膝关节滑膜血管瘤的超声诊断分析

Ultrasonic diagnosis of synovial hemangioma of the knee

目的探讨膝关节滑膜血管瘤(SHK)的超声表现及其在临床诊断中的应用价值。方法回顾性分析10例经手术及病理确诊为SHK患者的超声声像图表现及临床资料,并与MRI检查结果、手术及病理结果进行对比,对超声检查结果进行分析。结果超声检查诊断提示血管瘤者7例(弥漫型6例、局限型1例),来源于血管的占位1例、髌上囊占位1例、色素沉着绒毛结节性滑膜炎1例,提示血管瘤伴血栓1例、伴骨侵蚀和骨赘形成2例、伴关节腔积液3例。SHK患者的超声声像显示:7例弥漫型肿块二维超声呈边界不清楚、形态不规则、不均匀回声团,5例呈混合回声团、内见管网状无回声,站立位时体积增大,彩色多普勒血流图(CDFI)显示加压试验阳性;1例呈不均匀弱回声团伴多数结节样低回声,CDFI显示加压试验阳性;1例二维超声呈边界不清楚、形态不规则、不均质稍强回声团,加压前后均未见明显血流信号。3例局限型肿块超声表现无特征性。结论弥漫型SHK超声声像图表现具有一定特征性;局限型及伴显著滑膜增生的SHK超声声像图表现无特异性,仅采用超声诊断容易误诊。超声检查不仅能准确评估膝关节囊及周围软组织受累情况,且方便、无创、价廉,可作为弥漫型SHK常规首选无创性检查诊断方法。

Objectives To investigate the ultrasound findings of the synovial hemangioma of knee(SHK) and to evaluate its value in clinical diagnosis. Methods The ultrasonographic manifestations and clinical data of 10 patients with SHK confirmed by surgery and pathology were retrospectively analyzed and compared with MRI findings, surgery and pathological results. Results Seven cases of SHK(6 cases of diffuse type, 1 case of limited type) were assessed by ultrasound, including 1 case of vascular origin, 1 case of supraorbital sac origin, 1 case with pigmented villonodular synovitis, 1 case with thrombosis, 2 cases accompanied with bone erosion and osteophyte formation, and 3 cases with joint cavity effusion. Ultrasonic findings of SHK were as followed: 7 cases of SHK were manifestate as diffuse mass with unclear boundary, irregular shape and uneven echo mass;5 cases had mixed-echo mass with reticular structures inside, an increased volume in erect position and positive CDFI compression test;1 case had heterogeneous hypoechoic mass with a nodular appearance and the positive compression test;1 case as poorly-demarcated, irregular shape, heterogeneous hyperechoic mass without obvious blood flow signals under the compression test. There were no characteristic ultrasonic findings from other 3 cases of SHK. Conclusions Diffuse SHKs have characteristic ultrasonograms. SHKs with localized and significant synovial hyperplasia have no specific ultrasonic manifestation and are easily misdiagnosed. Ultrasound is convenient, noninvasive and inexpensive. It can accurately evaluate the involvement of knee joint capsule and surrounding soft tissues. It can be used as the first line diagnostic modality for routine scanning of SHKs.