CAJ | 학술논문

目的探讨脉络膜转移癌的荧光素眼底血管造影(FFA)特征及其与脉络膜黑色素瘤的鉴别诊断要点.方法回顾性病例系列研究.对2004年3月至2007年4月就诊的22例(23只眼)脉络膜转移癌患者临床资料和FFA图像进行回顾性分析,以同期行眼球摘除且经病理检查确诊的31例(31只眼)脉络膜黑色素瘤患者的完整临床资料作为对照.患者FFA图像特征比较采用Fisher确切概率法.结果根据脉络膜转移癌患者的眼底表现,肿瘤可分为孤立扁平型(肿瘤高度＜3 mm)、孤立隆起型(肿瘤高度＞3 mm)、弥漫型3类.3类脉络膜转移癌的FFA图像特征:动脉期肿块呈低荧光,造影过程中逐渐出现高荧光;动静脉期肿块边缘毛细血管扩张,造影早期至晚期肿块边缘针尖样高荧光渗漏,这两种表现主要见于孤立扁平型肿瘤;肿块中可见肿瘤血管,其与视网膜血管呈双循环特征,此种表现主要见于孤立隆起型肿瘤.脉络膜转移癌与脉络膜黑色素瘤的FFA图像特征比较,仅显示肿块边缘针尖样高荧光渗漏发生率明显不同,脉络膜转移癌为73.91%(17/23),脉络膜黑色素瘤为16.13%(5/31),两者差异有统计学意义(P=0.0000).针尖样高荧光渗漏对两种肿瘤鉴别诊断的灵敏度为73.91%,特异度83.87%,准确度79.63%,阳性预测值77.27%,阴性预测值81.25%.结论 FFA有助于脉络膜转移癌的诊断,针尖样高荧光渗漏在脉络膜转移癌与脉络膜黑色素瘤的鉴别诊断中有一定的参考价值.
목적 탐토맥락막전이암적형광소안저혈관조영(FFA)특정급기여맥락막흑색소류적감별진단요점.방법 회고성병례계렬연구.대2004년3월지2007년4월취진적22례(23지안)맥락막전이암환자림상자료화FFA도상진행회고성분석,이동기행안구적제차경병리검사학진적31례(31지안)맥락막흑색소류환자적완정림상자료작위대조.환자FFA도상특정비교채용Fisher학절개솔법.결과 근거맥락막전이암환자적안저표현,종류가분위고립편평형(종류고도＜3 mm)、고립륭기형(종류고도＞3 mm)、미만형3류.3류맥락막전이암적FFA도상특정:동맥기종괴정저형광,조영과정중축점출현고형광;동정맥기종괴변연모세혈관확장,조영조기지만기종괴변연침첨양고형광삼루,저량충표현주요견우고립편평형종류;종괴중가견종류혈관,기여시망막혈관정쌍순배특정,차충표현주요견우고립륭기형종류.맥락막전이암여맥락막흑색소류적FFA도상특정비교,부현시종괴변연침첨양고형광삼루발생솔명현불동,맥락막전이암위73.91%(17/23),맥락막흑색소류위16.13%(5/31),량자차이유통계학의의(P=0.0000).침첨양고형광삼루대량충종류감별진단적령민도위73.91%,특이도83.87%,준학도79.63%,양성예측치77.27%,음성예측치81.25%.결론 FFA유조우맥락막전이암적진단,침첨양고형광삼루재맥락막전이암여맥락막흑색소류적감별진단중유일정적삼고개치.
Objective To investigate the characteristics of fundus fluorescein angiography (FFA)in metastatic choroidal carcinomas and determine the value of FFA in differentiating metastatic choroidal carcinomas from primary choroidal melanomas. Methods It was a retrospective case series. The retrospective analysis of clinical data and FFA findings was performed in 23 eyes of 22 patients with metastatic choroidal carcinomas and 31 eyes of 31 patients with primary choroidal melanomas as the control.Results Ocular fundus findings of metastatic choroidal carcinomas were divided into three types: solitary flat ( tumor thickness less than 3 mm ) , solitary elevated ( tumor thickness more than 3 mm) or diffuse type.FFA of the three types showed hypofluorescence during the arterial phase and progressive hyperfluorescence during the subsequent phases. The border of the lesions revealed retinal capillary dilation during the arteriovenous phase and persistent pinpoint leakage throughout the angiogram. Retinal capillary dilation and pinpoint leakage were more frequently presented in the solitary flat type. Simultaneous visualization of retinal and tumor circulation (the so called double circulation ) was more frequently presented in the solitary elevated type. Pinpoint leakage could be detected in 17 (73.91%) eyes of metastatic choroidal carcinomas and in 5 ( 16. 13% ) eyes of primary choroidal melanomas. The difference between the visibility of pinpoint leakage in metastatic choroidal carcinomas and primary choroidal melanomas was statistically significant ( P =0. 0000). When pinpoint leakage of FFA was used to differentiate metastatic choroidal carcinomas from primary choroidal melanomas, the sensitivity, specificity, accuracy, positive and negative predictive values were 73. 91%,83. 87%, 79. 63%, 77. 27%, 81. 25% respectively. Conclusions FFA is helpful for the diagnosis of metastatic choroidal carcinomas. Pinpoint leakage on the border of lesions has some value in differentiating metastatic choroidal carcinomas from primary choroidal melanomas.