眼内淋巴瘤的超声图像特征分析

摘要

目的 探讨眼内淋巴瘤的超声图像特征.方法 回顾性分析2015年1月至2017年12月北京同仁医院眼科收治的眼内淋巴瘤患者19例(26只眼) ,其中4例行诊断性玻璃体切除手术, 8例行眼球摘除手术后经病理检查证实为眼内淋巴瘤,7例经脑部组织病理检查确诊为中枢神经系统淋巴瘤后经临床确诊为眼内淋巴瘤.分析所有患者的眼部超声图像特点.结果 19例眼内淋巴瘤患者(26只眼)中,玻璃体视网膜淋巴瘤12例(19只眼) ,占63 .2%,其中7例为双眼发病;葡萄膜淋巴瘤7例(7只眼) ,占 36 .8%,均为单眼发病.玻璃体视网膜淋巴瘤超声表现为玻璃体混浊、玻璃体后脱离,部分同时合并视网膜脱离,视网膜下不规则低回声占位病变,彩色多普勒示部分占位病变内可测及血流信号.葡萄膜淋巴瘤有两种不同的超声表现: 5例(5只眼)表现为全周葡萄膜弥漫性增厚呈低回声,球后眶内不规则形低回声病变包绕视神经和球壁,彩色多普勒示眼球及眼眶占位病变内均可见丰富血流信号,超声生物显微镜检查示虹膜睫状体回声增厚、内回声减低,此种超声表现占葡萄膜淋巴瘤的 71 .4%; 2例(2只眼)表现为孤立隆起的睫状体脉络膜低回声占位,可合并视网膜脱离,彩色多普勒示病变内可见血流信号,占葡萄膜淋巴瘤的28 .6%.结论 眼内淋巴瘤的超声表现多种多样,玻璃体视网膜淋巴瘤的超声表现不具特异性,而葡萄膜弥漫低回声占位,以及眶内包绕视神经和球壁的不规则低回声病变则提示葡萄膜淋巴瘤的可能性大.%Objective To describe the ultrasonographic features of intraocular lymphoma . Methods It was a retrospective analysis of 19 patients ( 26 eyes ) with intraocular lymphoma at the department of ophthalmology ,Beijing Tongren Hospital from January 2015 to December 2017 . T he diagnosis was established by tissue biopsy in 4 patients with diagnostic vitrectomy and 8 with enucleation ,and other 7 cases were clinically diagnosed followed by pathological examination of central nervous system lymphoma . T he ultrasonographic features of all patients were analyzed . Results Of the 19 patients ( 26 eyes ) with intraocular lymphoma ,12 cases ( 19 eyes) of vitreoretinal lymphoma accounted for 63 .2% ,of which 7 cases were bilateral eyes ,and 7 cases ( 7 eyes ) of uveal lymphoma accounted for 36 .8% ,all of w hich were monocular . Ultrasonography of vitreoretinal lymphoma included vitreous opacity , posterior vitreous detachment ,partial retinal detachment ,irregular hypoechoic lesions under the retina ,and CDFI detected blood flow signals in the lesion . T here were two different types of ultrasound findings in uveal lymphoma . Five cases ( 5 eyes ) showed diffuse thickening of the uveal membrane with low echo , and irregular hypoechoic mass around the optic nerve and the ball wall ,in w hich CDFI detected abundant blood flow signals . Ultrasound biological microscope examination showed that the iris‐ciliary body thickened and the internal echo decreased . T his ultrasound finding accounted for 71 .4% of uveal lymphoma . T wo cases ( 2 eyes) showed a solitary ciliary‐choroid choroidal hypoechoic mass ,combined with retinal detachment and blood flow signals with CDFI ,accounting for 28 .6% of uveal lymphoma . Conclusions T he ultrasonography of intraocular lymphoma is various . T he ultrasound findings of vitreoretinal lymphoma are not specific , w hile the diffuse thickened uvea and retrobulbar hypoechoic lesions encircled optic nerve and eye wall suggest the possibility of uveal lymphoma .