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双语推荐：视神经肿瘤

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目的视神经胶质瘤的MRI表现。方法总结经手术病理证实的15例视神经胶质瘤的MRI特征。15例均行横轴位、冠状位和斜矢状位平扫加增强扫描。结果 15例视神经胶质瘤均累及眶内段,其中累及球内段3例、管内段7例、视交叉4例、视束1例。视神经迂曲形增粗5例,梭形增粗4例,不规则肿块4例,圆形肿块1例,哑铃形1例。肿瘤在T_1WI上为略低或等信号,T_2WI上为略高、等、低信号;肿瘤内信号均匀12例,信号不均3例;肿瘤无强化4例,轻度强化6例,明显强化5例。结论 MRI在显示视神经胶质瘤位置形态、信号特征及强化特点均有典型表现。
Objective To study the MRI findings of optic glioma.Methods Axial,coronal and oblique sagittal high-resolution MR images of 15 patients with pathologically confirmed optic gliomas were analyzed.Results The intraorbital optic nerves were involved in all patients including intraocular(3),intracanalicular(7),optic chiasm(4),and optic tract(1)involvement.The optic nerve was tortuous(5),fusiform(4),irregular(4),round(1),or dumbbell-shaped(1).The tumor was homogeneously(12) T1 iso-or hypointense and T2 iso-or hyperintense,cystic with heterogeneous signal intensities(3).There was no(4),slight(6), or marked(5)contrast enhancement in the lesions.Conclusions MRI provides detailed information on the morphology,signal characteristics and enhancement of optic gliomas.

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目的 探讨眼眶内视神经脑膜瘤影像学和组织病理形态学特点以及波形蛋白(Vimentin)、细胞角蛋白(CK)、S-100、上皮膜抗原(EMA)抗体在瘤细胞内的表达情况.方法 回顾性系列病例研究.收集1989年1月至2010年12月在四川大学华西医院眼科住院并经手术后病理证实、病例资料完整的48例眼眶内视神经脑膜瘤患者的临床资料.均行CT扫描,17例行MRI扫描.均行组织病理学检查,包括石蜡包埋、切片、HE染色、读片和显微照相.21例用免疫组织化学法检测肿瘤中Vimentin、CK、S-100、EMA的表达情况.结果 CT影像学特点:39例眼眶内视神经脑膜瘤大小不等,边界较清楚,密度不均,其中26例肿瘤充满眼眶,特别是眶尖,“黑三角”消失.3例视神经增粗钙化,可见双轨征,3例视神经肿块近眼球后壁,3例肿块位于眼眶周围.根据组织病理形态学检查结果,将肿瘤分为上皮型35例,混合型8例,纤维型3例和血管型2例.在17例MRI检查中,13例见肿瘤靠后几乎充满眼眶,5例显示肿瘤侵犯视交叉、到达颅内.免疫组织化学染色结果显示,Vimentin阳性率为95％(21例)、EMA阳性率为70％(15例)、CK阳性率为45％(9例)以及S-100阳性率25％(5例).结论 眼眶内视神经脑膜瘤的CT、MRI影像学主要特点是视神经增粗、肿瘤样扩大,多数病例肿瘤达眼眶尖,密度不均,可能出现钙化.组织病理学特点为大部分病例为上皮型.免疫组织化学染色结果显示,Vimentin、EMA阳性比例大.
Objective To determine the characteristics of optic nerve meningiomas in medicalimageology (including CT and MRI),histopathology and immunohistochemical expression of Vimentin,CK,S-100,EMA in tumor cells.Methods This was a retrospective study on a serial of clinical cases.Forty-eight cases were collected from the past 21 years at the Department of Ophthalmology,West China Hospital,Sichuan University.All the cases underwent surgery and were confirmed as optic nerve meningiomas by histopathological test,including paraffin imbedded sectioning and HE staining.In addition,all the cases had medical records on CT and 17 cases had MIR scan.Immunohistochemical staining for VIMENTIN,CK,S-100,EMA was performed in the 21 cases.Results Characteristics of the CT scan include that,in 39 cases,among them 26 cases the tumors filled in the orbit especially at the orbital apex,which led to the disappearance of the black triangle.Three cases showed enlargement and calcification of optic nerve and therefor

