眼眶海绵状血管瘤与眼眶神经鞘瘤影像学鉴别诊断的研究
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摘要
目的：研究眼眶海绵状血管瘤(Orbital Cavernous Hemangioma)与眼眶神经鞘瘤(Orbital Neurilemmoma)影像学表现特点，探讨最适合鉴别区分二者的影像学检查方法。
方法：总结经手术后、组织病理学证实的眼眶海绵状血管瘤25例与眼眶神经鞘瘤24例的B型超声(brightness mode，B超)、彩色多普勒血流成像(color Doppler fiow imaging，CDFI)、计算机体层摄影(computedtomography CT)、磁共振成像(Magnetic resonance imaging，MRI)的表现，归纳各种检查方法所表现出来的影像学特点，对两种肿瘤进行鉴别诊断，以病理学诊断为标准，影像学诊断与之一致的为定性诊断符合；以手术定位为标准，影像学诊断与之一致的为定位诊断符合。诊断符合率比较采用Fisher’Exact test方法检验。总结出最适合鉴别这两种肿瘤的影像学检查方法。
结果：眼眶海绵状血管瘤的B超、CDFI、CT、MRI的定位诊断符合率分别为45％、47％、88％、100％，B超与CT(P=0．003<0．01)、B超与MRI(P=0．004<0．01)、CDFI与CT(P=0．009<0．01)、CDFI与MRI(P=0．008<0．01)对比之间的差异具有非常显著性意义，而B超与CDFI、CT与MRI之间对比无统计学意义，说明MRI、CT的在定位诊断上的正确率高于B超与CDFI。眼眶海绵状血管瘤的B超、CDFI、CT、MRI的定性诊断符合率分别为80％、87％、40％(增强扫描后93％)、70％(增强扫描后100％)，B超与CT平扫(P=0．014<0．05)对比之间的差异具有显著性意义，CDFI与CT平扫(P=0．007<0．01)对比之间的差异具有非常显著性意义，说明B超、CDFI检查定性诊断符合率明显高于CT平扫检查，而MRI平扫与B超(P=0．657>0．05)、MRI平扫与CDFI(P=0．358>0．05)的检查对比，无统计学意义，说明超声检查的定性诊断率与MRI平扫的定性诊断率基本相同，而当CT增强扫描后：B超与增强CT(P=0．365>0．05)、CDFI与增强CT(P=1．000>0．05)的统计学对比，无统计学意义，说明当CT增强扫描后，可大幅度提高定性诊断符合率，当MRI增强扫描后，B超与增强MRI(P=0．295>0．05)，CDFI与增强MRI(P=0．526>0．05)仍无统计学意义，虽然MRI增强扫描前后与B超、CDFI检查均无统计学意义，但是MRI增强扫描后检查的8例患者，定性检查全部准确，符合率为100％，较增强前符合率(70％)明显提高，因此说明CT或者MRI行增强扫描是提高定性诊断符合率必不可少的一种检查手段。
眼眶神经鞘瘤的B超、CDFI、CT、MRI的定位诊断符合率分别为42％、47％、92％、100％，B超与MRI(P=0．000<0．01)、B超与CT(P=0．001<0．01)、CDFI与MRI(P=0．001<0．01)、CDFI与CT(P=0．003<0．01)对比之间的差异具有非常显著性意义，而B超与CDFI、CT与MRI之间对比无统计学意义，说明MRI、CT的在定位诊断上的正确率高于B超与CDFI。眼眶神经鞘瘤的B超、CDFI、CT、MRI的定性诊断符合率分别为46％、53％、46％(增强扫描后47％)、88％(增强扫描后91％)。B超与MRI增强扫描(P=0．023<0．05)、CDFI与MRI(P=0．049<0．05)、CT增强扫描与MRI增强扫描(P=0．036<0．05)对比之间的差异具有显著性意义；CT平扫与MRI平扫(P=0．008<0．01)、B超与MRI(P=0．008<0．01)对比之间的差异具有非常显著性意义。CDFI与MRI增强扫描(P=0．084>0．05)，无统计学意义，但是定性诊断符合率CDFI为53％，MRI增强扫描为91％，增强MRI明显高于CDFI检查。说明无论MRI增强与否定性诊断率均高于其它检查方法，MRI(平扫+增强)检查，定性诊断符合率最高。
两种肿瘤的定位诊断上，MRI检查最准确，定位诊断符合率略高于CT，而B超及CDFI不及MRI和CT。定性诊断上，海绵状血管瘤的B超与CDFI检查符合率高于CT平扫和MRI平扫检查，但是当CT与MRI检查增强扫描后，定性诊断符合率略高于B超与CDFI检查，说明CT或MRI增强扫描是正确诊断海绵状血管瘤性质的必要手段，可很大程度提高定性诊断准确率。因此得出结论，CT(增强)或MRI(增强)联合超声检查(B超或CDFI)，可较为准确的诊断出海绵状血管瘤。神经鞘瘤的MRI平扫与增强扫描检查定性诊断符合率明显高于其它检查，而B超、CDFI、CT检查诊断符合率基本相同，所以得出结论MRI(增强)检查联合超声检查(B超或CDFI)，可较为准确的诊断出神经鞘瘤。
结论：综合以上两种肿瘤的影像学最佳诊断方法，得出结论，在鉴别难度较大的海绵状血管瘤与神经鞘瘤的时候，选择(MRI增强扫描+超声检查)，可以最大程度提高这两种肿瘤在定位、定性诊断上的符合率，从而作出正确的鉴别诊断。
Objective: Both orbital cavernous hemangioma and orbital neurilemmoma are common orbital tumors. They two have similarities on matter the confluence of the disease, age, gender, clinic sign or the formation, position of the tumor. However, they differ in the option of operation and treatment because the correct pre-operation diagnosis is the foundation for the right treatment. Imaging investigation is the best one for orbital cavernous hemangioma. Based on the different structures of the different tumor tissue, various image diagnosis investigations can reflect the respective clinic sign. Then, according to the features, the suitable investigation to differ the two kinds of tumors can be found.
