tumor body were abundant. The enface image clearly showed the three-dimensional shape of the tumor. Tumors with exudation or multi-level bleeding could be clearly documented for their bleeding range and boundary. The white signal co-localized with the superficial retinal blood vessels by the function of multi-color fluoroscopy. The pattern of blood flow density can also clearly show the three-dimensional shape of the tumor. Conclusion The complex RAM is a strong reflection signal in the superficial layer of retina, which is connected with the retinal vessels; B-scan images shows small tumors with a small piece of strong reflection and dilation, or large tumors with mountain-like elevation with abundant blood flow signals. En face image can clearly show the three-dimensional shape of the tumor.

关键词: 动脉瘤/诊断; 视网膜疾病/诊断; 体层摄影术,光学相干; 局部血流

Key words: Retinal aneurysms/diagnosis; Retinal diseases/diagnosis; Optical coherence tomography; Local blood flow

引用本文: 赵玥, 姚进. 视网膜大动脉瘤光相干断层扫描血管成像影像特征观察. 中华眼底病杂志, 2018, 34(1): 21-24. doi: 10.3760/cma.j.issn.1005-1015.2018.01.006 复制

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