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目的 探讨总结视神经胶质瘤的临床表现、影像学特征、诊断及治疗原则.方法 回顾性分析1995～2010年间在天津医科大学第二医院眼科诊治的经病理组织学证实的视神经胶质瘤32例,将其临床资料及B型超声、彩色多普勒超声、CT、MRI进行分析.结果 视神经胶质瘤多发于10岁以内的儿童,占72％ (23/32),视力减退或丧失、眼球突出以及视乳头水肿或萎缩为视神经胶质瘤的典型临床表现.CT可显示视神经不同形态增粗,部分可见视神经管、眶上裂扩大;MRI可更好地观察到肿瘤自眼眶向视神经管内及颅内蔓延情况.治疗以手术切除为主.结论 视神经胶质瘤临床表现多样,影像学检查有助于诊断和鉴别诊断,治疗应根据患者具体情况综合制定.
Objective To explore and summarize manifestation,iconographic characterizations,diagnosis and treatment principles of optic nerve glioma.Methods Retrospectively reviewed the clinical features and imaging features including B-scan ultrasonography,Color Doppler ultrasound (CDI),computed tomography (CT) and magnetic resonance imaging (MRI) of 32 patients with pathologically confirmed optic nerve glioma,who were treated in our department from 1995 to 2010.Results Optic nerve glioma was common within 10 years old children.Visual loss,proptosis,and optic nerve swelling or atrophy was the typical clinical characters.CT could show optic nerve enlarged with various morphology,and the enlarged optic canal and superior orbital fissure was also visible in some case.MRI could observe the lesions in the optic canal and cranium better.Surgical excision of the tumor was the main treatment method.Conclusions The clinical of optic nerve glioma are various.Iconographical examinations are very helpful for

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研究PDCD4和B7-H4在儿童视神经胶质瘤中的表达及临床意义。方法:采用免疫组织化学法对52例儿童视神经胶质瘤手术切除标本中PDCD4和B7-H4的表达进行检测,评估PDCD4和B7-H4的表达与儿童视神经胶质瘤临床病理因素的关系。结果:PDCD4在胶质瘤组织的阳性表达降低:52例胶质瘤组织中PDCD4表达阳性率随着肿瘤恶性程度增加呈降低趋势(P0.01);B7-H4在胶质瘤组织的阳性表达增高:B7-H4在52例胶质瘤组织中阳性率随着肿瘤恶性程度增加显著增高(P0.01);脑胶质瘤中PDCD4与B7-H4表达负相关(P0.01)。结论:PDCD4和B7-H4与儿童视神经胶质瘤的恶性程度有关,对于儿童视神经胶质瘤的转移防治及预后具有一定的临床意义。
AIM: To study the expressions and clinical significance of PDCD4 and B7-H4 in optic gliomas in children. METHODS:We used immunohistochemistry to evaluate the expressions of PDCD4 and B7-H4 in specimens from 52 optic gliomas in children cases, and analyzed the correlation of PDCD4 and B7 - H4 expression with clinicopathological factors children optic gliomas. RESULTS: PDCD4 expression reduced in optic glioma tissue:PDCD4 expression rate in 52 cases of optic glioma tissues decreasing was correlated with tumor malignancy increase (P CONCLUSION: Expressions of PDCD4 and B7-H4 may be clinically relevant to tumor malignancy of optic gliomas in children and prevention of metastasis and prediction of prognosis.

