腱鞘巨细胞瘤的MRI诊断要点分析

Analysis of the Effectiveness of MRI in Diagnosis of Giant Cell Tumor of Tendon Sheath

目的探讨MRI在诊断腱鞘巨细胞瘤(GCTTS)中的应用价值。方法回顾性分析19例经手术和病理证实的腱鞘巨细胞瘤患者的病例资料。所有患者均行MRI平扫(其中17例行增强扫描),分析其临床特征、发病部位和MRI特征。结果所有GCTTS均发生于肌腱旁或包绕肌腱生长(局限型12例,弥漫型7例),其中手部4例、足部1例、膝关节5例和踝关节9例。膝关节和踝关节GCTTS分别好发于髌骨和距骨周围。MRI示所有的GCTTS均见纤维包膜结构,与骨骼肌信号对比,7例表现为T1WI等信号、T2WI稍高信号,4例T1WI和T2WI上均呈等信号,1例T1WI和T2WI上呈稍高信号,余7例T1WI和T2WI上呈混杂信号,其中5例可见T1WI和T2WI特征性双低信号。GCTTS增强扫描,10例呈中度强化,7例呈均匀或不均匀性明显强化。结论 GCTTS具有特定的发病部位,以局限型多见;病灶周缘纤维包膜,MRI信号多样,T1WI和T2WI双向低信号为其较特异性征象,对其诊断具有重要价值。

Objective To analyze the effectiveness of MRI in diagnosis of GCTTS（Giant Cell Tumor of Tendon Sheath）. Methods Clinical data of 19 surgically-and-pathologically-confirmed GCTTS cases were retrospectively analyzed. All the patients underwent plain MRI examinations to analyze their clinical features, lesion locations and MRI features, among which 17 cases received the enhanced MRI scanning. Results Lesions were revealed beside or around the tendon sheath in all the cases, among which there were 12 cases with focal lesions and 7 cases with diffusion lesions. Of all the cases, lesions were located in the finger in 4 cases, the foot in 1 case, the knee in 5 cases and the ankle in 9 cases. For the GCTTS cases with lesions in the knee and ankle, most of the lesions appeared around the patella and astragalus respectively. MRI showed that all the lesions were embraced by fibrous capsule. Compared with skeletal muscle signals, 7 cases presented iso-intensity on T1 WI, and slight hyper-intensity on T2 WI, 4 cases presented iso-intensity on T1 WI and T2 WI, 1 case presented slight hyper-intensity on T1 WI and T2 WI, and the remaining 7 cases presented mixed signals on T1 WI and T2 WI. Additionally, the hypo-intensity on T1 WI and T2 WI were observed in 5 cases. For enhanced MRI, 10 cases showed moderate enhancement, and 7 cases showed obviously homogeneous or local enhancement. ConclusionGCTTS were seen in specific locations and especially presented as focal lesions. The lesions were usually embraced by fibrous capsule with diversified MRI signals. Low signals on T1 WI and T2 WI were the specific signs, which provided important references for diagnosis of patients with GCTTS.