Gallium scintigraphy in the investigation of retinal inflammatory vasculopathy.
Gallium scintigraphy in the investigation of retinal inflammatory vasculopathy.
复制标题
镓闪烁扫描在视网膜炎症性血管病变研究中的应用。
DOI：
10.1111/j.1755-3768.2009.01725.x
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发表时间：
2010
影响因子：
3.4
通讯作者：
Wong,WaiT
中科院分区：
文献类型：
--
作者：
Forooghian,Farzin;Cukras,Catherine;Meyerle,CatherineB;Nussenblatt,RobertB;Gottlieb,ChloeC;Chew,EmilyY;Wong,WaiT
视网膜炎症性血管病变可能是全身性炎症性疾病的一种威胁视力的表现。尽管进行了广泛的研究，但许多病例中炎症性视网膜血管病变的病因仍然难以捉摸。在没有提示全身性疾病的病史的情况下，系统评估的效用可能具有较低的诊断率。(George et al., 1996)。然而，全身镓 67 闪烁扫描的使用可能有助于阐明此类病例中炎症性视网膜血管病的病因。我们报告了连续 4 名患者的研究结果，这些患者在两年内出现视网膜炎症性血管病，但没有任何全身性疾病的体征或症状。 3 名患者为非裔美国人，1 名患者为白人，年龄范围为 42 至 59 岁。所有患者均表现出视网膜炎症变化，包括静脉周围炎、外周无灌注、动脉瘤样变化、黄斑水肿和新生血管形成。所有病例均未出现前葡萄膜炎，但一名患者出现单侧轻度玻璃体炎伴乳头炎。所有患者的血清血管紧张素转换酶（ACE）水平均正常。用于检测肺部疾病的放射学检查，包括胸部 X 光检查、高分辨率胸部 CT 和全身镓 67 扫描，结果均为阴性。所有患者的抗 Ro 和抗 La 抗体检测均为阴性，排除了干燥综合征的诊断。梅毒检测（FTA-ABS）也呈阴性。三名患者对纯化蛋白衍生物 (PPD) 皮肤测试呈阴性反应，而一名患者有长期 PPD 测试阳性史，且曾接受异烟肼 (INH) 治疗。高凝状态、镰状细胞病和结缔组织病的检查结果均为阴性。然而，镓 67 闪烁扫描显示，所有 4 例病例中泪腺双侧摄取增加，其中 4 例病例中有 2 例与并发腮腺受累有关。
Retinal inflammatory vasculopathy can be a sight-threatening manifestation of systemic inflammatory disease. Despite extensive investigation, the etiology of inflammatory retinal vasculopathy in many cases remains elusive. In the absence of a medical history suggestive of systemic disease, the utility of systemic evaluation can have a low diagnostic yield.(George et al., 1996). The use of whole-body gallium-67 scintigraphy, however, may shed light on the etiology of inflammatory retinal vasculopathy in such cases.We report the findings of four consecutive patients who presented over a two year period with retinal inflammatory vasculopathy without any signs or symptoms of systemic disease. Three patients were African-American and one was Caucasian, with an age range of 42–59 years. All patients exhibited inflammatory changes of the retina including periphlebitis, peripheral nonperfusion, aneurysmal changes, macular edema, and neovascularization. Anterior uveitis was absent in all cases, but unilateral mild vitritis associated with papillitis was seen in one patient. Serum angiotensin converting enzyme (ACE) levels were normal in all patients. Radiological examinations to detect pulmonary disease including chest x-ray, high-resolution chest CT, and whole-body gallium-67 scanning were negative. All patients tested negative for anti-Ro and anti-La antibodies, which excluded the diagnosis of Sjögren syndrome. Syphilis testing (FTA-ABS) was also negative. Three patients had negative reaction to purified protein derivative (PPD) skin testing, while one patient had a remote history of a positive PPD test that had been treated with isoniazid (INH). Investigations for hypercoagulability, sickle cell disease, and connective tissue disease were negative. Gallium-67 scintigraphy, however, showed in all 4 cases characteristic bilateral increased uptake in the lacrimal glands that in 2 out of 4 cases was associated with concurrent parotid gland involvement.