Methods: The paper sums up my faculty's verification on the reflection of the twenty-five cases of orbital cavernous hemangioma and twenty-four cases orbital neurilemmoma via B - mode, CDFI, CT,MRI, also concludes all kinds of the imaging features reflected from various checks, afterwards, based on results distinguish, statistic analyses. Finally, the most suitable way for differentiate the image investigation on the two kind tumor is found.
The statistic software SPSS 13.0 is used to process the stat.
Results: The position diagnosis accordance ratio of B-mode, CDFI, CT, MRI for the orbital cavernous hemangioma are 45%、47%、88%、100%(table 1), B-mode and CT (P = 0.003<0.01), B-mode and MRI (P=0.004<0.01), CDFI and CT (P=0.009<0.01), CDFI and MRI (P=0.008<0.01), obvious differences exist, statistically meaningful. It reveals that the correct ratio of MRI and CT in position diagnosis is higher than B-mode and CDFI. The accordance ratio of qualitative diagnosis are 80%, 87%, 40%(contrast enhancement scan is 93%),70%(contrast enhancement scan is 100%). B-mode and plain CT scan (P=0.014<0.05), CDFI and plain CT scan (P=0.007< 0.01),obvious differences exist, statistically meaningful. It means that accordance ratio of B-mode and CDFI is higher than plain CT scan investigation, while there is on statistical difference plain MRI scan and B-mode (P=0.657>0.05) between plain MRI scan and CDFI (P=0.358> 0.05) . So, there is on obvious difference on determine diagnosis ratio between ultrasonic investigation and MRI investigation. With the contrast enhancement of CT scan, B-mode and the CT(CE) (P=0.365>0.05), CDFI and CT(CE) (P =1.000>0.05), it is meaningless statistically. Though, it is meaningless in this sense, the after-check on the eight patients MRI scanned, all determine investigation are correct, accordance ratio is 100%. Contrast enhanced than before (70%) was significantly improved, it is more obvious. So we can say contrast enhancement on CT and MRI is a necessary investigation means.
Table 1 The Location and Qualitative for Diagnostic Accordance Rate of Varied Imaging Examination on Orbital Cavernous Hemangioma
The position diagnosis accordance ratio of B-mode, CDFI, CT, MRI for the orbital neurilemmoma are 42%, 47%, 92%, 100%(table 2), B-mode and MRI(P=0.000<0.05), B-mode and CT (P=0.001<0.05), CDFI and MRI(P=0.001<0.05), CDFI and CT(P=0.003<0.05), obvious differences exist, statistically meaningful. It reveals that the correct ratio of MRI and CT in position diagnosis is higher than B-mode and CDFI. The accordance ratio of qualitative diagnosis are 46%, 53%, 46%(contrast enhancement scan is 47%), 88%(contrast enhancement scan is 91%). B-mode and MRI(P=0.008<0.01), B-mode and MRI (CE) (P=0.023<0.05) , CDFI and plain MRI scan (P = 0.049<0.05),plain CT scan and plain MRI scan(P=0.008<0.05), CT (CE) and MRI(CE) (P=0.036<0.05) , obvious differences exist, so it is statistically meaningful. CDFI and MRI (CE) (P = 0.084>0.05) are statistically meaningless. But accordance ration of position diagnosis of CDFI is 53%, MRI(CE) is 91%, MRI(CE) is much higher than CDFI investigation. It confirms that no matter MRI (CE) or not, its qualitative diagnosis accordance ratio is higher than any other investigation means. MRI(plain scan + contrast enhancement scan) investigation has the highest accordance ration.
Table 2 The Location and Qualitative for Diagnostic Accordance Rate of Varied Imaging Examination on Orbital Neurilemmoma
For the position diagnosis of the two kinds of tumors, MRI is the most correct. The position diagnosis is higher than CT, while B-mode and CDFI are worse than MRI and CT. For the qualitative diagnosis, cavernous hemangioma's B-mode and CDFI investigation accordance ratio is higher than CT scan and MRI scan investigation. However, CT (CE) and MRI (CE) investigation scan, qualitative diagnosis accordance ratio is slightly higher than B-mode and CDFI. It reflects that CT (CE) or MRI (CE) scan is a necessary method for final diagnosis cavernous hemangioma and can greatly improve the determine diagnosis. The conclusion is that CT(CE) or MRI(CE) combining ultrasonic investigation(B-mode or CDFI),can diagnosis the cavernous hemangioma better. Neurilemmoma's MRI(plain scan + contrast enhancement scan) investigation accordance ratio is much higher than other kinds of investigation. B-mode , CDFI and CT investigation accordance ratio are mainly the same. So we can conclude MRI(CE) unites ultrasonography investigation(B-mode or CDFI) can diagnosis neurilemmoma correctly.
