眼球内脉络膜转移癌的影像学诊断

The diagnostic imaging of global choriodal metastatic carcinoma

目的描述眼球内脉络膜转移癌的CT、MRI及B超表现,探讨其诊断、鉴别诊断价值。方法回顾性分析16例(16只眼)经手术病理(11只眼)和临床(5只眼)证实的脉络膜转移癌病例,其中5只眼行CT扫描,9只眼行MRI检查,15只眼行B超检查,6只眼做了荧光素眼底血管造影(FFA)。结果4只眼CT增强扫描示弥漫性、不规则、边界不清、密度不均的扁平增生病变,3只眼增强后强化明显,1只眼呈脉络膜黑色素瘤表现,8只眼MRIT1WI呈中高信号,T2WI呈中低信号,1只眼T1WI呈与玻璃体等信号,T2WI呈略高信号,其中4只眼行增强T1WI瘤体显著强化。B超检查13只眼呈实质不均质肿块占位,其中3只眼有挖空,2只眼呈实质较均质占位;9只眼显示高回声,5只眼中等回声,1只眼回声偏低。6只眼FFA均显示早期低荧光,静脉期点簇状高荧光,晚期呈细点状高荧光。结论CT和MRI对脉络膜转移癌等眼球内病变均可作出定位的影像学诊断。MRI对脉络膜转移癌表现具有一定特征性。MRI+B超(+FFA)对脉络膜转移癌可得到较为准确的临床诊断。

Objective To describe CT ,MRI and ultrasound findings of the choroids metastatic tumors and to investigate their value in the diagnosis and differentiation. Methods 16 choroids metastatic tumors patients proven by surgical pathology（ n = 11） or clinic information （ n =5 ） were analyzed. CT scan was performed in 5 cases and MR/in 9 cases. 15 cases were examined by ultrasound and 6 with fundus tluorescein angiography （ FFA ）. Results 4 cases on en- hanced CT showed diffusive, irregnlar,and the boundary of the fiat mass is not pure on the wall of eyeball, with 3 eases marked enhancement ; 1 case was characterized by the choroidal melanoma. MR/ （ n = 8 ） revealed high signal intensity on T1WI and low signal intensity on T2WI; 1 case showed the same intensity on T1WI and a little high signal intensity on T2WI , with 4 cases marked enhancement. Ultrasound showed inhomogeneous mass （ n = 13 ） with 3 cases showed ＂empty sign＂, and homogeneous mass （ n = 2 ） ; high echo reaction was seen in 9 cases, and low echo in 1 case. Conclusion CT ＋ MR/can get fixed position of the diagnostic imaging data for choroids metastatic tumors. MR/was superior to CT and ultrasound in the differential diagnosis of choroids metastatic tumors. MRI ＋ ultrasound （ ＋ FFA ） can get accurate and clinical diagnosis.