[1]刘志强,吕丽娜,张胜娟,等.早期非典型性视网膜星形细胞错构瘤的多模式影像学特征[J].眼科新进展,2021,41(8):779-782.[doi:10.13389/j.cnki.rao.2021.0162]
　LIU Zhiqiang,L Lina,ZHANG Shengjuan,et al.Multimodal imaging characteristics of early atypical retinal astrocytic hamartoma[J].Recent Advances in Ophthalmology,2021,41(8):779-782.[doi:10.13389/j.cnki.rao.2021.0162]
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早期非典型性视网膜星形细胞错构瘤的多模式影像学特征/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年8期
页码:
779-782
栏目:
应用研究
出版日期:
2021-08-05

文章信息/Info

Title:
Multimodal imaging characteristics of early atypical retinal astrocytic hamartoma
作者:
刘志强; 吕丽娜; 张胜娟; 肖哲; 兴辰
054001　河北省邢台市，河北省眼科医院
Author(s):
LIU Zhiqiang;  L Lina;  ZHANG Shengjuan;  XIAO Zhe;  XING Chen
Hebei Eye Hospital, Xingtai 054001, Hebei Province, China
关键词:
非典型性视网膜星形细胞错构瘤; 荧光素眼底血管造影; 吲哚菁绿血管造影; 多模式影像学检查
Keywords:
atypical retinal astrocytic hamartoma;  fluorescein fundus angiography;  indocyanine green angiography;  multimodal imaging
分类号:
R774
DOI:
10.13389/j.cnki.rao.2021.0162
文献标志码:
A
摘要:
目的　探讨早期非典型性视网膜星形细胞错构瘤影像学特征。方法　收集2019年3月至2020年10月就诊于河北省眼科医院临床诊断为早期非典型性视网膜星形细胞错构瘤的患者8例8眼，对所有患者进行常规眼科检查以及彩色眼底照相、红外眼底照相、荧光素眼底血管造影（FFA）或吲哚菁绿血管造影（ICGA）、 OCT、OCTA检查。同时给予患者药物治疗，在治疗期间密切检测眼底变化，病情稳定后继续观察3~6个月。观察患者不同时期的OCT、OCTA及FFA的特征性变化。对患者不同时期各项检查的临床特征进行汇总分析。结果　所有患者头颅CT及皮肤检查均未发现异常。B超检查未见患者眼底肿物发生钙化；8例（8眼）早期非典型性视网膜星形细胞错构瘤均为单眼单个病灶；病变位置在盘周和后极部附近。彩色眼底照相及红外眼底照相显示，6眼患者瘤体为卵圆形结节状不规则扁平隆起，呈半透明状，可透见视网膜血管，2眼呈扁平隆起，周围无渗出及水肿。FFA检查结果显示，6眼患者瘤体表面毛细血管呈团状扩张，发出弱荧光，毛细血管位于视网膜血管之下；1眼患者后期FFA检查呈强荧光渗漏，1眼仅后期呈强荧光表现。ICGA检查结果显示，患者瘤体对应脉络膜血管未发现异常改变。OCT检查结果显示，所有患者病变区的视网膜内层均出现局限性不均匀增厚，结构紊乱，5眼为虫蚀状改变并伴有低反射区域；3眼仅表现为视网膜神经纤维层局限性增厚并伴有低反射区域。OCTA检查结果显示，8眼患者早期病灶内均可看到团状扩张血管，浅层毛细血管层瘤体表面可见大量的毛细血管网，深层毛细血管层瘤体内可见杂乱的血管影，呈不规则的低反射。利用OCTA追踪复查扫描患者瘤体同一位置，发现随着病情进一步好转，瘤体缩小，最后血管扩张逐渐减轻，恢复正常形态。结论　采用多模式影像学检查有助于对早期非典型性视网膜星形细胞错构瘤进行确诊，该病无需特殊治疗，瘤体可自行退化，水肿和渗出可自行吸收，但在完全钙化前应密切观察，定期进行眼底、OCT及OCTA检查。
Abstract:
Objective　To investigate the imaging characteristics of early atypical retinal astrocytic hamartoma (RAH).Methods　Together 8 patients (8 eyes) who visited Hebei Eye Hospital during March 2019 to October 2020 with clinical diagnosis of early atypical RAH were included in this study. All patients underwent routine ophthalmic examinations, color fundus photography, infrared fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) during and 3-6 months accompanied with drug therapy, the changes of OCT, OCTA and FFA in different periods were recorded. Then the clinical features of patients in different periods were summarized and analyzed.Results　The head CT and skin examination results of all patients were normal, and no calcification was found in the fundus masses through B-ultrasonography. The lesion of all the 8 patients (8 eyes) with early atypical RAH occurred singly, located at the peripapillary region and posterior pole. Color fundus photography and infrared fundus photography showed that the tumors were oval, nodular, irregular, translucent and flat bulges in 6 eyes, and the retinal vessels were observed. The tumors were flat bulges in 2 eyes with no exudation or edema. FFA showed that the capillaries on the surface of tumor represented clustered dilation with weak fluorescence in 6 eyes, and the capillaries were located under the retinal vessels. The lesion of 1 eye showed strong fluorescence leakage in the late stage of FFA, while 1 eye showed strong fluorescence in the late stage of FFA with no leakage. ICGA were normal in the choroidal vessels corresponding to the tumor body. OCT showed inhomogeneous thickening and disorder of the inner retinal layer in all 8 eyes. The moth-eaten lesion with low reflex areas was demonstrated in 5 eyes. The other 3 eyes showed localized thickening of the retinal nerve fiber layer with low reflex areas. OCTA represented clump-like dilated blood vessels in the early lesions of all the 8 eyes, a large number of capillary networks were observed on the superficial capillary layer of the tumor, and messy vessels were observed in the deep capillary layer of the tumor with irregular low reflection. OCTA was used to follow up and re-scan the same site of the tumor, and it was found that as conditions improved, the tumor body became little, and the angiectasis gradually decreased, and finally the retina returned to normal.Conclusion　Multimodal imaging is helpful for the diagnosis of early atypical RAH. No special treatment needs for the disease. The tumor can fade away on its own, and the edema and exudation may absorb on its own, but regular fundus examinations, OCT and OCTA should be taken before the complete calcification of the tumor mass.