Conclusion: by concluding the above two kinds of tumor's imaging best diagnosis method, we can conclude when it is difficult to differ relatively big cavernous hemangioma and neurilemmoma by using (contrast enhancement MRI scan + ultrasonography) investigation can greatly improve the accordance ratio of these two kinds of tumors in position and determine diagnosis, then various diagnosis can be chosen.
方法：总结经手术后、组织病理学证实的眼眶海绵状血管瘤25例与眼眶神经鞘瘤24例的B型超声(brightness mode，B超)、彩色多普勒血流成像(color Doppler fiow imaging，CDFI)、计算机体层摄影(computedtomography CT)、磁共振成像(Magnetic resonance imaging，MRI)的表现，归纳各种检查方法所表现出来的影像学特点，对两种肿瘤进行鉴别诊断，以病理学诊断为标准，影像学诊断与之一致的为定性诊断符合；以手术定位为标准，影像学诊断与之一致的为定位诊断符合。诊断符合率比较采用Fisher’Exact test方法检验。总结出最适合鉴别这两种肿瘤的影像学检查方法。
结果：眼眶海绵状血管瘤的B超、CDFI、CT、MRI的定位诊断符合率分别为45％、47％、88％、100％，B超与CT(P=0．003<0．01)、B超与MRI(P=0．004<0．01)、CDFI与CT(P=0．009<0．01)、CDFI与MRI(P=0．008<0．01)对比之间的差异具有非常显著性意义，而B超与CDFI、CT与MRI之间对比无统计学意义，说明MRI、CT的在定位诊断上的正确率高于B超与CDFI。眼眶海绵状血管瘤的B超、CDFI、CT、MRI的定性诊断符合率分别为80％、87％、40％(增强扫描后93％)、70％(增强扫描后100％)，B超与CT平扫(P=0．014<0．05)对比之间的差异具有显著性意义，CDFI与CT平扫(P=0．007<0．01)对比之间的差异具有非常显著性意义，说明B超、CDFI检查定性诊断符合率明显高于CT平扫检查，而MRI平扫与B超(P=0．657>0．05)、MRI平扫与CDFI(P=0．358>0．05)的检查对比，无统计学意义，说明超声检查的定性诊断率与MRI平扫的定性诊断率基本相同，而当CT增强扫描后：B超与增强CT(P=0．365>0．05)、CDFI与增强CT(P=1．000>0．05)的统计学对比，无统计学意义，说明当CT增强扫描后，可大幅度提高定性诊断符合率，当MRI增强扫描后，B超与增强MRI(P=0．295>0．05)，CDFI与增强MRI(P=0．526>0．05)仍无统计学意义，虽然MRI增强扫描前后与B超、CDFI检查均无统计学意义，但是MRI增强扫描后检查的8例患者，定性检查全部准确，符合率为100％，较增强前符合率(70％)明显提高，因此说明CT或者MRI行增强扫描是提高定性诊断符合率必不可少的一种检查手段。
眼眶神经鞘瘤的B超、CDFI、CT、MRI的定位诊断符合率分别为42％、47％、92％、100％，B超与MRI(P=0．000<0．01)、B超与CT(P=0．001<0．01)、CDFI与MRI(P=0．001<0．01)、CDFI与CT(P=0．003<0．01)对比之间的差异具有非常显著性意义，而B超与CDFI、CT与MRI之间对比无统计学意义，说明MRI、CT的在定位诊断上的正确率高于B超与CDFI。眼眶神经鞘瘤的B超、CDFI、CT、MRI的定性诊断符合率分别为46％、53％、46％(增强扫描后47％)、88％(增强扫描后91％)。B超与MRI增强扫描(P=0．023<0．05)、CDFI与MRI(P=0．049<0．05)、CT增强扫描与MRI增强扫描(P=0．036<0．05)对比之间的差异具有显著性意义；CT平扫与MRI平扫(P=0．008<0．01)、B超与MRI(P=0．008<0．01)对比之间的差异具有非常显著性意义。CDFI与MRI增强扫描(P=0．084>0．05)，无统计学意义，但是定性诊断符合率CDFI为53％，MRI增强扫描为91％，增强MRI明显高于CDFI检查。说明无论MRI增强与否定性诊断率均高于其它检查方法，MRI(平扫+增强)检查，定性诊断符合率最高。
两种肿瘤的定位诊断上，MRI检查最准确，定位诊断符合率略高于CT，而B超及CDFI不及MRI和CT。定性诊断上，海绵状血管瘤的B超与CDFI检查符合率高于CT平扫和MRI平扫检查，但是当CT与MRI检查增强扫描后，定性诊断符合率略高于B超与CDFI检查，说明CT或MRI增强扫描是正确诊断海绵状血管瘤性质的必要手段，可很大程度提高定性诊断准确率。因此得出结论，CT(增强)或MRI(增强)联合超声检查(B超或CDFI)，可较为准确的诊断出海绵状血管瘤。神经鞘瘤的MRI平扫与增强扫描检查定性诊断符合率明显高于其它检查，而B超、CDFI、CT检查诊断符合率基本相同，所以得出结论MRI(增强)检查联合超声检查(B超或CDFI)，可较为准确的诊断出神经鞘瘤。
结论：综合以上两种肿瘤的影像学最佳诊断方法，得出结论，在鉴别难度较大的海绵状血管瘤与神经鞘瘤的时候，选择(MRI增强扫描+超声检查)，可以最大程度提高这两种肿瘤在定位、定性诊断上的符合率，从而作出正确的鉴别诊断。
Objective: Both orbital cavernous hemangioma and orbital neurilemmoma are common orbital tumors. They two have similarities on matter the confluence of the disease, age, gender, clinic sign or the formation, position of the tumor. However, they differ in the option of operation and treatment because the correct pre-operation diagnosis is the foundation for the right treatment. Imaging investigation is the best one for orbital cavernous hemangioma. Based on the different structures of the different tumor tissue, various image diagnosis investigations can reflect the respective clinic sign. Then, according to the features, the suitable investigation to differ the two kinds of tumors can be found.
