中国医学计算机成像杂志2004年第10卷第4期眼球脉络膜黑色素瘤的CT和MRI表现包兵宋济昌陈荣家目的:分析眼球脉络膜黑色素瘤的CT和MRI表现,并探讨其在诊断和鉴别诊断中的价值。材料和方法:回顾性分析经手术和病理证实的25例眼球脉络膜黑色素瘤,其中CT扫描13例,MRI检查7例,CT加MRI检查5例。结果:本组仅1例肿瘤侵及球外,其余均局限于眼球内。3例为梭形,2l例为蘑菇形。CT平扫密度较均匀,接近眼环密度;增强后12例呈明显均匀强化,3例不均匀强化。1例伴有斑片状钙化。14例显示肿瘤的一侧或两侧周边区半月形视网膜剥离。与玻璃体比较T。WI呈高信号,T:WI呈低信号。10例显示视网膜剥离,渗液在T。WI、T:WI上均呈中高信号。增强后T.WI示瘤体中等至明显强化,周边积液未见强化,仅1例周边积液显示中等强化。结论:CT与MRI均能显示眼球内的病灶,MRI对该病的诊断及鉴别诊断优于CT且具有特征性。关键词脉络膜黑色素瘤CT磁共振成像CTandMRIManifestationsofGlobalChoroidalMelanomaBaoBing,SongJichang,ChenRongjiaDepartmentofRadiology,EyeandEarNoseThroatHospital,FudanUniversity,Shanghai200031Purpose:ToanalysetheCTandMRIfeaturesofglobalchoroidalmelanomaandtoevaluatetheuseful—nessintermsofthediagnosisanddifferentialdiagnosisofthisdisease.MaterialsandMethods:25casesofglobalchoroidalmelanomapathologicallyprovedwereretrospectivelyanalysed.AlloftheselesionswerescannedbyCTand(or)MRIbeforeoperation.Amongthem,13caseswithCTscan,7casesbvMRI,and5casesbyCTpulsMRI.Results:Of25globalchoroidalmelanoma.1caseinvolvedoutsidetheeyeball,and24werelocatedwithintheeyeball.3casesshowedashuttle—shapedmass,21casesshowedamushroom—shapedinass.OnplainCTimages,thelesionsappearhomogenonsly,consistentwiththedensityoftheWalloftheeyeball.Aftercontrast,12caseswereenhancedhomogenonslyanddramati—cally,3caseswereenhancedheterogeneouslyandonecaseaccompaniedbypatchycalcification.14casesaccompaniedbysemilunarretinaldetachmentsemilaterallyorbilaterally.OnMRI,thetumorsappearedhighsignalintensityinT1WIandlowsignalintensityinT2WIcomparedwiththevitreousbody.10casesaccompaniedbyretinapeelingoffwhichshowedmoderateorhighsignalintensityinbothT1WIandT2WI.Afteradministrationofcontrastmaterial,thetumorswereenhancedmoderatelyordramaticallv.Theexudationwerenotenhancedexceptforonecasewhichhadamoderateenhancementoftheperipheralexudation.Conclusion:BothCTandMRIhavethepotentialtoshowstheintraocularlesions.MRIhasthesuperioradvantageindiagnosinganddifferentiallydiagnosingthediseasethanCT.KeywordsChoroidalmelanomaCTMRI脉络膜黑色素瘤是成人最常见的眼内原发恶性肿瘤,临床早期诊断不易,误诊率为2.7%~39.7%⋯。本文报告本院1995~2003年经手术、病理证实的25例脉络膜黑色素瘤,分析CT和MRI表现及其在诊断和鉴别诊断价值。一、一般资料材料和方法一229一男14例,女11例。年龄21。77岁,平均46.8岁。均为单眼发病,左眼9例,右眼16例。主诉视力减退19例,眼前黑影3例,视力下降伴眼前黑影3例。眼底检查视网膜下增厚隆起,表面呈黑灰色(12例)、黑褐中国医学计算机成像杂志2004;10:229~231ChinComputMedlmag2004;10:229—231作者单位:200031复旦大学附属跟耳喉鼻科医院放射科万方数据色(5例)、棕色(4例)或青灰色(4例),均伴有视网膜脱离。二、检查方法CT检查18例,采用岛津5000型cT扫描仪,矩阵512×512。横断位加冠状位平扫1例,单纯横断面平扫2例,横断位平扫加增强2例,直接冠状位增强扫描2例,直接横断面增强扫描11例。造影剂为碘海醇100ml(300mgI/m1),静脉内加压注射。MR检查12例,采用GESigna1.5T超导型磁共振成像仪,SE序列,均为平扫加增强。常规作横断面T,WI和T:WI平扫,静脉内注射钆喷替酸葡甲胺(Gd—DTPA)行T。WI增强扫描,剂量为0.1...