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目的了解脉络膜转移癌共焦激光扫描检眼镜同步荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)影像特点,为该疾病的准确诊断提供依据。设计回顾性病例系列。研究对象明确原发灶的脉络膜转移癌患者12例(17眼)。方法经临床诊断、有明确原发恶性肿瘤病灶的患者12例(17眼),散大瞳孔后拍摄彩色眼底像,用海德堡共焦激光扫描检眼镜进行FFA及ICGA同步造影,观察两种影像学检查的异同。主要指标FFA及ICGA各期瘤体荧光表现及差异。结果 FFA早期16眼瘤体呈低荧光。ICGA早期17眼瘤体均为低荧光,且低荧光范围略大于FFA;11眼在瘤体边缘见异常脉络膜血管。FFA静脉期显示瘤体表面视网膜血管迂曲、毛细血管扩张及微血管瘤;中晚期渗漏明显,肿瘤边界模糊,色素斑块及出血表现为荧光遮蔽。ICGA中晚期,13眼瘤体边缘见斑驳淡荧光,4眼淡荧光位于瘤体中央,晚期瘤体轮廓较FFA清晰。对于1眼瘤体扁平、面积较小的病灶I,CGA可清晰显示,而FFA表现不典型。结论 ICGA对确定肿瘤特别是小而扁平的瘤体的轮廓及脉络膜血管异常有优越性,FFA可显示肿瘤导致的视网膜血管及色素上皮改变。二者结合,有助于脉络膜转移癌的诊断。
Objective To understand the characteristics of synchronous fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) images of confocal laser scanning ophthalmoscope in choroidal metastatic carcinoma, and to provide evidence for the accurate diagnosis of this disease. Design retrospective case series. The study identified 12 patients with primary choroidal metastasis (17 eyes). Methods Twelve patients (17 eyes) with definite primary malignant tumor were diagnosed clinically. After the pupil was dilated, the color fundus image was taken. Synchrotopic FFA and ICGA were performed with Heidelberg confocal laser scanning ophthalmoscope. Two kinds of imaging Check the similarities and differences. The main indicators FFA and ICGA tumor of the various stages of fluorescence performance and differences. Results FFA early 16 eyes showed low fluorescence tumor. In the early stage of ICGA, all 17 eyes had low fluorescence and the low fluorescence range was slightly larger than that of FFA. In 11 eyes, abnormal choroidal blood vessels were seen at the edge of the tumor. FFA venous phase showed tortuous retinal vessels on the surface of the tumor, telangiectasia and capillary hemangioma; obvious leakage in mid-late, tumor border blurred, pigmented plaque and bleeding showed fluorescence shading. ICGA middle and late, 13 eyes showed mottled margin light fluorescence, 4 eyes of light fluorescence in the center of the tumor, advanced tumor contour more clear than FFA. For 1 eye tumor flat, lesser lesions I, CGA can be clearly displayed, while the performance of FFA is not typical. Conclusion ICGA is superior to determine the outline of tumor, especially small and flat tumor, and choroidal vascular abnormalities. FFA can show tumor-induced changes of retinal blood vessels and pigment epithelium. The combination of the two will help diagnose choroidal metastases.