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目的 探讨副肿瘤性视网膜视神经病变患者的临床特征及其临床意义.方法 系列病例研究.2006年10月至2012年3月解放军总医院眼科连续诊治副肿瘤性视网膜视神经病变患者8例(16只眼),行眼部照相、视觉电生理、荧光素眼底血管造影、相干光断层扫描、眼底自发荧光、视野、超声、MRI检查及腰穿脑脊液化验、副肿瘤综合征抗体检测等,并经门诊和(或)电话随访患者的病情变化和结局,分析其病变类型、临床表现及治疗结果等.结果 8例患者中,癌症相关性视网膜病变3例、双眼弥漫性葡萄膜黑色素细胞增生2例,副肿瘤性视神经病变3例.5例患者进行了副肿瘤综合征的抗体检测,3例结果阳性,2例结果阴性.8例患者中,肿瘤源自肺癌4例,源自侵袭性胸腺瘤、肾癌、急性淋巴细胞白血病、宫颈癌各1例.患者均主诉视物模糊或视力进行性下降,并有2例主诉视物遮挡,其他主诉包括眼前闪光感、炫目、复视、眼痛各1例.其中1例患者是由于进行性视力下降首诊于眼科后发现患有恶性肿瘤.在8例16只眼中,随访结束时无光感的6只眼,光感至0.05的5只眼,视力≥0.4的5只眼.5例患者接受糖皮质激素治疗,总体疗效不明显.结论 各型副肿瘤性视网膜视神经病变有其相应的临床表现,副肿瘤综合征尤其是双眼弥漫性葡萄膜黑色素细胞增生可能是一种转移前病变.
Objective To analyze the clinical characteristics of paraneoplastic retinopathy and optic neuropathy(PRON).Methods Case series study.Eight patients were enrolled from October 2006 to March 2012 visited in ophthalmology department,the People Liberation Army General Hospital.The patients were underwent a series of examinations,including fundus photography,visual electrophysiology,fundus fluorescein angiography,optic coherent tomography,fundus autofluorescent imaging,perimetry,ultrasonography,magnetic resonance imaging,spinal tap and cerebrospinal fluid test,paraneoplastic syndrome (PNS) antibody test.The patients were followed up in outpatient department and(or) by phone.The clinical manifestation,entity types,and treatment were analyzed.Results Of the eight patients,there were cancer associated retinopathy (CAR) 3 cases,bilateral diffuse uveal melanocytic proliferation (BDUMP) 2 cases and paraneoplastic optic neuropathy(PON) 3 cases.Five patients were detected the PNS antibodies and rev

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放射治疗用于治疗眼部肿瘤及炎性疾病是放射治疗学及肿瘤学的重要进展.它可用于治疗视网膜母细胞瘤、视神经鞘膜瘤、Graves眼病、炎性假瘤等,除了单独放射治疗外,也可与手术、化疗等联合使用.近年来,随着医学影像学和计算机技术的发展,放射治疗技术取得了一些进展,使对病灶的精确定位放射治疗如三维适形放射治疗、调强放射治疗、图像引导放射治疗等成为可能.但伴随的干眼症、虹膜红变、放射性视网膜视神经病变等并发症对患者生活质量的影响值得关注.
Radiotherapy has been widely used in the treatment of ocular tumors and inflammatory diseases.It can be used either alone or combined with surgery and chemotherapy.With the improvements of medical images and computer technologies in recent years,radiotherapy has made great progress,enabling precise location such as 3-dimentional conformal radiotherapy,intensity-modulated radiation therapy,and image-guided radiotherapy.However,clinicians should pay attention to the complications of radiotherapy,such as dry eye,neovascular glaucoma,radiation retinopathy and neuropathy

