CAJ | 학술논문

目的观察息肉样脉络膜血管病变(PCV)中分支血管网(BVN)的影像特征.方法初诊为PCV且未经治疗的80例患者90只眼纳入研究.其中,男性58例,女性22例;年龄49～85岁,平均年龄61.4岁.所有患者均行眼底彩色照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)检查.FFA检查显示的荧光逐渐增强的视网膜下边界清楚的欠均质强荧光斑视为纤维血管性色素上皮脱离(PED);ICGA检查显示的晚期呈苔藓样边界清楚的强荧光斑视为晚期苔藓样强荧光斑;OCT检查显示的视网膜色素上皮(RPE)光带与Bruch膜光带较大范围的浅脱离视为双层征.结果 90只眼中,伴有BVN者76只眼,占84.4％.眼底检查发现,橘红色病灶中含有与BVN对应的分支状成分18只眼,占所有患眼的20.0％,占伴有BVN患眼的23.7％.FFA检查发现,伴有BVN的76只眼中,早期可透见部分或全部BVN者56只眼,占73.7％;BVN造影全程仅显示为对应的分支状透见荧光3只眼,占3.9％;表现为隐匿性脉络膜新生血管73只跟,占96.1％,其中表现为纤维血管性PED者21只眼,占伴有BVN患眼的27.6％.ICGA检查发现,伴有BVN的76只眼,其BVN显影均早于息肉样病灶,息肉样病灶位于BVN末端62只眼,占81.6％;晚期显示与BVN对应的苔藓样强荧光斑69只眼,占90.8％.苔藓样强荧光斑范围均等于或大于ICGA早期显示的BVN和息肉样病灶范围.OCT检查发现,伴有BVN的76只眼中,可见双层征72只眼,占94.7％.其中,双层征脱离腔内存在与ICGA影像中息肉样病灶对应的管腔样结构15只眼,占20.8％;双层征脱离腔内的中等反射填充不均匀,夹杂点状和线状强反射65只眼,占90.3％;双层征底部存在与ICGA影像中的BVN起点对应的短段弱反射和Bruch膜缺口2只跟,占2.8％;双层征范围与ICGA晚期显示的苔藓样强荧光斑范围吻合63只眼,占87.5％.结论 PCV中BVN眼底可表现为视网膜下的橘红色分支;FFA大多表现为早期可透见其分支行径但全程显示为隐匿性脉络膜新生血管;ICGA晚期大多表现为苔藓样强荧光斑;OCT主要表现为双层征且大部分与苔藓样强荧光斑范围吻合. 目的觀察息肉樣脈絡膜血管病變(PCV)中分支血管網(BVN)的影像特徵.方法初診為PCV且未經治療的80例患者90隻眼納入研究.其中,男性58例,女性22例;年齡49～85歲,平均年齡61.4歲.所有患者均行眼底綵色照相、熒光素眼底血管造影(FFA)、吲哚青綠血管造影(ICGA)和光相榦斷層掃描(OCT)檢查.FFA檢查顯示的熒光逐漸增彊的視網膜下邊界清楚的欠均質彊熒光斑視為纖維血管性色素上皮脫離(PED);ICGA檢查顯示的晚期呈苔蘚樣邊界清楚的彊熒光斑視為晚期苔蘚樣彊熒光斑;OCT檢查顯示的視網膜色素上皮(RPE)光帶與Bruch膜光帶較大範圍的淺脫離視為雙層徵.結果 90隻眼中,伴有BVN者76隻眼,佔84.4％.眼底檢查髮現,橘紅色病竈中含有與BVN對應的分支狀成分18隻眼,佔所有患眼的20.0％,佔伴有BVN患眼的23.7％.FFA檢查髮現,伴有BVN的76隻眼中,早期可透見部分或全部BVN者56隻眼,佔73.7％;BVN造影全程僅顯示為對應的分支狀透見熒光3隻眼,佔3.9％;錶現為隱匿性脈絡膜新生血管73隻跟,佔96.1％,其中錶現為纖維血管性PED者21隻眼,佔伴有BVN患眼的27.6％.ICGA檢查髮現,伴有BVN的76隻眼,其BVN顯影均早于息肉樣病竈,息肉樣病竈位于BVN末耑62隻眼,佔81.6％;晚期顯示與BVN對應的苔蘚樣彊熒光斑69隻眼,佔90.8％.苔蘚樣彊熒光斑範圍均等于或大于ICGA早期顯示的BVN和息肉樣病竈範圍.OCT檢查髮現,伴有BVN的76隻眼中,可見雙層徵72隻眼,佔94.7％.其中,雙層徵脫離腔內存在與ICGA影像中息肉樣病竈對應的管腔樣結構15隻眼,佔20.8％;雙層徵脫離腔內的中等反射填充不均勻,夾雜點狀和線狀彊反射65隻眼,佔90.3％;雙層徵底部存在與ICGA影像中的BVN起點對應的短段弱反射和Bruch膜缺口2隻跟,佔2.8％;雙層徵範圍與ICGA晚期顯示的苔蘚樣彊熒光斑範圍吻閤63隻眼,佔87.5％.結論 PCV中BVN眼底可錶現為視網膜下的橘紅色分支;FFA大多錶現為早期可透見其分支行徑但全程顯示為隱匿性脈絡膜新生血管;ICGA晚期大多錶現為苔蘚樣彊熒光斑;OCT主要錶現為雙層徵且大部分與苔蘚樣彊熒光斑範圍吻閤.
