原发性肛管直肠恶性黑色素瘤影像学诊断.docVIP

原发性肛管直肠恶性黑色素瘤影像学诊断【摘要】 目的 探讨原发性肛管直肠恶性黑色素瘤(AMM)的CT和MRI诊断价值。 方法 回顾性分析经组织病理学证实的AMM 7例,其中男3例,女4例。6例行CT检查,1例行MRI检查。结果 AMM表现明显蕈伞型肿块充满肠腔不伴肠梗阻(n=5),肠壁明显增厚(n=2);3例伴肠周脂肪浸润,其中1例延伸至骶前间隙;5例伴淋巴结转移,其中1例淋巴结直径3 cm。 CT平扫示肿块呈稍低密度影,轻度强化2例、中度强化4例;AMM及其转移灶在MRI T1WI均呈高信号,T2WI为低信号。抑脂T1WI能更好的显示病灶范围及转移灶。结论 肛门直肠部AMM可表现为腔内较大蕈伞型肿块,虽充满肠腔,但不伴肠梗阻,同样具转移淋巴结转移及明显肠周脂肪浸润。MRI对鉴别黑色素性AMM有提示价值。 【关键词】 肛门;直肠;黑色素瘤;体层摄影术,X线计算机;磁共振成像 Imaging diagnosis of anorectal m alignant melanoma YAO-Gang.Department of X-Ray Room,,the Hospital of Zaozuang,Shandong 277000,China 【Abstract】 Objective To discuss the diagnostic value of CT and MRI for primary anorectal m alignant melanoma(AMM).Methods Seven patients(3 males and 4 females)with AMM confirmed pathologically were analyzed retrospectively,which were examined by CT(n=6) and 1.5T MRI(n=1).Results AMM presented as bulky intraluminal fungating masses without causing obstruction(n=5) and irragular rectal wall thickening(n=2).Three cases had perirectal infiltration with 1 case extended to the presacral space,Five cases had perirectal enlarged lymph nodes with 1 case larger than 3 cm in diameter.Nonenhanced CT showed a hypodense lesion and Enhanced CT manifested slight enhancement(n=2) and mild enhancement(n=4).The tumor scanned by MRI depicted high intensity on T1WI and low intensity on T2WI,so did the enlarged lymph nodes and bone metastasis.Fat-saturation T1WI significantly improved the extention of tumor and detection of metastasis.Conclusion Bulky intraluminal fungating masses without causing obstruction,perirectal infiltration and enlarged lymph nodes may be helpful to diagnose AMM.MRI is especially useful for differentiating melanotic AMM from other rectal tumors. 【Key words】Anus; Rectum; Melanoma; Tomography; X-ray computed; Magnetic Resonance Imaging 原发性肛管直肠恶性黑色素瘤(Anorectal M alignant Melanoma,AMM)为临床少见且恶性程度高,预后极差的肿瘤,临床表现缺乏特异性,常被误认为痔或息肉。其影像学表现国外文献较少[1-4],且多数为个例报道[2-4],国内未见相关文献报道。笔者搜集我院经病理证实的AMM7例,结合文献分析其CT和MRI表现,旨在提高对本病的影像学表现的认识。 1 材料与方法 1.1