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目的：评价中医治疗不同病因视神经萎缩（OA）的效果。方法将243例（415只眼）OA患者按病因分类，并对中医综合治疗的效果进行评估。结果经中医综合治疗后视力改善193只眼，整体有效率为46.5%。前部缺血性视神经病变（AION）有效率最高为68.8%，其他病因OA的有效率依次为Leber遗传性视神经病变（LHON）61.4%，视神经炎53.0%，视网膜色素变性40.9%，青光眼40.0%，视网膜动脉阻塞40.0%、不明原因性38.7%、药物中毒37.5%、外伤32.3%、其他25.0%、肿瘤压迫23.1%。结论中医方法治疗OA有效，其中AION、LHON、视神经炎性OA有效率均超过50%，疗效相对较好。
OBJECTIVE To evaluate effects on optic atrophy (OA) of different causes by traditional Chinese medicine treatment. METHODS According to the data of etiology classification of 243 OA patients with 415 eyes, the effect of comprehensive treatment of traditional Chinese medicine (TCM) was evaluated. RESULTS After treat-ment with TCM, visions of 193 eyes were improved, and effective rate was 46.5%. Anterior ischemic optic neuropathy (AION), effective rate was 68.8%, followed by Leber’s hereditary optic neuropathy (LHON), optic nerve inflamma-tory, retinitis pigmentosa, glaucoma, retinal artery obstruction, effective rate was 61.4%, 53.0%, 40.9%, 40%, and 40% respectively. Unknown reason, drug intoxication, trauma, other, the tumor oppression were 38.7%, 37.5%, 32.3%, 25.0%, and 23.1%respectively. CONCLUSIONS TCM treatment for OA was effective, and AION, LHON, optic inflammatory OA were the most effective.

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目的：分析常见脊髓非肿瘤性病变的 MRI 表现及鉴别诊断要点。方法回顾性分析本院28例脊髓非肿瘤性病变的临床和 MRI 资料，总结其 MRI 特征。结果28例患者中急性脊髓炎5例、脊髓多发性硬化16例、视神经脊髓炎4例、脊髓亚急性联合变性1例、脊髓梗死2例。所有病例 MRI 信号相似，均为 T1 WI 等或稍低、T2 WI 高信号，急性脊髓炎常累及5个以上椎体节段，脊髓均匀性肿胀；脊髓多发性硬化受累范围一般<2个椎体节段，病变小于横截面积的1/2；视神经脊髓炎累及3个以上椎体节段，累及大部分灰质和部分白质；脊髓亚急性联合变性病变位于脊髓后部，轴位 T2显示对称性分布于后索或侧索；脊髓梗死可累及1至数个椎体节段，局限在脊髓前2/3区域，形成“猫头鹰眼征”。结论常见脊髓非肿瘤性病变的 MRI 表现有一定特征性，结合病变的形态、累及范围及临床资料有助于定性诊断。
Objective To analyze magnetic resonance imaging (MRI)features and differential diagnosis of non-neoplastic lesions in the spinal cord.Methods Clinical manifestations and MRI data of 28 patients with non-neoplastic lesions in the spinal cord were analyzed retrospectively.Results Of the 28 cases,5 cases were acute myelitis,1 6 were multiple sclerosis,4 were neuromyelitis op-tica,1 case was subacute combined degeneration of spinal cord and 2 cases were spinal cord infarction.The MR signal intensity of the spinal cord lesions in all patients are similar presenting as isointensity or slight hypointensity on T1 weighted images and hyperinten-sity on T2 weighted images.In our study,both gray matter and white matter were involved in acute myelitis and the size is about more than 5 vertebral segments.For multiple sclerosis,the lesions were less than 2 vertebral segments in length and occupy 1/2 of the spinal cord in cross-sectional view.The neuromyelitis optica invade most of the gray matter an

