米粒体滑囊炎MRI表现及病理特征

MRI Manifestations and Pathological Features of Bursitis with Rice Bodies

目的观察米粒体滑囊炎的影像及病理学特征。方法8例10个关节经病理确诊为米粒体滑囊炎,分析其实验室、影像及病理学资料。8例行血沉(ESR)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、尿酸、降钙素原、血常规检查。2例行类风湿因子(RF)检查,2例行结核分支杆菌T细胞斑点试验(T-SPOT.TB)。10个受累关节行X线、CT及MRI平扫检查。3例行肩关节镜手术,5例行开放性手术,病理组织行苏木精-伊红(HE)染色并镜检。结果5例ESR升高,hs-CRP、IL-6及尿酸升高各4例,2例RF增高,2例T-SPOT.TB(+)。8例降钙素原、白细胞、中性粒细胞绝对数及百分比均正常。X线及CT检查示10个关节肿胀,无明显骨质破坏及高密度结节。MRI示10个关节积液增多,滑膜增生,大量米粒体形成。相比关节积液,米粒体在T;WI序列及脂肪抑制T;WI序列呈低信号。术中见滑膜增生及大量直径1~12 mm的米粒体。镜下米粒体为嗜酸性蛋白质,滑膜呈慢性炎症改变。结论米粒体滑囊炎脂肪抑制T;WI序列示大量低信号米粒体,结合实验室检查有助于诊断,病理证实米粒体为蛋白质可确诊。

Objective To observe the imaging and pathological features of bursitis with rice bodies.Methods 8 cases with 10 joints were pathologically diagnosed as bursitis with rice bodies.The laboratory,imaging and pathological data were analyzed.The erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),uric acid,procalcitonin and blood routine tests were examined in all cases.The rheumatoid factor(RF)and T cell spot test of mycobacterium tuberculosis(T-SPOT.TB)were examined in 2 cases,respectively.10 joints were examined by X-ray,CT and MRI plain scanning.Shoulder arthroscopic surgery was performed in 3 cases,and 5 cases were underwent with open operation.The pathological tissues were performed with hematoxylin-eosin(HE)staining and microscopic examination.Results The ESR in 5 cases,hs-CRP,IL-6,uric acid in 4 cases,respectively,and RF in 2 cases were increased.The result of T-SPOT.TB in 2 cases was positive.The absolute number and percentage of leukocytes and neutrophile granulocytes and procalcitonin were all normal.X-ray and CT scanning in all joints just showed joint swelling without any obvious bone destruction or high density nodules.MRI scanning in all showed increased effusion,synovial hyperplasia and numerous rice bodies.Compared with effusion,these bodies were shown with low signal in T;WI and fat-saturated T;WI(fs-T;WI)sequences.Synovial hyperplasia and bodies in 1~12 mm were observed intraoperatively.Microscopically,the bodies were eosinophilic proteins and synovial tissue were presented with chronic inflammatory reaction.Conclusion Bursitis with rice bodies is most characteristic of numerous low-signal particles in fs-T;WI sequence.Laboratory tests is helpful to diagnosis and pathological confirmation of rice bodies as proteins can be diagnosed definitely.