Patten R M, Shuman W P, Teefey S
Department of Radiology, University of Washington, Harborview Medical Center, Seattle 98104.
AJR Am J Roentgenol. 1990 Jul;155(1):109-12. doi: 10.2214/ajr.155.1.2112830.
Radiologic detection of bone lesions from malignant melanoma is reported to be uncommon or infrequent. To ascertain the characteristics and frequency of detection of melanoma metastases to the axial skeleton by CT, we retrospectively reviewed 464 body CT studies of 125 consecutive melanoma patients for presence, appearance, and site of skeletal metastases. Results were correlated with patient's age, sex, clinical course, and both the Clark and Breslow classifications of the primary lesion. Of 98 patients with metastatic disease evident on their CT studies, 17 (17%) had bony metastases; two (12%) of these 17 patients had skeletal lesions as the only CT evidence of metastatic disease. Metastatic bony lesions were predominantly osteolytic, slightly expansile, and commonly located in the spine. Associated soft-tissue masses were frequent, but periosteal reaction and identifiable tumor matrix were not seen. Skeletal metastases were found only in those patients with thick or intermediate primary melanoma (Breslow) classified as Clark level III or greater, and the CT demonstration of osseous metastases was a poor prognostic sign. The data suggest that CT detection of skeletal melanoma metastases is not uncommon. When CT is performed to evaluate for metastatic melanoma, the axial skeleton should be carefully examined, especially in those patients with more advanced primary lesions.
据报道，恶性黑色素瘤骨转移灶的放射学检测并不常见。为了确定通过CT检测黑色素瘤转移至中轴骨骼的特征及频率，我们回顾性分析了125例连续黑色素瘤患者的464份全身CT研究，以了解骨骼转移灶的存在情况、表现及部位。将结果与患者的年龄、性别、临床病程以及原发灶的克拉克（Clark）和布雷斯洛（Breslow）分类进行关联分析。在98例CT检查显示有转移病灶的患者中，17例（17%）存在骨转移；这17例患者中有2例（12%）的骨骼病变是转移疾病的唯一CT证据。转移性骨病变主要为溶骨性，轻度膨胀，常见于脊柱。常伴有软组织肿块，但未见骨膜反应和明确的肿瘤基质。骨转移仅见于那些原发黑色素瘤较厚或中等厚度（布雷斯洛分类）且克拉克分级为III级或更高的患者，CT显示骨转移是预后不良的征象。数据表明，CT检测黑色素瘤骨转移并不少见。当进行CT检查以评估黑色素瘤转移时，应仔细检查中轴骨骼，尤其是那些原发灶较晚期的患者。