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目的 观察眼球摘除术后病理侵犯视神经的视网膜母细胞瘤(RB)患儿的治疗及预后情况.方法 回顾性分析北京同仁医院2006年1月至2013年12月临床确诊为单眼RB,眼球摘除后病理诊断侵犯视神经的465例患儿的病例资料,根据其病理侵犯程度分为4级:1级为肿瘤细胞侵犯视乳头;2级为侵犯筛板;3级为侵犯筛板之后,未到视神经断端;4级为侵犯视神经断端.1级和2级统称为侵犯筛板前视神经,视为病理学低风险因素;3级和4级统称为侵犯筛板后视神经,视为病理学高风险因素.其他病理学高风险因素包括侵犯大范围脉络膜、巩膜、前房、虹膜和睫状体.将患儿分为合并及不合并其他病理学高风险因素组.分别给予相应的治疗并观察其预后.随访时间6个月～7年,平均随访时间3年7个月.结果 465例患儿中男279例,女186例.右眼260例,左眼205例.从发现症状到就诊的时间为1d～2年,平均2.7个月.465例患儿中25例死亡,总生存率为94.6％.侵犯筛板前视神经的患儿有338例,2例复发死亡,生存率为99.4％ (336/338);侵犯筛板后视神经的患儿有127例,23例复发死亡,生存率为81.9％ (104/127);二者差异有统计学意义(x2=52.299,P=0.000).1～4级视神经侵犯患儿的病死率分别为0.4％、1.0％、8.7％、60.9％;465例患儿中379例不合并其他病理学高风险因素,8例死亡,病死率为2.1％;86例合并其他病理学高风险因素,17例死亡,病死率为19.8％;二者差异有统计学意义(x2=42.955,P=0.000).侵犯筛板前视神经的338例患儿中304例不合并其他高风险因素,复发死亡O例;34例合并其他高风险因素,2例复发死亡,病死率为5.9％;二者差异有统计学意义(P =0.010).侵犯筛板后视神经的127例患儿中76例不合并其他高风险因素,9例复发死亡,病死率11.8％;51例合并其他高风险因素,14例复发死亡,病死率27.5％;二者差异有统计学意义(x2 =5.014,P =0.025).病理学高风险因素Cox回归分析显示:侵犯巩膜、视神经和视神经断端是影响预后的危险因素.结论 侵犯视神经的RB患儿总体治疗效果较好,但是侵犯视神经断端的患儿复发率高,应当积极予以辅助化疗.
Objective To observe the treatment and prognosis of optic nerve invasion in retinoblastoma (RB).Method The children who had been diagnosed with unilateral RB and had received enucleation from January 2006 to December 2013 in our hospital were recruited.Tumor extension into the optic nerve were disclosed.Optic nerve involvement was classified into four grades according to the degree of invasion.Grade Ⅰ is superficial invasion of the optic nerve head only,grade Ⅱ is involvement up to and including the lamina cribrosa,grade Ⅲ is involvement beyond the lamina cribrosa,and grade Ⅳ is involvement up to and including the surgical margin.Grade Ⅰ and Ⅱ are called invasion of the optic nerve before the sieve plate.Grade Ⅲ and Ⅳ are called invasion of the optic nerve after the sieve plate.Other high-risk factors included extensive invasions of the choroid,sclera,anterior chamber,iris,and ciliary body.They were divided into two groups according to whether the merger of other high

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目的 探讨眼眶CT检查在眼病诊断中的应用价值.方法 收集2007年1月至2012年5月诊治的457例眼眶CT病例的影像学特征进行回顾性分析.结果 457例CT检查病例其中95例未见明显眼部异常影像,362例显示异常,如眼球破裂变形,晶状体脱位,球内、眶内异物,眼球、眼眶肿瘤,眼眶骨折,视神经管骨折和眼球突出等.结论 眼眶CT扫描广泛应用于眼外伤、眼肿瘤等的诊断,可为临床诊断及手术提供重要依据.
Objective To evaluate orbital CT examination in the clinical application.Methods This was a retrospective case series.The data of 457 cases of orbital CT examination treated by us in the past five and a half years were reviewed and analyzed.Results CT examination of 95 cases were found normal,362 cases were found abnormalities,including the orbital and intraocular foreign body,orbital bone fracture,orbital soft tissue injury,lens dislocation,lens extrusion,deformation,compound eye damage,the orbital and intraocular tumor,exophthalmos and inflammatory pseudotumor.Conclusions CT is used widely in ocular trauma,the orbital and intraocular tumor etc.It''s proved that CT is the preferred methods of examination for clinical diagnosis and surgical.

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