Methods: The paper sums up my faculty's verification on the reflection of the twenty-five cases of orbital cavernous hemangioma and twenty-four cases orbital neurilemmoma via B - mode, CDFI, CT,MRI, also concludes all kinds of the imaging features reflected from various checks, afterwards, based on results distinguish, statistic analyses. Finally, the most suitable way for differentiate the image investigation on the two kind tumor is found.
The statistic software SPSS 13.0 is used to process the stat.
Results: The position diagnosis accordance ratio of B-mode, CDFI, CT, MRI for the orbital cavernous hemangioma are 45%、47%、88%、100%(table 1), B-mode and CT (P = 0.003<0.01), B-mode and MRI (P=0.004<0.01), CDFI and CT (P=0.009<0.01), CDFI and MRI (P=0.008<0.01), obvious differences exist, statistically meaningful. It reveals that the correct ratio of MRI and CT in position diagnosis is higher than B-mode and CDFI. The accordance ratio of qualitative diagnosis are 80%, 87%, 40%(contrast enhancement scan is 93%),70%(contrast enhancement scan is 100%). B-mode and plain CT scan (P=0.014<0.05), CDFI and plain CT scan (P=0.007< 0.01),obvious differences exist, statistically meaningful. It means that accordance ratio of B-mode and CDFI is higher than plain CT scan investigation, while there is on statistical difference plain MRI scan and B-mode (P=0.657>0.05) between plain MRI scan and CDFI (P=0.358> 0.05) . So, there is on obvious difference on determine diagnosis ratio between ultrasonic investigation and MRI investigation. With the contrast enhancement of CT scan, B-mode and the CT(CE) (P=0.365>0.05), CDFI and CT(CE) (P =1.000>0.05), it is meaningless statistically. Though, it is meaningless in this sense, the after-check on the eight patients MRI scanned, all determine investigation are correct, accordance ratio is 100%. Contrast enhanced than before (70%) was significantly improved, it is more obvious. So we can say contrast enhancement on CT and MRI is a necessary investigation means.
Table 1 The Location and Qualitative for Diagnostic Accordance Rate of Varied Imaging Examination on Orbital Cavernous Hemangioma
The position diagnosis accordance ratio of B-mode, CDFI, CT, MRI for the orbital neurilemmoma are 42%, 47%, 92%, 100%(table 2), B-mode and MRI(P=0.000<0.05), B-mode and CT (P=0.001<0.05), CDFI and MRI(P=0.001<0.05), CDFI and CT(P=0.003<0.05), obvious differences exist, statistically meaningful. It reveals that the correct ratio of MRI and CT in position diagnosis is higher than B-mode and CDFI. The accordance ratio of qualitative diagnosis are 46%, 53%, 46%(contrast enhancement scan is 47%), 88%(contrast enhancement scan is 91%). B-mode and MRI(P=0.008<0.01), B-mode and MRI (CE) (P=0.023<0.05) , CDFI and plain MRI scan (P = 0.049<0.05),plain CT scan and plain MRI scan(P=0.008<0.05), CT (CE) and MRI(CE) (P=0.036<0.05) , obvious differences exist, so it is statistically meaningful. CDFI and MRI (CE) (P = 0.084>0.05) are statistically meaningless. But accordance ration of position diagnosis of CDFI is 53%, MRI(CE) is 91%, MRI(CE) is much higher than CDFI investigation. It confirms that no matter MRI (CE) or not, its qualitative diagnosis accordance ratio is higher than any other investigation means. MRI(plain scan + contrast enhancement scan) investigation has the highest accordance ration.
