Shields C L, Shields J A, De Potter P
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Br J Ophthalmol. 1995 Mar;79(3):237-45. doi: 10.1136/bjo.79.3.237.
Indocyanine green video-angiography is a recently popularised technique for imaging the retina and choroid. Little is known about the value of this technique in the evaluation of choroidal tumours.
Indocyanine green video-angiograms of 51 patients with choroidal tumours, including 32 with choroidal melanoma, five with choroidal naevus, four with choroidal metastasis, four with choroidal haemangioma, one with choroidal osteoma, one with choroidal vortex vein varix, and four with irradiated choroidal melanoma were reviewed in a masked fashion.
The choroidal melanoma group achieved maximal fluorescence at an average of 18.2 (range 0.4 to 60) minutes after injection. At maximum fluorescence, the pattern varied from hypofluorescent in 17 cases, to isofluorescent in eight cases, and hyperfluorescent in seven cases. Non-pigmented choroidal melanoma generally showed an earlier average onset of fluorescence than the pigmented choroidal melanoma (mean 28 versus 185 seconds, respectively) (p = 0.04). The two subgroups otherwise overlapped substantially in angiography characteristics. The choroidal metastasis group demonstrated maximal fluorescence at an average of 8.9 (range 1.7 to 13) minutes. All choroidal metastases had a homogeneous diffuse fluorescence with late isofluorescence. The choroidal metastases allowed a subtle blurred perception of the normal choroidal pattern through the tumour. The choroidal haemangioma group revealed very characteristic findings with an onset of filigree fluorescence at an average of 0.6 (range 0.4 to 0.7) minutes with little variation. The maximal fluorescence was typically hyperintense in all cases and was achieved at an average of 1.2 minutes and was reached by 1.8 minutes in all cases. In these cases the fluorescence appeared as a lacy diffuse 'fluorescent mulberry' pattern with visibility of the vascular channels and demonstrated 'washout' of the dye in the late frames.
Indocyanine green may be a useful adjunct in the differentiation of amelanotic choroidal melanoma, choroidal metastasis, and choroidal haemangioma. The different patterns of fluorescence may be explained by the intrinsic choroidal vascular architecture in these three tumours.
吲哚菁绿视频血管造影术是一种最近流行起来的用于视网膜和脉络膜成像的技术。关于该技术在脉络膜肿瘤评估中的价值，人们了解甚少。
以盲法回顾了51例脉络膜肿瘤患者的吲哚菁绿视频血管造影图像，其中包括32例脉络膜黑色素瘤、5例脉络膜痣、4例脉络膜转移瘤、4例脉络膜血管瘤、1例脉络膜骨瘤、1例脉络膜涡静脉静脉曲张以及4例放射治疗后的脉络膜黑色素瘤。
脉络膜黑色素瘤组在注射后平均18.2（范围0.4至60）分钟达到最大荧光强度。在最大荧光强度时，其表现各异，17例为低荧光，8例为等荧光，7例为高荧光。无色素脉络膜黑色素瘤的荧光平均出现时间通常比有色素脉络膜黑色素瘤更早（分别为平均28秒和185秒）（p = 0.04）。在血管造影特征方面，这两个亚组在其他方面有很大重叠。脉络膜转移瘤组平均在8.9（范围1.7至13）分钟达到最大荧光强度。所有脉络膜转移瘤均呈现均匀的弥漫性荧光，并伴有晚期等荧光。通过肿瘤可隐约模糊地看到正常脉络膜的形态。脉络膜血管瘤组显示出非常典型的表现，平均在0.6（范围0.4至0.7）分钟开始出现细网状荧光，变化很小。所有病例的最大荧光强度通常为高信号，平均在1.2分钟达到，所有病例在1.8分钟时均达到最大荧光强度。在这些病例中，荧光呈现为花边状弥漫性“荧光桑葚”样形态，血管通道可见，且在后期图像中染料出现“消退”。
吲哚菁绿可能有助于鉴别无黑色素脉络膜黑色素瘤、脉络膜转移瘤和脉络膜血管瘤。这三种肿瘤不同的荧光模式可能由其内在的脉络膜血管结构所解释。
