合并骨质改变的腱鞘巨细胞瘤多模态影像诊断应用

Diagnostic Utilization of Multi-mode Imaging in Giant Cell Tumor of Tendon Sheath with Bone change

目的 分析腱鞘巨细胞瘤伴有骨质侵犯的临床、影像特征性表现,以提高对本病的认知及诊断水平。方法 回顾性总结12例腱鞘巨细胞瘤,同时合并有骨质侵犯表现的病理结果和影像学资料,接受X线检查的患者7例,接受CT检查的患者有5例,接受MRI检查的患者有11例。结果 8例患者病理结果为弥漫型腱鞘巨细胞瘤,4例患者为局限型腱鞘巨细胞瘤;5例病灶位于手部,1例病灶位于足部,2例病灶位于腕关节,2例病灶位于踝关节,1例病灶位于膝关节,2例病灶位于髋关节,1例病灶位于髋关节,其中1例病灶恶变为恶性腱鞘巨细胞瘤。上述各病灶MRI表现,均为T1WI序列呈等低、等信号为主,T2WI序列信号表现多种多样,8例病灶出现特征性的“双低信号”表现。结论 发病部位和影像征象在诊断GCTTS时不难,当出现病灶周围骨质改变,需要仔细分析骨质改变的多模态影像特征,并与相应部位恶性肿瘤性病变进行鉴别,确诊需要结合病理结果。

Objective To explore the clinical and imaging manifestations of giant cell tumor of tendon sheath(GCTTS) with bone change and to improve the diagnosis. Methods A retrospective study of clinical data and imaging features of 12 patients with GCTTS combined with bone change. X-ray was performed in 7 patients, plain CT was performed in 5 patients, Plain MR was performed in 11 patients. Results Of all the 12 patients, 8 cases were proved to be diffuse GCTTS, while the other 4 cases were localized,5 lesions were in the hand, 1 in the foot, 2 in the wrist joint, 3 in the ankle joint, 1 in the knee joint, 2 in the hip joint, 1 in the elbow joint. Among the 12 patients, one was found to be malignant. In the MRI examination, the lesions were mainly characterized by hypointensity and isointensity on T1WI. The presentation was varied on T2WI, and 9 cases showed characteristic double hypointensity on T1WI and T2WI. Conclusion GCTTS is easy to be found when lesion location and imaging features considered, when bone change happens, differential diagnosis with malignant lesion in same location is necessary, and to confirm diagnosis, pathological results is needed.