Table 2 The Location and Qualitative for Diagnostic Accordance Rate of Varied Imaging Examination on Orbital Neurilemmoma
For the position diagnosis of the two kinds of tumors, MRI is the most correct. The position diagnosis is higher than CT, while B-mode and CDFI are worse than MRI and CT. For the qualitative diagnosis, cavernous hemangioma's B-mode and CDFI investigation accordance ratio is higher than CT scan and MRI scan investigation. However, CT (CE) and MRI (CE) investigation scan, qualitative diagnosis accordance ratio is slightly higher than B-mode and CDFI. It reflects that CT (CE) or MRI (CE) scan is a necessary method for final diagnosis cavernous hemangioma and can greatly improve the determine diagnosis. The conclusion is that CT(CE) or MRI(CE) combining ultrasonic investigation(B-mode or CDFI),can diagnosis the cavernous hemangioma better. Neurilemmoma's MRI(plain scan + contrast enhancement scan) investigation accordance ratio is much higher than other kinds of investigation. B-mode , CDFI and CT investigation accordance ratio are mainly the same. So we can conclude MRI(CE) unites ultrasonography investigation(B-mode or CDFI) can diagnosis neurilemmoma correctly.
Conclusion: by concluding the above two kinds of tumor's imaging best diagnosis method, we can conclude when it is difficult to differ relatively big cavernous hemangioma and neurilemmoma by using (contrast enhancement MRI scan + ultrasonography) investigation can greatly improve the accordance ratio of these two kinds of tumors in position and determine diagnosis, then various diagnosis can be chosen.
引文
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12、Headerson JW, Farrow GM, Garrity JA.Clinical course of an incompletely removed cavernous hemangioma of the orbit. Ophthalmology, 1990,97:625
13、肖利华主编 现代眼眶病诊断学 北京：北京科学技术出版社 2006．4??161-171，280-288
14、金亚明 范先群等 眼眶海绵状血管瘤的影像学诊断 现代实用医学 2006年8月 第18卷 第8期
15、赵红 宋国祥等 眼眶肿瘤的彩色多普勒超声动力学检查及海绵状血管 瘤的血流成像特征 中华医学超声杂志(电子版)2007年10月第4卷第5 期
16、鲜军舫，王振常，安裕志，等．眼眶海绵状血管瘤的影像学表现及其意义． 中华放射学杂志，1999，33：400-402．
17、王宏等主编 眼眶病磁共振(MRI)诊断图谱 北京：军事医学科学出 版社 37-38
18、孙丰源主译 眼眶疾病 天津：天津科技翻译出版公司 2006．7 53， 214-218，436-440
19、孙为荣主编 眼科病理学 北京：人民卫生出版社 1998．1 682-684， 686-687
20、McDonald P, et al.benign peripheral nerve sheath tumors(neurilemmoma)ofthe lacrimal gland. Ophthalmology, 1983,90:1403
21、Freedman SF,Elner VM,Donev I,et al.Intraocular neurilemmoma arisingfrom the posterior ciliary nerve in neurofibromatosis. Ophthalmology, 1988,95:1559
22、Graham CM,McCartney ACE,Buckley RJ.Intrascleral neurilemmoma.Br JOphthalmol,1989,73:378
23、廖志强，夏瑞南．角巩膜神经鞘瘤1例．中华眼科杂志，1992，28：149
24、Rootman J, Goldbery C, Robertson W. Primary orbital schwannomas.Br JOphthalmol, 1982,66:194
25、Chisholm IA,et al.recurrence of benign orbital neurilemmoma after 22??years.Can J Ophthalmol, 1982,17:271
26、Schatz H.Benign orbital neurilemmoma.Arch Ophthalmol, 1971,86:268
27、周钢主编 眼科多普勒技术和应用 昆明：云南科技出版社 2004．7， 85-86，91-92
28、Abe T,KawamuraN,HommaH,SasakK,IzumiyamaH,Matsumotok.MRI oforbital schwannoma. Neuroradidigy,2000;42(6):466-468
29、GunduzK,ShieldsCL, Gunalpl, ErdenE, ShieldsJA Orbital schwannomacorrelation of magneticresonanceimaging and pathologic findings[J].Graefes Arch Clin Exp Ophthalmd,2003;241(7):593-591
30、陈娟 魏锐利 MRI在眼眶肿瘤诊断中的作用 International Journal of Ophtalmology,Vo1．5,No．1,Feb．2005
31、ThornKanyM,ArrueP,DelisleMB,LagarrigueJ,ManelfeC. Cavernoushemangioma of orbit:MR imagmg[J].J Neuroradidogy,1999;26(2):79
32、Kim YH, BaekSH,ChoiWC. The transconjunctivat approach to a largeretrobulbar Cavernous hemangioma of the orbit[J].Korean JOphthalmd,2002,16(1):37-42
33、GuptaS, GoelA. Cavemoushemangioma of cavemoussinusassociated withan internal carotidartery aneurysm[J].Br J Neurosurg,2000;14(1):56-59
34、田其昌，鲜军舫,王振常，等．MRI脂肪抑制和增强技术在诊断眼眶疾病 中的应用．中华放射学杂志，1999，33：395-399．
35、Wilms G,RaatH,DomR,ThywissenC,DemaereP,DralandsG,BaertAL.Orbital cavemoushemangiomafingings on sequential Gd-enhanced MRI[J].J Comput Assist Tomogr, 1995;19:548-551
36、肖利华 眼眶泪腺上皮性肿瘤的影像学诊断[J]．国际眼科杂志，2001；1 (4)：22-24
37、吕剑 王春柳 王宏 马毅 眼眶神经鞘瘤的MRI诊断[J]．中国医学影像技 术，2002；18(8)：753-755
38、SchatzH.Benighorbital reurilemona sarcamatou transformation von Reckling hause disease.Arch Ophthalmd,l997;120(1):268-273
39、GabiborGA,BhnkSM TcherekayerVA.The management of optic nervemeningiomaandgliomas[J].J Neurosurg,1988,68:889
40、孙丰源 宋国祥等 432例眼眶肿瘤影像诊断分析 中国实用眼科杂志第 18卷(2000)第10期
1、HarrisGJ,JakobiecFA.Cavernous hemangioma of the orbit.J Neurosurg, 1979,51:219-228.
