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The Application of Ultra-wide-field Scanning Laser Ophthalmoscopy in the Detection of Tuberous Sclerosis Complex-associated Retinal Astrocytic Hamartomas
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摘要:目的 比较超广角扫描激光检眼镜(ultra-wide-field scanning laser ophthalmoscopy, UWF-SLO)与传统彩色眼底照相(color fundus photography, CFP)对结节性硬化症(tuberous sclerosis complex, TSC)相关视网膜星形细胞错构瘤(retinal astrocytic hamartomas, RAH)的检出情况, 评估UWF-SLO在TSC相关RAH识别及随访中的应用价值。方法 回顾性分析2018年10月至2021年3月就诊于北京协和医院内科和眼科且明确诊断为TSC合并RAH患者的临床资料。以散瞳前置镜检查结果为参照标准, 比较两种眼底成像技术的TSC相关RAH检出率, 分析可能影响病灶检出的相关因素。结果 共24例TSC合并RAH患者参与本研究。在TSC相关RAH病灶检出方面, UWF-SLO(合成"伪彩"双激光通道成像)检出率显著高于9点固视CFP[98.6%(138/140)比65.7%(92/140), P＜0.001], 检出差异主要在于对中周部和远周部RAH的检出(P＜0.001)。在UWF-SLO病灶检出方面, 单红激光(633 nm)通道成像检出率显著低于单绿激光(532 nm)[52.1%(73/140) 比98.6%(138/140), P＜0.001]和合成双激光通道成像[52.1%(73/140) 比98.6%(138/140), P＜0.001]。单红激光通道成像中未检出的病灶均为1型RAH, 且病灶检出组光学相干断层扫描中RAH病灶最大厚度显著高于未检出组[(527.3±134.7)μm比(389.7±76.6)μm, P＜0.001], 但两组病灶分布及病灶累及深度无显著统计学差异(P=0.812, P=1.000)。结论 相较于传统CFP, UWF-SLO可能具有更高的TSC相关RAH检出率, 可考虑将其应用于TSC相关RAH的临床评估。
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关键词:
- 超广角扫描激光检眼镜 /
- 结节性硬化症 /
- 视网膜星形细胞错构瘤 /
- 彩色眼底照相
Abstract:Objective To evaluate the clinical value of ultra-wide-field scanning laser ophthalmology(UWF-SLO) in tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartoma (RAH) by comparing the detection rate of RAH lesions between UWF-SLO and traditional color fundus photography (CFP).Methods The clinical data of patients with established TSC-associated RAH diagnosis by the Department of Internal Medicine and Ophthalmology of Peking Union Medical College Hospital from October 2018 to March 2021 were retrospectively reviewed. The detection rate of TSC-associated RAH lesions between 9-fixation-point CFP and UWF-SLO was compared with fundoscopic recordings as the reference standard. The factors that may affect the detection of lesions were analyzed.Results A total of 24 patients with TSC-associated RAH were included in this study. UWF-SLO (composed pseudocolor dual-channel images) performed better than 9-fixation-point CFP in the identification of TSC-associated RAH lesions[98.6%(138/140)vs. 65.7%(92/140), P < 0.001], especially for RAH lesions located in the mid and far peripheral retina (P < 0.001). In UWF-SLO, red-channel (633 nm) images showed significantly lower detection rate than green-channel (532 nm) [52.1% (73/140) vs. 98.6% (138/140), P < 0.001] and composed dual-channel images[52.1%(73/140) vs. 98.6%(138/140), P < 0.001]. Undetected RAH lesions in red-channel UWF-SLO images were all type 1 RAH, and the lession thickness was significantly higher in the detected group than that in the undetected group [(527.3±134.7)μm vs. (389.7±76.6)μm, P < 0.001], while the location and retinal involving depth of type 1 RAH were not significantly different(P=0.812, P=1.000).Conclusions Compared to CFP, UWF-SLO may be associated with higher detection rate of TSC-associated RAH and could be applied to the evaluation of TSC-associated RAH. -
本刊执行GB/T 15835-2011《出版物上数字用法》中有关数字的规定及其书写规则，对参数与偏差范围的表示的要求如下。(1)数值的范围：一般使用浪纹连接号“~”。例如：5至10可写成5~10；但5万至10万应写成5万~10万，不能写成5~10万。(2)幂次相同的参数范围：前一个参数的幂次不能省略。例如：3×109~5×109不能写成3~5×109，但可以写成(3~5) ×109。(3)百分数范围：前一个参数的百分号不能省略。例如：20%~30%不能写成20~30%。(4)单位相同的参数范围：只需写出后一个参数的单位。例如：15~20 ℃不必写成15 ℃~25 ℃，但不能写成15°~25 ℃。(5)单位不完全相同的参数范围：每个参数的单位必须全部写出。例如：36°~42°18′。(6)偏差范围：参数与其偏差单位相同时，单位可以只写1次，并应加圆括号将数值组合，置共同的单位符号于全部数值之后。例如：(15.2 ± 0.2) mm。表示带中心值的百分数偏差时，可以写成(27±2)%，也可以写成27%±2%，而不应写成27±2%。
作者贡献：张辰茜负责论文撰写、数据分析；张枝桥和徐凯峰负责研究设计、论文修订；龙琴、张潇、杨治坤、戴荣平负责数据采集。利益冲突：所有作者均声明不存在利益冲突 -
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图 1 TSC相关RAH的9点固视CFP(拼图)与UWF-SLO影像学表现
9点固视CFP中可见4个1型RAH病灶(白色箭头)，UWF-SLO成像范围更广，除上述病灶外，另可见周边部2个1型RAH病灶(白色虚线圆)，病灶均表现为无明显钙化的灰白病灶；TSC、RAH、CFP、UWF-SLO：同表 1
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图 2 不同类型RAH的9点固视CFP、UWF-SLO及OCT影像学表现
A.1型RAH：位于视盘颞上方，在CFP及UWF-SLO表现为灰白、扁平半透明病灶，OCT表现为神经纤维层增厚伴内层视网膜结构紊乱，病灶处玻璃体视网膜粘连；B.2型RAH：两处病灶均位于视盘，在CFP及UWF-SLO表现为钙化隆起结节，其中较大者呈桑葚样改变，OCT表现为神经上皮层内散在高反射点及蚕食空洞，后方有声影遮挡；C.3型RAH：位于颞下视盘处，在CFP及UWF-SLO表现为灰白半透明病灶中合并钙化结节及空腔，各组成部分在UWF-SLO中显示更为清晰，OCT表现为增厚的神经纤维层中出现蚕食样空腔改变。CFP、UWF-SLO同表 1；OCT：光学相干断层扫描
表 1 两种眼底成像技术对TSC相关RAH病灶的检出情况比较[n(%)]
RAH定位 UWF-SLO检出数(个) 9点固视CFP检出数(个) χ2值* P值 双通道 单绿激光通道 单红激光通道 后极部(n= 68) 66(97.1) 66(97.1) 39(57.4) 68(100) 0.500 0.480 中周部(n= 58) 58(100) 58(100) 27(46.6) 24(41.4) 32.029 ＜0.001 远周部(n= 14) 14(100) 14(100) 7(50) 0(0) 12.071 ＜0.001 总体情况(n= 140) 138(98.6) 138(98.6) 73(52.1) 92(65.7) 40.500 ＜0.001 TSC：结节性硬化症；RAH：视网膜星形细胞错构瘤；UWF-SLO：超广角扫描激光检眼镜；CFP：彩色眼底照相；*为双通道UWF-SLO与9点固视CFP的病灶检出率比较 
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