脉络膜黑色素瘤眼外蔓延彩色多普勒超声表现与病理特点：附三例报告

The characteristics of color Doppler ultrasound image and pathology of extraocular extension of choroidal melanoma

目的探讨眼内脉络膜黑色素瘤彩色多普勒超声及病理表现特征。方法对3例眼内脉络膜黑色素瘤眼外蔓延患者的CT、MRI、彩色多普勒超声表现进行综合分析,并与病理检查结果进行对照分析。结果 3例眼内脉络膜黑色素瘤影像学表现:CT检查:可见眼内占位病变且与眼眶内病变相连,眼球壁破坏。MRI检查:3例眼内病变T1WI为高信号,T2WI为低信号,并显示病变向眼外蔓延。彩色多普勒超声显示眼内病变为实体占位,病变基底与眶内病变沟通;脉冲多普勒显示眼内病变不见血流信号,基底部有少许血流信号,眶内病变显示分枝状丰富的血流信号,为动脉频谱。眼内脉络膜黑色素瘤切除术后病理检查显示,3例脉络膜黑色素瘤侵及眶内组织和视神经;肿瘤内大量坏死瘤组织阻塞供养血管。结论眼内脉络膜黑色素瘤眼外蔓延彩色多普勒超声的特殊表现及临床影像学(超声、CT、MRI)检查对本病正确诊断均有重要价值,确诊仍需病理检查。

Objective To investigate the characteristics of CDI and pathological feature of extraocular extension in choroidal melanoma. Methods Three cases of extraocular extension in choroidal melanoma were retrospectively analyzed from June, 2007 to January, 2008 at Tianjin Eye Hospital. All the cases had been diagnosed as choroidal melanoma by Ultrasound, MRI or CT, which were confirmed definitely by post-operative pathologic examination. Results The CT of extraoeular extension in choroidal melanoma showed intraocular lesions spreading outside of the eye. High signals on T1-weighted images, and low signals on T2- weighted images can been showed in extraoeular extension of ehoroidal melanoma by MRI. The color Doppler ultrasound image （CDFI） showed that intraocular lesions were substantial and moderate iso-echo, uniform or not, which were related with the orbital lesions. Pulse Doppler showed that intraocular lesions without blood flow signal, except for fundaments, while orbital lesions showed extensive branching blood flow signal, which was artery blood flowing spectrum. The operations from three patients were partial or total removal of orbital contents, and diagnosed invasion of orbital organization and optic nerve by ocular choroidal melanoma were confirmed by postoperative pathological examination, and there were a lot of necrotic tissues in intraocular lesions that blocked vascular vessels. Conclusion The special images can be shown in extraocular extension of choroidal melanoma by ultrasound, MRI, CT and color Doppler ultrasound image （CDFI） examinations, which could be of great value in diagnosis of extraocular extension in choroidal melanoma diagnosed by post-operative pathologic examination.