踝关节色素沉着绒毛结节性滑膜炎的影像学诊断

The Imaging Diagnosis of Ankle Pigmented Villonodular Synovitis

目的:探讨踝关节色素沉着绒毛结节性滑膜炎(PVNS)的影像学表现特点。方法:回顾性分析13例经病理证实为踝关节PVNS的影像学表现,包括X线平片、CT和MRI,重点观察踝关节滑膜增生的部位、形态,骨侵蚀的部位、范围、边缘硬化以及邻近关节、肌腱受累情况。结果:13例X线示踝关节软组织肿胀或软组织肿块,5例踝关节面骨质破坏;8例CT示踝关节囊肿胀或踝周软组织肿块;6例距骨滑车及4例胫骨远端关节面骨质破坏并有硬化缘;MRI示13例滑膜弥漫或局限性增生并部分突破关节囊,6例突向胫距关节前方,10例向踝关节后方并包绕踇长屈肌腱,4例侵犯下胫腓关节,7例侵及距下关节。5例距骨滑车及4例胫骨远端骨侵蚀。结论:踝关节色素沉着绒毛结节性滑膜炎的X线平片仅显示软组织肿胀或肿块形成,征象无特异性;CT显示骨侵蚀优于X线平片及MRI;MRI诊断有一定特征性,可显示典型的含铁血黄素沉积;MRI发现易侵犯邻近关节且增殖滑膜常包绕踇长屈肌腱生长,有利于早期发现和确诊。

ObjectiveTo investigate the imaging characteristics of ankle pigmented villonodular synovitis（PVNS）.MethodsThe imaging data of 13 ankle PVNS cases diagnosed pathologically were evaluated retro-spectively,including X-ray,CT and MRI.The location and shape of synovial hyperplasia,the location,extentand border sclerosis of bone erosion and the damage level of adjacent joints and tendons were evaluated mainly.ResultsOn X-ray films,the ankle swelling or soft tissue mass was found in all 13 cases,and the articularsurface destruction was shown in 5 cases.On preoper-ative CT,the swelling of the ankle capsule and softtissue mass around the ankles were seen in 8 cases,while the articular bone destruction of talar trochlea surface was shown in 6 cases and the destruction of distaltibia was found in 4 cases,in which also could be found the bone sclerotic rims.MRI showed that all 13 casespresented diffuse or located synovial hyperplasia and partially penetrated the joint capsule;the anterior capsulewas invaded in 6 cases,and the posterior capsule was invaded in 10 cases associated with growth around the ten-don of flexor hallucis longus.The distal tibiofibular joint was violated in 4 cases,and the subtalar joint was vio-lated in 7 cases.Bone erosion in the trochlea of talus and in the distal tibia was seen in 5 cases and 4 casesre-spectively.ConclusionThe X-ray of ankle PVNS only shows soft tissue swelling or mass without the specificperformance.CT is better than X-ray and MRI on evaluating bone erosion of ankle PVNS.MRI can show a spe-cific sign of ankle PVNS,which is hemosiderin.MRI indicates that the ankle PVNS is apt to invade neighbor-ing joints and the proliferative synovium often grows around the tendon of flexor hallucis longus.The applicationof MRI is preferable in early detection and diagnosis of the ankle PVNS,being the best diagnostic method.