Ординатура / Офтальмология / Английские материалы / Ophthalmic Ultrasound A Diagnostic Atlas 2nd edition_ DiBernardo, Greenberg_2006
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Figure 7–10 Extrascleral extension. (A) Transverse scan showing slightly lobulated intraocular tumor (arrow) and the typical round appearance of tumor outside of the globe (E). (B) Longitudinal scan showing the intraocular portion (arrow) and extraocular portion (E) of the tumor. (C) A-scan at tissue sensitivity showing the surface of the intraocular tumor (T) with low internal reflectivity (arrow), sclera (S), and low reflective area of tumor outside of the globe wall (E). (D) The gain has been turned down to measure the intraocular portion of the lesion (double arrows) and the extrascleral nodule (arrow).
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Figure 7–11 Growth. (A) Transverse scan of small localized, dome-shaped tumor. (B) Longitudinal view showing minimal elevation and radial extent. (C) On standardized A-scan the internal reflectivity was high (arrow).
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Figure 7–12 Growth. Same patient from Figure 7–11, the patient was lost to follow-up for more than 2 years and returned because of a noticeable decrease in vision. (A) Transverse scan showing area of collar-button formation (arrow) and marked increase in lateral extent. (B) Longitudinal scan showing collar button (arrow). (C) A-scan taken from the area of the collar button showing mainly low reflectivity.
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Figure 7–13 Intrascleral invasion. (A) Transverse image showing a small dome-shaped lesion that measured only 2.4 mm (arrow). (B) Longitudinal scan showing the lateral extent of this small lesion that was just temporal to the optic nerve (ON). (C) Axial B-scan showing the slight out-pouching of the sclera that is typically seen when the inner sclera has been invaded (arrow ). (D) Tissue sensitivity A-scan showing low internal reflectivity (arrow).
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Figure 7–14 Preplaque. Echograms from the initial visit, echography was performed to confirm the diagnosis of melanoma. (A) Transverse scan showing the height and lateral extent of this solid mass. (B) A-scan at tissue sensitivity to evaluate the low internal reflectivity. (C) Longitudinal B-scan showing the radial extent. (D) A-scan at measuring sensitivity.
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Figure 7–15 Postplaque. Echographic evaluation 11 months after brachytherapy showing decreased height and increased reflectivity, common findings following treatment. (A) Transverse view. (B) Tissue sensitivity showing higher internal reflectivity (arrow). (C) Longitudinal image. (D) Measurement showing the decreased height. Initially, the tumor measured 7 mm.
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Figure 7–16 Preplaque. Even though this was a relatively small tumor at initial visit, the low internal reflectivity made it very suspicious for melanoma. (A) Transverse view. (B) Longitudinal view.
(C) Tissue sensitivity A-scan showing low internal reflectivity (arrow).
Figure 7–17 Postplaque. Almost one year following brachytherapy, the tumor has shrunk significantly. (A) Transverse showing only irregular fundus thickening (arrow). (B) Longitudinal view. (C) Tissue sensitivity A-scan showing an increase in reflectivity (arrow).
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Figure 7–18 Proton beam irradiation. Aside from |
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treatment options such as radiation plaque or enucle- |
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ation, patients may receive proton beam irradiation. |
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Treatment with iodine-125 plaque is a localized treat- |
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ment, performed using radioactive seeds that are em- |
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bedded in a silicone-like material. The plaque is left in |
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place for 5 days and then removed. For proton beam irra- |
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diation, small metal markers or clips are implanted adja- |
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cent to the tumor and external beam radiation is directed |
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toward these clips, which remain in place indefinitely. |
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(A) Transverse scan showing highly reflective clips (C) and |
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slight reverberation artifacts (arrows). (B) Standardized |
A-scan, at a markedly reduced gain, showing a significant |
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signal from the proton seeds (arrow). |
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Figure 7–19 Post-treatment. Sometimes following treatment the retina remains elevated over a lesion that is decreasing in size. (A) Transverse scan showing the elevation of the retina (R) over a minimally elevated lesion (arrow).
(B) Longitudinal scan showing the radial extent of the localized retinal detachment and it’s insertion into the optic disc (ON). (C) A-scan at tissue sensitivity showing the elevated retina (R) and the high reflectivity of the treated tumor (arrow). (D) A-scan at measuring sensitivity often helps to improve the resolution of the spikes created by the retina
(R) and the tumor surface (arrow).
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Figure 7–20 Post-treatment. This patient had an intraocular melanoma that was treated with brachytherapy. After multiple follow-up examinations, and a few years after treatment, the intraocular tumor had completely regressed. However, this large, round lesion (arrow) was noted in the orbit adjacent to the location of the original lesion. This transverse B-scan was taken using a 20-MHz probe for the posterior segment. The eye was enucleated and extrascleral extension in the setting of a completely regressed intraocular tumor was confirmed.
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Figure 7–21 Metastatic. Characteristically, metastatic carcinoma to the choroid appears as a minimally elevated lesion with an irregular surface, often with a central area of excavation on B-scan. On standardized A-scan, the internal reflectivity is irregular. (A) Transverse scan. Note the central area of excavation (arrow). (B) Longitudinal scan showing the radial extent. (C) A-scan at tissue sensitivity showing irregular internal reflectivity (arrow). (D) A-scan at measuring sensitivity.
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Figure 7–22 Metastatic lesions. (A) Transverse scan showing elevation of the retina overlying an irregularly shaped lesion with an area of central excavation (arrow). (B) Longitudinal scan showing the radial extent of the lesion.
(C) The first high spike (arrow) is from the elevated retina. The second high spike (open arrow) is from the surface of the lesion. (D) A-scan at measuring sensitivity.
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Figure 7–23 Choroidal nevus. Echographically, choroidal nevi have no elevation or minimal elevation (usually2 mm). They can be slightly dome-shaped and the internal reflectivity is high. (A) Transverse B-scan showing only mild irregular thickening of the fundus (arrow). (B) Longitudinal scan showing the same area of fundus thickening (arrow). (C) A-scan at tissue sensitivity showing high internal reflectivity (arrow). (D) A-scan at measuring sensitivity shows minimal enlargement (arrow).
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Figure 7–24 Hemangioma. (A) Transverse B-scan showing slight dome-shaped elevation of the posterior fundus. Even on B- scan, it can be determined that this lesion will have high reflectivity.
(B) Longitudinal scan. (C) Standardized A-scan, at tissue sensitivity, showing the high internal reflectivity of the lesion (arrow).
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Figure 7–25 Hemangioma. (A) Transverse scan showing bullous, serous retinal detachment (arrow) overlying choroidal hemangioma. (B) A-scan at tissue sensitivity showing two high spikes, one from the retina (R), the other from the hemangioma (H).
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Figure 7–26 Melanocytoma. (A) Transverse scan showing a small dome-shaped lesion (arrow) overlying the optic disc and optic nerve (ON). (B) Longitudinal scan showing the lesion overlying the optic nerve (ON). (C) Axial scan showing the tumor over the optic nerve. (D) Axial A-scan showing the high reflectivity of the lesion (arrow).
Note: Performing an axial A-scan to evaluate lesions that are over the disc or at the posterior pole may allow for the best perpendicularity of the sound beam and better imaging.