脉络膜黑色素瘤的核磁诊断价值

The Value of Nuclear Magnetic Diagnosis of Choroidal Melanoma

目的分析32例(32只眼)脉络膜黑色素瘤的核磁共振信号特征与病理和眶内蔓延的关系。方法对天津市眼科医院2003年9月至2014年3月收治的脉络膜黑色素瘤患者32例(32只眼)进行回顾性研究。结果 32例脉络膜黑色素瘤的核磁显像中有29例在T1W1呈高信号、T2W呈低信号;3例在T1W1呈中等信号、T2W1呈低信号(2例侵犯睫状体和前部脉络膜,均为混合型细胞型伴有视网膜下和玻璃体出血;1例梭形细胞型,伴有渗出性视网膜脱离),可能因视网膜下和玻璃体出血,瘤体并发出血伴大量肿瘤细胞坏死,信号特征不典型;1例在T1WI和T2WI呈中等信号,可能是由于黑色素含量少。结论核磁共振对于脉络膜黑色素瘤的诊断率为90.6%(29/32),但在小肿瘤、弥漫生长、少量或无色素、伴有大量细胞坏死的大肿瘤者,信号强度不典型,诊断较为困难,需要借助其他检查方法。

Objective The relationship between mri signal characteristics of 32 cases（32 eyes） choroidal melanoma and the pathologic and intraorbital spread was analyzed. Methods A retrospective study was performed on 32 patients（32 eyes） of choroidal melanoma patients admitted to tianjin eye hospital from September 2003 to March 2010.Results In 32 cases of choroidal melanoma, 29 cases showed high signal and T2W low signal in T1W1. In 3 cases, T1W1 showed moderate signal and T2W1 showed low signal（2 cases of the ciliary body and the anterior choroid were all mixed with retinal subretinal and vitreous hemorrhage）. 1 case of spindle cell type, with exudative retinal detachment, may be caused by the hemorrhage of the retina and vitreous body, and the hemorrhage of the tumor accompanied by a large number of tumor cell necrosis, and the signal characteristics are atypical.In one case, T1WI and T2WI were intermediate signals, possibly due to low melanin content. Conclusion Nuclear magnetism is characteristic of choroidal melanoma, but in small tumors or diffuse growth, the signal strength of low pigment is not typical, and other methods of examination are needed.