2、Henderson JW. Orbital Tumors.3Zrd ed. New York:Raven Press, 1994.43-52
3、Shields JA. Diagnosis and Management of Orbital Tumors. Philadelphia: Sauder, 1989.20-27
4、倪逴，马小葵，郭秉宽．1422例眼眶肿瘤的病理分类．中华眼科杂志，1991， 27：71
5、宋国祥主编．眼眶病学．北京：人民卫生出版社 1999，23-28，38-48， 135-141
6、易伟华 魏锐利 眼眶海绵状血管瘤病理学机制研究 眼科新进展 2004 年10月 第24卷 第5期
7、孙丰源主译 眼眶疾病 天津：天津科技翻译出版公司 2006．7 436-440
8、Char DH．orbital cavernous hemangioma．Orbit,1989,8：205
9、宋国祥，田文芳．眼眶海绵状血管瘤的临床分析[J]．中华眼科杂志，1988， 24(5)：132-134．
10、肖利华主编 现代眼眶病诊断学 北京：北京科学技术出版社 2006．4 161-171
11、周钢主编 眼科多普勒技术和应用 昆明：云南科技出版社 2004．7， 85-86
12、赵红 宋国祥等 眼眶肿瘤的彩色多普勒超声动力学检查及海绵状血管 瘤的血流成像特征 中华医学超声杂志(电子版)2007年10月第4卷第5 期
13、Rootman J,Vascular malformations of the orbit hemodynamic concepts??Orbit，2003,22(2)：103-120
14、安裕志 李彬 鲜军舫等．易混淆的眶尖部肿瘤的MRI特点．中华眼科杂 志,2000,36(4)：270-271．
15、张文静 赵慧芬 宋国祥．彩色多普勒超声在眼眶病诊断中的价值．中华 眼科杂志,2001,37(6)：447-450．
16、宋国祥 主编．现代眼科影像学．天津：天津科学技术出版社,2002．184-185．
17、王宏等主编 眼眶病磁共振(MRI)诊断图谱 北京：军事医学科学出 版社 37-38
18、陈娟 魏锐利 MRI在眼眶肿瘤诊断中的作用 International Journal of Ophtalmology,Vo1．5,No．1,Feb．2005
19、ThornKanyM,ArrueP,DelisleMB,LagarrigueJ,ManelfeC. Cavernoushemangioma of orbit:MR imaging[J].J Neuroradidogy,1999;26(2):79
20、Kim YH, BaekSH,ChoiWC. The transconjunctivat approach to a largeretrobulbar Cavernous hemangioma of the orbit[J].Korean J Ophthalmol,2002,16(1):37-42
21、GuptaS, GoelA. Cavernous hemangioma of cavemoussinusassociated withan internal carotidartery aneurysm[J].Br J Neurosurg,2000;14(1):56-59
22、田其昌，鲜军舫，王振常，等．MRI脂肪抑制和增强技术在诊断眼眶疾病 中的应用．中华放射学杂志，1999，33：395-399．
23、Wilms G,RaatH,DomR,ThywissenC,DemaereP,DralandsG,BaertAL.Orbital cavemoushemangiomafingings on sequential Gd-enhanced MRI [J].J Comput Assist Tomogr,1995;19:548-551
24、陶晓峰 肖湘生等 动态增强MRI对眼眶海绵状血管瘤诊断及鉴别诊断的 价值 中国医学计算机成像杂志2006年第12卷第3期
25、Ohtsuka K, Hashimoto M,Akiba H.Serial dynamic magnetic resonance??imaging of orbital cavernous hemangioma.Am J Ophthalmd, 2002, 16 (1):37-42
26、Potter D.Advances in imaging in oculoplastics.Curr Opin Ophthalmol, 2001 ,2:342-346
27、Wilms G, Raat H, DomR, et al. Orbital cavernous hemangioma: fingings onsequential Gd-enhanced MRI. J Comput Assist Tomogr 1995, 19: 548-551
28、 Ohtsuka K ,Hashimoto M, Akiba H. Serial dynamic magnetic Resonanceimaging of orbital cavernous hemangioma. Am J Ophthalmol, 1997, 123: 396-398
29、Harris GJ,et al. Cavernous hemangioma of the orbit.J Neurosurg,1979,51:219
30、肖利华主编 眼眶手术彩色图谱 上海：第二军医大学出版社 2003年11 月第1版 45～47
31、Headerson JW, Farrow GM, Garrity JA. Clinical course of an incompletely removed cavernous hemangioma of the orbit. Ophthalmology, 1990,97:625
32、李添天 刘晓 杨明 眼眶海绵状血管瘤的手术治疗 眼外伤职业眼病杂 志2007年4月 第29卷 第4期
2、HarrisGJ,JakobiecFA.Cavemous hemangioma of the orbit.J Neurosurg, 1979,51:219-228.
