MRI及动态增强扫描对鼻腔及鼻窦恶性黑色素瘤的诊断价值  

The role of MRI and dynamic contrast enhancement MRI in the evaluation of malignant sinonasal melanoma

作　　者：许庆刚[1] 尹红霞[1] 鲜军舫[1] 刘承耀[2] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730 [2]首都医科大学附属北京同仁医院耳鼻喉科,北京100730

出　　处：《放射学实践》2016年第2期155-158,共4页Radiologic Practice

基　　金：国家自然科学基金资助项目(81201075;81000612)

摘　　要：目的:探讨MRI及动态增强扫描对鼻腔及鼻窦恶性黑色素瘤的诊断价值。方法:回顾性分析26例经手术病理证实的鼻腔及鼻窦恶性黑色素瘤的MRI资料。结果:肿瘤位于鼻腔16例,上颌窦3例,筛窦6例,额窦1例,表现为侵袭性、破坏性或膨胀性生长。免疫组化及组织病理学检查示3例肿瘤内未发现黑色素成分,余23例肿瘤内黑色素均呈阳性。与脑灰质比较,肿瘤T_1WI呈高信号17例,等信号9例;T_2WI呈低信号14例,等信号10例,高信号2例;T2WI信号混杂,20例瘤内见多发线状低信号影。10例肿瘤DWI表现:9例呈高信号,1例呈等信号。26例肿瘤动态增强扫描后21例呈轻-中度强化;14例肿瘤中12例时间信号强度曲线(TIC)呈速升缓降型,1例呈速升速降型,1例呈持续上升型。结论:鼻腔及鼻窦恶性黑色素瘤具有特征性的MRI表现:T_1WI上呈高信号,T2WI信号混杂且可见多发纡曲、线状低信号影。TIC及DWI能更好地了解恶性黑色素瘤内部的多形性成分。Objective：To delineate MR findings of malignant sinonasal melanoma（MSM）.Methods：MR imaging findings of 26patients（15women and 11 men,mean age 57years）with pathologically confirmed MSM were retrospectively reviewed.Results：Of 26 MSM,16 were found in the nasal cavity,3in the maxillary sinus,6in the ethmoid sinus,and one in the frontal sinus.The lesions showed invasive,destructive or expansive growth.There were 23 tumors which were pathologically confirmed to contain melanin,and the other 3tumors confirmed to contain no melanin.Compared to gray matter of the brain,17 of the tumors demonstrated hyperintensity,9showed isointensity on T1WI;and on T2 WI,14demonstrated hypointensity,10 showed isointensity,2showed hyperintensity.There were multiple linear,low signals on T2 WI within the mass in20 of the 26 tumors.On DWI in 10 cases,there were 9cases showing hyperintensity and one showing isointensity.Evaluated with gadolinium-enhanced imaging,21 patients showed mild to moderate enhancement.The time-intensity curve（TIC）of dynamic contrast enhancement of MRI showed rapid enhancing and slow wash out type in 12 cases,rapid enhancing and rapid wash-out type in one case and steady enhancement pattern in one case.Conclusion：MSM shows characteristic MR signal intensity：hyperintensity on T1 WI and heterogeneous linear,low-signal intensity on T2 WI,these may provide valuable information for clinical diagnosis.Together with conventional MRI,TIC and DWI are useful for indicating pleomorphic patterns of MSM.

关 键 词：恶性黑色素瘤 鼻窦肿瘤 鼻腔肿瘤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.62[医药卫生—诊断学]