大关节腱鞘巨细胞瘤的MRI表现特征

MRI features of giant cell tumor of tendon sheath involving giant joint

目的:探讨大关节腱鞘巨细胞瘤(giant cell tumor of tendon sheath,GCTTS)的MRI表现特征。方法:回顾性分析15例经手术病理证实的大关节GCTTS的病例资料,其中3例为术后复发。所有病例均经MRI检查,其中10例GCTTS患者接受增强扫描(4例行动态增强扫描),总结其MRI表现特点。结果:15例大关节GCTTS中,弥漫型11例,局限型4例。发生在踝关节7例,膝关节3例,肘和腕关节各2例,肩关节1例。病灶在T1WI上呈等信号,在T2WI上以稍高或高信号为主(11/15),增强扫描均呈欠均匀中等或明显强化,动态增强扫描2例为流出型、2例为延迟上升型。伴骨与软骨破坏6例,骨髓水肿6例,关节间隙狭窄5例,关节积液5例,13例肌腱受累,11例韧带受累,病灶周围软组织渗出水肿4例。结论:GCTTS的MRI表现具有一定的特征性,MRI能清晰显示病灶与邻近组织结构的关系,对诊断和治疗有重要意义。

Objective： To investigate the signal characteristics of giant cell tumor of tendon sheath（ GCTTS） involving greater joints on magnetic resonance imaging（ MRI）. Methods： MRI presentation was retrospectively examined in 15 cases of GCTTS（ 3 were postoperative relapse） confirmed by pathology. Ten cases received enhanced scans,in which 4 underwent dynamic enhanced scanning. Results： In 15 cases of GCTTS,11 were diffuse type and 4 localized.The tumor occurred in the ankle joint in 7,knee joint in 3,elbow and wrist joint in respective 2 and shoulder joint in 1. The lesions primarily demonstrated homogeneity on T1 WI,and slightly high or high signal intensity on T2WI（ 11 /15）. Enhanced scanning showed moderate or unhomogeneous enhancement of the lesion. Dynamic enhancement scan indicated washout- type curve in 2 cases,delayed-up curve in another 2. Six cases were associated with destruction of bone and cartilage,and another 6 with bone marrow edema. Joint space stenosis was seen in 5 cases and joint effusion in anther 5. Involvement of the tendon and ligament was found in 13 and 11,respectively. Soft tissue exudation occurred around the lesions in 4 cases. Conclusion： Signal features of GCTTS can be characteristic on MRI,suggesting that MRI may be diagnostic value because of its efficient definition of the lesion and the structure of the adjacent tissues.