参考文献/References:

［1］　VAN DER HEVE J.Eye symptoms in tuberous sclerosis of the brain［J］.Trans Ophthalmol Soc UK,1920,40:329-334.
［2］　吴琨芳,文峰.视网膜星状细胞错构瘤［M］.北京:人民军医出版社,2011:246-248.
WU K F,WEN F.Retinal astrocytic hamartoma［M］.Beijing:People’s Military Medical Publisher,2011:246-248.
［3］　李海凌,梁建宏,黎晓新.视网膜星形胶质细胞错构瘤一例［J］.中华眼科杂志,2010,46(6):558-559.
LI H L,LIANG J H,LI X X.A case of retinal astrocyte hamartoma［J］.Chin J Ophthalmol,2010,46(6):558-559.
［4］　ELIESERSDTTIR T H,HOLM E,ECKMANN-HANSEN C,TORM M W,BELMOUHAND M,LARSEN M.Peripheral bright streaks in tuberous sclerosis［J］.Am J Ophthalmol Case Rep,2021,22:101050.
［5］　SHIELDS C L,BENEVIDES R,MATERIN M A,SHIELDS J A.Optical coherence tomography of retinal astrocytic hamartoma in 15 cases［J］.Ophthalmology,2006,113(9):1553-1557.
［6］　NEELAM K,MULDREW A,HOGG R,STACK J,CHAKRAVARTHY U,BEATTY S.Grading of age-related maculopathy: slit-lamp biomicroscopy versus an accredited grading center［J］.Retina,2009,29(2):192-198.
［7］　SAITO W,KASE S,OHGAMI K,MORI S,OHNO S.Intravitreal anti-vascular endothelial growth factor therapy with bevacizumab for tuberous sclerosis with macular oedema［J］.Acta Ophthalmol,2010,88(3): 377-380.
［8］　何璐,易佐慧子,王晓玲,许阿敏,刘珏君,陈长征.孤立性视网膜星状细胞错构瘤多波长炫彩和光相干断层扫描血管成像观察一例［J］.中华眼底病杂志,2019,35(1):79-81.
HE L,YI Z H Z,WANG X L,XU A M,LIU Y J,CHEN C Z.Multi-mode image observation in one patients of tuberous sclerosis combined with retinal astrocytehamartoma［J］.Chin J Ocul Fundus Dis,2019,35(1):79-81.
［9］　NAKAYAMA M,KEINO H,HIRAKATA A,OKADA A,TERADO Y.Exudative retinal astrocytic hamartoma diagnosed and treated with pars plana vitrectomy and intravitreal bevacizumab［J］.Eye (Lond),2012,26(9): 1272-1273.
［10］　LONNGI M,GOLD A S,MURRAY T G.Combined bevacizumab and triamcinolone acetonide injections for macular edema in a patient with astrocytic hamartomas and tuberous sclerosis［J］.Ophthalmic Surg Lasers Imaging Retina,2013,44(1): 85-90.
［11］　QUERQUES G,KERRATE H,LEVEZIEL N,COSCAS G,SOUBRANE G,SOUIED E H.Intravitreal ranibizumab for choroidal neovascularization associated with retinal astrocytic hamartoma［J］.Eur J Ophthalmol,2010,20(4): 789-791.
［12］　VRABEC T R,AUGSBURGER J J.Exudative retinal detachment due to small noncalcified retinal astrocytic hamartoma［J］.Am J Ophthalmol,2003,136(5): 952-954.

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更新日期/Last Update: 2021-08-05