Bellerive Claudine, Ouellet Etienne, Kamaya Aya, Singh Arun D
Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
Ocul Oncol Pathol. 2018 Jun;4(4):254-260. doi: 10.1159/000485424. Epub 2018 Jan 19.
The liver is the most common site for metastases of several primary malignancies including uveal melanoma.
Review of imaging characteristics of incidental common benign liver lesions including hepatic cyst, hemangioma, focal nodular hyperplasia, and hepatic adenoma and contrasting them with uveal melanoma metastases.
Benign hepatic lesions may be cystic or, if solid, relatively stable in size over time. For hepatic lesions larger than 10 mm in size, characteristic imaging features typically allow for confident diagnosis. When lesions are small (less than 10 mm), definitive characterization can be difficult. Moreover, lesions smaller than 10 mm can be difficult to biopsy under ultrasound or computed tomography (CT) guidance, and short-term follow-up will often be useful to assess for stability or progression. Overall, magnetic resonance imaging is more specific than CT scan and at least as sensitive as CT for detecting uveal melanoma liver metastases.
New multiple enhancing solid liver lesions should raise suspicion of uveal melanoma liver metastases. Discussion of challenging cases with the radiologist may be beneficial, as pertinent information such as size, location, and molecular prognostication status of the primary tumor can guide radiological interpretation of hepatic lesions.
肝脏是包括葡萄膜黑色素瘤在内的几种原发性恶性肿瘤最常见的转移部位。
回顾偶然发现的常见肝脏良性病变的影像学特征，包括肝囊肿、血管瘤、局灶性结节性增生和肝腺瘤，并将它们与葡萄膜黑色素瘤转移灶进行对比。
肝脏良性病变可能是囊性的，或者如果是实性的，其大小随时间相对稳定。对于直径大于10毫米的肝脏病变，典型的影像学特征通常能做出可靠诊断。当病变较小时（小于10毫米），明确其特征可能会很困难。此外，小于10毫米的病变在超声或计算机断层扫描（CT）引导下难以进行活检，短期随访通常有助于评估病变的稳定性或进展情况。总体而言，磁共振成像在检测葡萄膜黑色素瘤肝转移方面比CT扫描更具特异性，且至少与CT一样敏感。
新出现的多个强化实性肝脏病变应引起对葡萄膜黑色素瘤肝转移的怀疑。与放射科医生讨论疑难病例可能会有所帮助，因为诸如原发肿瘤的大小、位置和分子预后状态等相关信息可指导对肝脏病变的放射学解读。
