人体大关节腱鞘巨细胞瘤的MRI特点及其病理基础

Giant cell Tumor of the Tendon Sheath in Large Joints of Human: MRI-pathology Correlation

目的:探讨人体大关节腱鞘巨细胞瘤的MRI表现特点及其病理基础,以提高临床对其诊断水平。材料与方法:回顾性分析34例经病理证实的大关节腱鞘巨细胞瘤的MRI影像资料,并与病理结果对照。结果:34例腱鞘巨细胞瘤患者中,局限型29例,弥漫型5例(均发生于膝关节),其中发生于膝关节28例;踝关节3例;肘关节2例;髋关节1例。与周围正常骨骼肌信号相比,T1WI:20例表现为等信号,12例表现为稍低信号,2例表现为稍高或低混杂信号;T2WI:13例表现为等信号,7例表现为稍低信号,14例表现为稍高或低混杂信号。20例行注射Gd-DTPA增强扫描,4例表现为明显的强化,11例表现为轻中度强化,5例强化不明显。其中病灶T1WI及T2WI上均可见内部或边缘裂隙状或斑片状低信号区域,常规增强扫描低信号区域不强化对腱鞘巨细胞瘤诊断具有特征性。结论:大关节腱鞘巨细胞瘤的MRI影像表现由其病理组织成分决定,MRI为目前术前诊断的首选方法。

Purpose： To explore the MRI features and pathologic finding of the giant cell tumor of the tendon sheath （GCTTS） in large joints of human to improve the diagnostic accuracy. Materials and Methods： MR imaging features of 34 pathologically confirmed GC＇I^S cases in large joints were analyzed retrospectively and comparatively with pathologic findings. Results： 5 cases were the diffuse form（all cases were located in knee） , 29 were focal. Among 34 cases of GCTFS, 28 cases were located in knee joint, 3 in ankle joint, 2 in elbow joint, 3 in hip joint. Compared with the signal intensity of the skeletal muscle, the signal intensity of the lesions on T1WI was similar to that of skeletal muscle in 20 cases, slightly less in 12 cases, and slightly higher mixed low in 2 cases. On T2WI： 13 lesions showed isointensity, 7 lesions showed slightly hypointensity, and 14 lesions showed higher mixed low signal intensity. In 20 c0aea underwent routine enhance scan. The lesions were strong homogeneous enhancement in 4 cases, moderate and mild homogeneous enhancement in 11 cases and no enhancement in the other 5 cases. Both on T1WI and T2 WI, cleft-like low signal intensity region or focal prominent low signal intensity region can be found were characteristic which no enhancement underwent routine enhance scan. Conclusion： MR imaging features of GCTI＇S in large joints may be different depending on the histological compositions of the lesions and MRI is the first modality for the preoperative diagnosis of GCTFS.