影像学对滑膜软骨瘤病的诊断价值

Evaluation of imaging diagnosis on synovial chondromatosis of temporomandibular joint

目的探讨影像学对颞下颌关节滑膜软骨瘤病的诊断价值。方法对北京大学口腔医学院1989～2 0 0 3年6例(7侧)手术患者临床、病理及影像学进行综合对照分析。结果滑膜软骨瘤病在临床上无特征性改变,术前诊断主要依靠影像学检查,而多个游离体的存在为最重要的诊断依据。本组病例普通X线检查发现2侧(2 / 7) ,CT检查发现3侧(3/ 5 ) ,MRI检查发现3侧(3/ 4 )存在多个游离体,均为Milgram病理分期Ⅱ、Ⅲ期病例;而在2侧CT(2 / 5 )、1侧MRI(1/ 4 )上未发现游离体者均为Ⅰ期病例。结论影像学检查对于滑膜软骨瘤病MilgramⅡ、Ⅲ期有重要诊断价值,而对于其Ⅰ期病例往往术前无法做出诊断。

Objective To investigate the imaging capability in the diagnosis of synovial chondromatosis of temporomandibular joint.Methods Six patients (7 joints) with synovial chondromatosis who came to Peking University School of Stomatology during 1989 to 2006 were included in this study. Clinical, pathological and imaging findings of these patients were compared.Results There were no specific clinical characteristics for the diagnosis of synovial chondromatosis. The pre-operative diagnosis for synovial chondromatosis was mainly dependent on the imaging findings, especially the findings of free bodies in the joints. Free bodies were found in two joints (~2/7 ) on the conventional radiogram; three joints (~3/5 ) on CT scans and three joints (~3/4 ) on MRI. All the cases with the positive imaging findings of free bodies were graded as Ⅱ or Ⅲ stage according to Milgram's pathological classification. The free bodies were not found on CT, or on MRI for Ⅰ stage of Milgram's classification.Conclusion Imaging findings play a very important role in the diagnosis of synovial chondromatosis on stage Ⅱ and Ⅲ, but not for the diagnosis of stage Ⅰsynovial chondromatosis.