腱鞘巨细胞瘤的影像学特征

Imaging features of giant cell tumors of tendon sheath

目的分析和总结腱鞘巨细胞瘤(GCTTS)的影像诊断和鉴别诊断特点,旨在提高对GCTTS的诊断水平。方法分析43例经病理证实的GCTTS患者的影像及病理资料。23例行X线检查; 9例行CT平扫检查; 25例行MRI平扫,8例同时行增强检查。结果 1) 43例患者无特征性临床表现;病灶在四肢大小关节发病率有显著统计学意义(P <0. 05); 2) X线平片7例骨质破坏,16例骨质及关节间隙正常,仅见关节周围软组织肿胀。CT平扫关节周围等密度肿块,密度均匀,边缘清楚; 1例见明显骨质破坏; 8例骨质结构未见明显破坏。在T1WI与骨骼肌信号对比11例呈等信号,10例呈稍低信号,4例呈等低信号;在T2WI与骨骼肌信号对比10例呈等信号,11例呈低信号,4例呈混杂信号;增强扫描肿块呈中度到明显的不均匀强化。结论 GCTTS主要发生在手足部,MRI对于GCTTS的诊断具有极高的敏感性和特异性。

Objective To analyze and summarize the imaging features of giant cell tumor of tendon sheath （GCTTS）, so as to elevate the level of the diagnosis of GCTTS. Methods We analysed the imaging and pathological data from 43 patients with pathologically confirmed GCTTS. 23 patients were examined with X-ray; 9 patients were examined with CT; 25 patients were examined by MRI and 8 received contrast enhanced MRI. Results 1）43 patients had no characteristic clinical manifestations; The morbidity in limb joints showed remarkable statistical significance （ P 〈0.05）; 2）Bony erosion of 7 cases was found in X-ray plain film; other showed no bony and joint abnormality, soft tissue swelling was found only around joints. CT scan showed equally-density lump around joints with clear border and homogeneous density; 1 case was obviously bony erosion; other showed no bony and joint abnormality. The lesions showed iso-intensity （n=11）, hypo-intensity （n=10）, and iso-and hypo-intensity （n=4） on T 1WI compared with that of muscle; The lisions showed iso-intensity （n=10）, hypo-intensity （n=11） and mixed hyper-and hypo-intensity （n=4） on T 2WI compared with that of muscle. The lesions showed mainly moderately to marked inhomogeneous enhancement. Conclusion Most of GCTTS occured in distal limbs such as hands or feet. MRI has extremely high sensitivity and specificity for the diagnosis of GCTTS.