骨内腱鞘囊肿的X线、CT诊断

X-ray and CT diagnosis of intraosseous ganglion

目的 讨论骨内腱鞘囊肿的发病机制、临床特征、影像表现、诊断及鉴别诊断。方法回顾性分析经病理证实的 15例骨内腱鞘囊肿的临床及影像资料 ,男 5例 ,女 10例 ,平均 3 9.7岁。 5例只经X线平片检查 ;10例经CT检查 ,其中 3例还经X线平片检查。病灶共 17个 ,其中髋臼 6个 ,月骨4个、胫骨近端 3个 ,肱骨大结节、股骨头、腕舟状骨、足拇指近节趾骨各 1个。结果 (1) 8例 9个病灶X线表现为骨内邻近关节面的类圆形或不规则形囊样透亮区 ,边缘清楚 ,有完整、薄层硬化边 ,相邻关节间隙无改变。 (2 ) 10例 11个病灶CT显示病灶轮廓呈圆形或类圆形单囊状 (8个病灶 )、花瓣形多房囊状 (2个病灶 )和单囊样膨胀破坏 (1个病灶 ) 3种类型 ;(3 )CT显示 1例病灶通过小裂隙与关节腔相通 ;(4)病灶CT值 18～ 84HU ;(5 ) 3个病灶内见细小气体密度影。结论 结合发病年龄、病变部位、临床症状和影像学表现 ,对本病可以作出正确的术前诊断。

Objective To investigate the pathogenesis, clinical manifestations, imaging features, and differential diagnosis of intraosseous ganglion. Methods Clinical and imaging features of 15 cases (5 men, 10 women; mean age 39.7 years) with intraosseous ganglia were retrospectively analyzed. There were 17 lesions, including 6 acetabula, 4 lunate, 3 proximal ends of tibia, 1 major tuberculum of humeral, 1 femoral head, 1 scaphoid, and 1 phalange. Results (1) Common radiological features included a unilocular or multilocular cyst surrounded by a full and thin rim of sclerotic bone in the subchondral epiphysis without any signs of degenerative joint disease. (2) Lesions were displayed as well defined round radiolucent defect or multi cystic changes with surrounding bony sclerosis or cystic and expansile change with irregular shape on CT scans. (3) CT showed an intraosseous ganglion communicating with adjacent joint in 1 patient. (4) CT values of the lesions were between 15- 80 HU. (5) Gas in the cyst could be seen in 3 cases. Conclusion Combined with patient′s age, lesion distribution, clinical manifestations, and imaging features, it is possible to make a correct diagnosis of intraosseous ganglion.