颅内恶性黑色素瘤的影像学特点分析  

Analysis of imaging characteristics of intracranial malignant melanoma

作　　者：刘俊杰[1] 汪卫建 周彦汝 张岚[3] LIU Junjie;WANG Weijian;ZHOU Yanru;ZHANG Lan(The Third Hospital of Zhengzhou,Zhengzhou 450000,China;The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]郑州市第三人民医院,河南郑州450000 [2]郑州大学第一附属医院,河南郑州450052 [3]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中国实用神经疾病杂志》2021年第17期1506-1515,共10页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划项目(编号:201702070)。

摘　　要：目的总结颅内恶性黑色素瘤(MM)的MRI表现,提高对该病的诊断准确性。方法回顾性分析经病理和免疫组化证实15例MM患者的影像学表现、临床资料和病理结果并复习相关文献。结果15例患者中原发性颅内恶性黑色素瘤(PIMM)3例,继发性颅内恶性黑色素瘤(MIMM)12例。3例PIMM为颅内单发病灶,2例呈稍长T1混杂稍长T_(2)信号,FLAIR序列呈混杂高信号。1例位于脑干的PIMM,呈不均匀T1WI高信号和T_(2)WI低信号,DWI呈轻度弥散受限,增强后病变呈中度不均匀强化,并见"脑膜尾征"。12例MIMM中,11例为单发肿瘤,1例为分布在额、顶、颞叶的多发病灶。MIMM病灶信号表现多样,T1WI为低或高信号,T_(2)WI多为混杂高信号,增强扫描多呈不均匀强化,病灶周围轻至中度水肿。结论颅内恶性黑色素瘤包括原发性和继发性黑色素瘤,典型的黑色素瘤MRI具有特征性表现,非典型的黑色素瘤MRI表现多样,确诊需依靠病理学。Objective To summarize the MRI imaging manifestation of intracranial malignant melanoma(MM)in order to improve the correct diagnosis of MM.Methods The imaging manifestations,medical records and pathological results of 15 cases of MM confirmed by pathology and immunohistochemistry were retrospectively analyzed,and a review of the relevant literature was done.Results Among the 15 patients,3 patients had primary intracranial malignant melanoma(PIMM)and 12 patients had metastatic intracranial malignant melanoma(MIMM).Three cases of PIMM were intracranial solitary lesions,among which 2 cases showed slightly longer T1and heterogeneously longer T_(2)signal intensity,and heterogeneous high signal intensity on FLAIR.One case was located in the brain stem,and the lesion showed heterogeneous hyperintensity on T1WI and hypointensity on T_(2)WI,mild restriction on DWI and moderately heterogeneous enhanced after enhancement with"dural tail sign".Among12 cases of MIMM,11 cases were solitary tumors,and 1 case was multiple lesions distributed in the frontal,parietal,and temporal lobes.MIMM lesions showed diversity of signal intensity,with low or high signal on T1WI,heterogeneously high signal intensity on T_(2)WI,and inhomogenous enhancement,and mild to moderate edema around lesions.Conclusion Intracranial malignant melanoma includes primary and metastatic melanoma.Thetypical melanoma has characteristic MRI manifestations,while atypical melanoma has various manifestations and the definite diagnosis need depend on pathology.

关 键 词：颅内恶性黑色素瘤 磁共振成像 原发性 继发性 脑转移 

分 类 号：R739.41[医药卫生—肿瘤]