3、Henderson JW. Orbital Tumors.3Zrd ed. New York:Raven Press, 1994.43-52
4、Shields JA. Diagnosis and Management of Orbital Tumors. Philadelphia: Sauder, 1989.20-27
5、倪逴，马小葵，郭秉宽．1422例眼眶肿瘤的病理分类．中华眼科杂志，1991， 27：71
6、Char DH.orbital cavernous hemangioma.Orbit,1989,8:205
7、宋国祥，田文芳．眼眶海绵状血管瘤的临床分析[J]．中华眼科杂志，1988， 24(5)：132-134．
8、Song Guo-Xiang.Orbital lesions:Englightenment from 1012 orbital operations.Asian Hospital,1988,(8):23
9、宋国祥．眶内神经鞘瘤．中华眼科杂志，1980，16：306
10、肖利华主编 眼眶手术彩色图谱 上海：第二军医大学出版社 2003年11 月第1版 45-47，61
11、Harris GJ,et al. Cavernous hemangioma of the orbit.J Neurosurg, 1979, 51:219
12、Headerson JW, Farrow GM, Garrity JA.Clinical course of an incompletely removed cavernous hemangioma of the orbit. Ophthalmology, 1990,97:625
13、肖利华主编 现代眼眶病诊断学 北京：北京科学技术出版社 2006．4??161-171，280-288
14、金亚明 范先群等 眼眶海绵状血管瘤的影像学诊断 现代实用医学 2006年8月 第18卷 第8期
15、赵红 宋国祥等 眼眶肿瘤的彩色多普勒超声动力学检查及海绵状血管 瘤的血流成像特征 中华医学超声杂志(电子版)2007年10月第4卷第5 期
16、鲜军舫，王振常，安裕志，等．眼眶海绵状血管瘤的影像学表现及其意义． 中华放射学杂志，1999，33：400-402．
17、王宏等主编 眼眶病磁共振(MRI)诊断图谱 北京：军事医学科学出 版社 37-38
18、孙丰源主译 眼眶疾病 天津：天津科技翻译出版公司 2006．7 53， 214-218，436-440
19、孙为荣主编 眼科病理学 北京：人民卫生出版社 1998．1 682-684， 686-687
20、McDonald P, et al.benign peripheral nerve sheath tumors(neurilemmoma)ofthe lacrimal gland. Ophthalmology, 1983,90:1403
21、Freedman SF,Elner VM,Donev I,et al.Intraocular neurilemmoma arisingfrom the posterior ciliary nerve in neurofibromatosis. Ophthalmology, 1988,95:1559
22、Graham CM,McCartney ACE,Buckley RJ.Intrascleral neurilemmoma.Br JOphthalmol,1989,73:378
23、廖志强，夏瑞南．角巩膜神经鞘瘤1例．中华眼科杂志，1992，28：149
24、Rootman J, Goldbery C, Robertson W. Primary orbital schwannomas.Br JOphthalmol, 1982,66:194
25、Chisholm IA,et al.recurrence of benign orbital neurilemmoma after 22??years.Can J Ophthalmol, 1982,17:271
26、Schatz H.Benign orbital neurilemmoma.Arch Ophthalmol, 1971,86:268
27、周钢主编 眼科多普勒技术和应用 昆明：云南科技出版社 2004．7， 85-86，91-92
28、Abe T,KawamuraN,HommaH,SasakK,IzumiyamaH,Matsumotok.MRI oforbital schwannoma. Neuroradidigy,2000;42(6):466-468
29、GunduzK,ShieldsCL, Gunalpl, ErdenE, ShieldsJA Orbital schwannomacorrelation of magneticresonanceimaging and pathologic findings[J].Graefes Arch Clin Exp Ophthalmd,2003;241(7):593-591
30、陈娟 魏锐利 MRI在眼眶肿瘤诊断中的作用 International Journal of Ophtalmology,Vo1．5,No．1,Feb．2005
31、ThornKanyM,ArrueP,DelisleMB,LagarrigueJ,ManelfeC. Cavernoushemangioma of orbit:MR imagmg[J].J Neuroradidogy,1999;26(2):79
32、Kim YH, BaekSH,ChoiWC. The transconjunctivat approach to a largeretrobulbar Cavernous hemangioma of the orbit[J].Korean JOphthalmd,2002,16(1):37-42
33、GuptaS, GoelA. Cavemoushemangioma of cavemoussinusassociated withan internal carotidartery aneurysm[J].Br J Neurosurg,2000;14(1):56-59
34、田其昌，鲜军舫,王振常，等．MRI脂肪抑制和增强技术在诊断眼眶疾病 中的应用．中华放射学杂志，1999，33：395-399．
35、Wilms G,RaatH,DomR,ThywissenC,DemaereP,DralandsG,BaertAL.Orbital cavemoushemangiomafingings on sequential Gd-enhanced MRI[J].J Comput Assist Tomogr, 1995;19:548-551
36、肖利华 眼眶泪腺上皮性肿瘤的影像学诊断[J]．国际眼科杂志，2001；1 (4)：22-24
37、吕剑 王春柳 王宏 马毅 眼眶神经鞘瘤的MRI诊断[J]．中国医学影像技 术，2002；18(8)：753-755
38、SchatzH.Benighorbital reurilemona sarcamatou transformation von Reckling hause disease.Arch Ophthalmd,l997;120(1):268-273
39、GabiborGA,BhnkSM TcherekayerVA.The management of optic nervemeningiomaandgliomas[J].J Neurosurg,1988,68:889
40、孙丰源 宋国祥等 432例眼眶肿瘤影像诊断分析 中国实用眼科杂志第 18卷(2000)第10期
1、HarrisGJ,JakobiecFA.Cavernous hemangioma of the orbit.J Neurosurg, 1979,51:219-228.