목적 관찰식육양맥락막혈관병변(PCV)중분지혈관망(BVN)적영상특정.방법 초진위PCV차미경치료적80례환자90지안납입연구.기중,남성58례,녀성22례;년령49～85세,평균년령61.4세.소유환자균행안저채색조상、형광소안저혈관조영(FFA)、신타청록혈관조영(ICGA)화광상간단층소묘(OCT)검사.FFA검사현시적형광축점증강적시망막하변계청초적흠균질강형광반시위섬유혈관성색소상피탈리(PED);ICGA검사현시적만기정태선양변계청초적강형광반시위만기태선양강형광반;OCT검사현시적시망막색소상피(RPE)광대여Bruch막광대교대범위적천탈리시위쌍층정.결과 90지안중,반유BVN자76지안,점84.4％.안저검사발현,귤홍색병조중함유여BVN대응적분지상성분18지안,점소유환안적20.0％,점반유BVN환안적23.7％.FFA검사발현,반유BVN적76지안중,조기가투견부분혹전부BVN자56지안,점73.7％;BVN조영전정부현시위대응적분지상투견형광3지안,점3.9％;표현위은닉성맥락막신생혈관73지근,점96.1％,기중표현위섬유혈관성PED자21지안,점반유BVN환안적27.6％.ICGA검사발현,반유BVN적76지안,기BVN현영균조우식육양병조,식육양병조위우BVN말단62지안,점81.6％;만기현시여BVN대응적태선양강형광반69지안,점90.8％.태선양강형광반범위균등우혹대우ICGA조기현시적BVN화식육양병조범위.OCT검사발현,반유BVN적76지안중,가견쌍층정72지안,점94.7％.기중,쌍층정탈리강내존재여ICGA영상중식육양병조대응적관강양결구15지안,점20.8％;쌍층정탈리강내적중등반사전충불균균,협잡점상화선상강반사65지안,점90.3％;쌍층정저부존재여ICGA영상중적BVN기점대응적단단약반사화Bruch막결구2지근,점2.8％;쌍층정범위여ICGA만기현시적태선양강형광반범위문합63지안,점87.5％.결론 PCV중BVN안저가표현위시망막하적귤홍색분지;FFA대다표현위조기가투견기분지행경단전정현시위은닉성맥락막신생혈관;ICGA만기대다표현위태선양강형광반;OCT주요표현위쌍층정차대부분여태선양강형광반범위문합.
Objective To observe the imaging features of branching vascular network (BVN) in polypoidal choroidal vasculopathy (PCV).Methods Eighty PCV patients (90 eyes) were enrolled in this study.The patients included 58 males and 22 females.The age was ranged from 49 to 85 years,with a mean age of 61.4 years.All the patients were examined for fundus photography,fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optical coherence tomography (OCT).The fibrovascular retinal pigment epithelium detachment (PED) was defined as a well-demarcated subretinal heterogeneous plaque with increasing fluorescence on FFA.The late lichenoid hyperfluorescent plaque was defined as a well-demarcated lichenoid hyperfluorescent plaque on late phase ICGA.The double-layer sign on OCT was defined as a wide range of shallow PED from Bruch membrane.Results BVN were found on early ICGA in 76 eyes among the 90 eyes (84.4％).Among these 76 eyes,18 eyes (23.7％) demonstrated the subretinal reddish-orange branches corresponding to BVN.Fifty-six eyes (73.7％) demonstrated all or part of the BVN on early FFA.Three eyes (3.9％) demonstrated branching transmitted fluorescence corresponding to BVN throughout the FFA.Seventy-three eyes (96.1％) were manifested by occult choroidal vascularization on FFA,and 21 eyes (27.6％) of them were fibrovascular PED.Among the 76 eyes with BVN,all BVN appeared earlier than polypoidal lesions on ICGA.Polypoidal lesions located on the terminal of BVN in 62 eyes (81.6％).Sixty-nine eyes (90.8％) on ICGA demonstrated the late lichenoid hyperfluorescent plaque,whose area was equal to or greater than the area of BVN shown on early ICGA.Seventy-two eyes (94.7％) had the double layer sign.Among these 72 eyes,15 eyes (20.8％) had lumen like structure within the double-layer sign.Sixty-five eyes (90.3％) had punctate and linear hyperreflectance within the double-layer sign.Two eyes (2.8％) demonstrated a hyporeflective short segment and a gap of Bruch membrane on OCT corresponding to the origin of the BVN.Sixty-three eyes (87.5％) had an area of double-layer sign that matched the area of late lichenoid hyperfluorescent plaque on ICGA.Conclusions BVN in PCV can be noted as reddish-orange branches on fundus examination.Most of the BVN are shown as early branching transmitted fluorescence but collectively an occult choroidal vascularization on FFA,as lichenoid hyperfluorescent plaque on late ICGA,and as double-layer sign on OCT whose area matches late lichenoid hyperfluorescent plaque.