腱鞘巨细胞瘤MRI征象与病理对照分析

Comparative analysis of MRI manifestations and pathology of giant cell tumor of tendon sheath

目的探讨腱鞘巨细胞瘤(GCTTS)的MRI征象并与病理对照。方法收集我院经手术病理证实的13例GCTTS进行回顾性研究。男6例,女7例,年龄28～65岁,平均(42.5±10.1)岁。所有病例均行MRI平扫及增强检查。结果局灶型GCTTS 9例,病灶与腱鞘关系密切,位于手指5例,均呈≥180°包绕指骨,邻近骨皮质均不同程度侵蚀、吸收破坏,其中左手1例360°包绕拇指骨,邻近骨皮质均不同程度侵蚀、吸收破坏。弥漫型4例,病灶呈散在结节样或团块状分布于膝、踝关节腔及周围存在滑膜组织的间隙内。与邻近骨骼肌相比,T1WI上病灶呈等或稍低信号为主,右髌上囊内病灶大部分囊变且T1WI上囊液呈稍高信号。T2WI/PDWI上病灶信号复杂,内见低信号区。病灶实性部分不均质强化。镜下见较多单核组织细胞、多核巨细胞,并见散在泡沫细胞及含铁血黄素沉积。结论 GCTTS的MRI征象具有一定特征,是其病理改变的反映。

Objective To investigate the MRI features of giant cell tumor of tendon sheath(GCTTS)and to compare them with pathology.Methods A retrospective study was carried out in 13 cases of GCTTS confirmed by pathology in our hospital.There were 6 males and 7 females,aged 28~65 years,with an average age of 42.5±10.1 years.All cases underwent MRI plain and enhanced scan.Results Nine cases of localized-type GCTTS lesions grew close to the tendon sheath.Five cases were located in the digits,all the lesions embraced the digits 180 degrees or more than 180 degrees,in one case the lesion embraced the thumb completely in the left hand.Adjacent digital bone cortex of GCTTS lesions was eroded and absorbed in varying degrees.There were 4 cases of diffuse-type GCTTS,the lesions distributed nodular-or mass-like in the knee,ankle joint cavity and the space surrounding synovial tissue.Compared with adjacent skeletal muscles,lesions showed iso-or mild hypointensity on T1WI.The most part of the lesion in the bursae suprapatellaris showed cystic component,and the cystic fluid showed mild hyperintensity on T1WI.The lesion signal on T2WI/PDWI was complex,presenting hypointense region.The solid part showed heterogeneous enhancement.Pathological examination revealed large number of mononuclear histiocytes and multinucleated giant cells.Foam cells and hemosiderin deposition were also identified.Conclusion The MRI manifestaions of GCTTS have certain characteristics,which reflect corresponding pathological changes.