MRI在腱鞘巨细胞瘤分型中的应用价值

The value of MRI in Classification of giant cell tumor of tendon sheath

目的:通过分析不同类型腱鞘巨细胞瘤的MRI特征,探讨MRI检查在其分型中的应用价值。方法:52例经手术病理证实的腱鞘巨细胞瘤患者,术前均接受MRI检查,其中17例行增强扫描。回顾性分析病灶的部位、形态、大小、信号特征、强化方式、邻近结构改变等。结果:57.7%(30/52例)的患者为局限性腱鞘巨细胞瘤型,病灶主要位于手足部(占67%),MRI表现为境界清晰的结节状的长/等T1稍长T2信号;17.3%(9/52例)的患者为弥漫性腱鞘巨细胞瘤型,病灶主要位于足部(占44%),MRI表现为边界欠清的结节状或团片状长T1稍长/短T2信号;25%(13/52例)的患者为色素沉着绒毛结节性滑膜炎型,病灶主要位于膝关节(占54%),MRI表现为关节腔内弥漫性肿块影,呈长T1短T2信号,其内大量增生的滑膜组织,易累及周边结构。结论:MRI检查能够显示肿块的信号特征、范围及其与周围组织结构的关系,有助于腱鞘巨细胞瘤的术前分型诊断。

Objective:To study the MRI features of different types of giant cell tumor of tendon sheath(GCTS)and evaluate MRI value in the classification of GCTS.Methods:52 cases of GCTS proved by operating pathology were analyzed retrospectively.All patients were examined by MRI,and 17 of them received contrast enhanced MRI scanning.The location,size,shape and the signal feature,the relationship with the surrounding tissue and enhancing pattern of the tumor were analyzed by two physicians with experience in the imaging diagnosis of bone and joint system.Results:L-GCTS accounts for 57.7%,mainly occured in the hand and foot(20/30),showing as nodular long or equal T1 and slightly long T2 signal on MRI,with clear boundary;D-GCTS accounted for 17.3%,mainly occurs in the foot(4/9),presenting as nodular or patchy long T1 and slightly longer/short T2 signal,with obscure boundary;PVNS accounts for 25%,mainly occured in the knee joint(7/13),presenting as diffuse mass shadow in the articular cavity,with a long T1 and short T2 signal,and hyper proliferation of synovial tissue,which could infiltrate surrounding structures easily.Conclusions:MRI is able to depict the signal characteristics and the range of GCTS,and its relationship with the adjacent tissues,which is valuable for typing diagnosis.