2、Henderson JW. Orbital Tumors.3Zrd ed. New York:Raven Press, 1994.43-52
3、Shields JA. Diagnosis and Management of Orbital Tumors. Philadelphia: Sauder, 1989.20-27
4、倪逴，马小葵，郭秉宽．1422例眼眶肿瘤的病理分类．中华眼科杂志，1991， 27：71
5、宋国祥主编．眼眶病学．北京：人民卫生出版社 1999，23-28，38-48， 135-141
6、易伟华 魏锐利 眼眶海绵状血管瘤病理学机制研究 眼科新进展 2004 年10月 第24卷 第5期
7、孙丰源主译 眼眶疾病 天津：天津科技翻译出版公司 2006．7 436-440
8、Char DH．orbital cavernous hemangioma．Orbit,1989,8：205
9、宋国祥，田文芳．眼眶海绵状血管瘤的临床分析[J]．中华眼科杂志，1988， 24(5)：132-134．
10、肖利华主编 现代眼眶病诊断学 北京：北京科学技术出版社 2006．4 161-171
11、周钢主编 眼科多普勒技术和应用 昆明：云南科技出版社 2004．7， 85-86
12、赵红 宋国祥等 眼眶肿瘤的彩色多普勒超声动力学检查及海绵状血管 瘤的血流成像特征 中华医学超声杂志(电子版)2007年10月第4卷第5 期
13、Rootman J,Vascular malformations of the orbit hemodynamic concepts??Orbit，2003,22(2)：103-120
14、安裕志 李彬 鲜军舫等．易混淆的眶尖部肿瘤的MRI特点．中华眼科杂 志,2000,36(4)：270-271．
15、张文静 赵慧芬 宋国祥．彩色多普勒超声在眼眶病诊断中的价值．中华 眼科杂志,2001,37(6)：447-450．
16、宋国祥 主编．现代眼科影像学．天津：天津科学技术出版社,2002．184-185．
17、王宏等主编 眼眶病磁共振(MRI)诊断图谱 北京：军事医学科学出 版社 37-38
18、陈娟 魏锐利 MRI在眼眶肿瘤诊断中的作用 International Journal of Ophtalmology,Vo1．5,No．1,Feb．2005
19、ThornKanyM,ArrueP,DelisleMB,LagarrigueJ,ManelfeC. Cavernoushemangioma of orbit:MR imaging[J].J Neuroradidogy,1999;26(2):79
20、Kim YH, BaekSH,ChoiWC. The transconjunctivat approach to a largeretrobulbar Cavernous hemangioma of the orbit[J].Korean J Ophthalmol,2002,16(1):37-42
21、GuptaS, GoelA. Cavernous hemangioma of cavemoussinusassociated withan internal carotidartery aneurysm[J].Br J Neurosurg,2000;14(1):56-59
22、田其昌，鲜军舫，王振常，等．MRI脂肪抑制和增强技术在诊断眼眶疾病 中的应用．中华放射学杂志，1999，33：395-399．
23、Wilms G,RaatH,DomR,ThywissenC,DemaereP,DralandsG,BaertAL.Orbital cavemoushemangiomafingings on sequential Gd-enhanced MRI [J].J Comput Assist Tomogr,1995;19:548-551
24、陶晓峰 肖湘生等 动态增强MRI对眼眶海绵状血管瘤诊断及鉴别诊断的 价值 中国医学计算机成像杂志2006年第12卷第3期
25、Ohtsuka K, Hashimoto M,Akiba H.Serial dynamic magnetic resonance??imaging of orbital cavernous hemangioma.Am J Ophthalmd, 2002, 16 (1):37-42
26、Potter D.Advances in imaging in oculoplastics.Curr Opin Ophthalmol, 2001 ,2:342-346
27、Wilms G, Raat H, DomR, et al. Orbital cavernous hemangioma: fingings onsequential Gd-enhanced MRI. J Comput Assist Tomogr 1995, 19: 548-551
28、 Ohtsuka K ,Hashimoto M, Akiba H. Serial dynamic magnetic Resonanceimaging of orbital cavernous hemangioma. Am J Ophthalmol, 1997, 123: 396-398
29、Harris GJ,et al. Cavernous hemangioma of the orbit.J Neurosurg,1979,51:219
30、肖利华主编 眼眶手术彩色图谱 上海：第二军医大学出版社 2003年11 月第1版 45～47
31、Headerson JW, Farrow GM, Garrity JA. Clinical course of an incompletely removed cavernous hemangioma of the orbit. Ophthalmology, 1990,97:625
32、李添天 刘晓 杨明 眼眶海绵状血管瘤的手术治疗 眼外伤职业眼病杂 志2007年4月 第29卷 第4期