腕关节腱鞘滑膜结核的临床及影像学诊断

Imaging diagnosis of synovial tuberculosis of sheath of wrist

目的:探讨腕关节腱鞘滑膜结核的影像学表现。方法:回顾分析2002年10月至2009年10月3例经手术病理证实为腕关节腱鞘滑膜结核患者的临床和影像学资料,男2例,女1例;年龄分别为48、67、76岁。3例均行X线摄片,其中2例行CT扫描,1例同时行MRI检查。结果:3例患者均表现为腕关节掌侧软组织肿块,界欠清。3例均无明确骨质疏松及骨质破坏改变。1例软组织内示点状钙化灶。MRI上表现为包埋屈肌腱囊性肿块,于腕管处受压呈"8"字或葫芦形。其内示多发米仁大小异常信号(T1等低信号,T2呈略高信号),部分内部示小点状高信号。增强扫描滑膜明显增厚强化,腱鞘内游离体未见明确强化。结论:腕关节腱鞘滑膜结核影像学表现具有相对特征性,MRI较X线片及CT更具有临床应用价值。

Objective：To investigate the imaging features of synovial tuberculosis of sheath of wrist. Methods：Three patients of synovial tuberculosis of sheath of wrist underwent surgical operation from Oct.2002 to Oct.2009 included 2 males and 1 female,the age of 48,67,76 years respectivly. X-rays of 3 patients,CTs of 2 patients and MRI of 1 patient were retrospectively analyzed and the relevant literature were reviewed. Results：There were 3 cases with the soft tissue mass in the palm side of wrist,the section was unclear. There were no osteoporosis and no changes of bone destruction. There was 1 case with the punctate calcification in the soft tissue. MRI showed the embedded cystic mass of flexor tendon and ＂8＂ shape in carpal tunnel pressure,and showed abnormal signal（T1 low-signal,T2 slightly higher signal）,a small part of the internal point showed high signal. CT showed the synovial membrane were obvious thickening and enhanced,corpus liberum in tendon sheath were no obvious strengthening. Conclusion：Synovial tuberculosis of sheath of wrist has certain characteristics on radiographic image. The MRI has more clinical value than X-ray and CT.