腱鞘巨细胞瘤MRI影像学特征与病理对照分析

MRI features and differential diagnosis of giant cell tumor of tendon sheath

目的探讨腱鞘巨细胞瘤(GCTTS)的MRI影像学特征并与病理对照,提高对GCTTS的诊断水平。方法回顾性分析经手术病理证实的38例GCTTS患者的临床资料、MRI影像学资料及病理资料。结果38例患者中局限型23例,弥漫型15例;MRI表现23例局限型GCTTS,表现为类圆形软组织肿块,边界清晰,邻近骨质未见明显异常,与骨骼肌信号相比,T1WI序列11例呈等信号,7例呈等或低信号,5例呈低信号,T2WI-FS序列17例呈高或低混杂信号,6例呈低信号。15例弥漫型GTCCS,其中6例弥漫型为术后复发,表现为关节旁多发形态欠规则软组织肿块,与周围肌腱、血管、韧带分界不清,邻近骨质未见明显异常,与骨骼肌信号相比,T1WI序列呈等或低信号,T2WI-FS序列呈高低混杂信号。镜下见较多组织细胞样单核细胞、多核巨细胞,并见散在泡沫细胞及含铁血黄素沉积。结论GCTTS具有一定特征性的MRI影像表现,反映病理改变,结合临床症状和体征,可帮助临床医生提高诊断正确率。

Objective To analyze and summarize the MRI features of giant cell tumor of the tendon sheath(GCTTS),so as to elevate the level of the diagnosis of GCTTS.Methods The imaging and clinical data of 34 patients with pathologically confirmed GCTTS were retrospectively analyzed,and MRI examination was performed.Results Among the 38 patients,24 were female and 14 were male.There were 27 single cases and 11 multiple cases.It occurred in 28 cases of lower limbs and 10 cases of upper limbs.There were 23 cases of localized type and 15 cases of diffuse type.MRI showed there were 23 cases of localized GCTTS,presenting as round soft tissue mass with clear boundaries and no obvious abnormalities in the adjacent bone.Compared with skeletal muscle signals,11 cases of T1WI sequence presented equal signal,7 cases presented equal or low signal,5 cases presented low signal,17 cases of T2wi-fs sequence presented high or low mixed signal,and 6 cases presented low signal.Among the 15 patients with diffuse GTCCS,6 patients with diffuse GTCCS had postoperative recurrence,presenting as multiple irregular soft tissue masses around the joints,unclear boundaries with the surrounding tendons,blood vessels and ligaments,and no obvious abnormalities in the adjacent bone.Compared with skeletal muscle signals,T1WI sequences showed isointensity or hypointensity,while T2wi-fs sequences showed high and low mixed signals.Conclusion GCTTS has a certain characteristic MRI image performance,combined with clinical symptoms and signs can help clinicians improve the diagnostic accuracy.