髂腰肌囊扩张的影像学诊断

CT and MRI diagnosis of enlarged iliopsoas bursa

目的 探讨髂腰肌囊扩张的CT、MRI表现和诊断价值。方法 回顾性阅读经穿刺抽吸或手术病理证实的 2 3例髂腰肌囊扩张病人的CT(2 3例 )、MR(8例 )片并记录、分析各种征象。结果2 3例扩张髂腰肌囊均发生于单侧 ,出现于全部或部分髋臼层面上 ,上下范围 2 0～ 6 5cm。最大显示层面面积 (横径×纵径 )为 1 0cm× 1 0cm～ 2 8cm× 3 8cm。均为圆形、卵圆形或倒水滴状囊性肿物 ,位于髋关节囊前方 ,髂外或股动静脉外后方和髂腰肌 (腱 )内侧。 16例有髂外或股动静脉向前和(或 )向内推移 ,10例髂腰肌内侧有与该囊相应的弧形压迹。 15例表面有厚薄不一的肌束覆盖 ,自上而下逐渐变薄 ,直至消失。 3例沿髋臼或髂骨基底内侧面向上延伸并突入髂腰肌内。 8例延续到髋臼下方 ,位于耻骨肌前外侧 ,止于股骨小转子以上 ,其中 5例呈倒水滴状。CT扫描均为低密度 ,CT值为12～ 46HU。 11例显示薄层囊壁 ,其余 12例囊壁难以辨认。 7例行增强扫描 ,其中 5例囊壁呈细线样轻度强化。 8例行MR检查 ,T1WI呈低信号 ,T2 WI呈水样高信号。冠状面亦呈圆形或卵圆形 ,边缘锐利 ,沿髂腰肌 (腱 )上下走行。结论 CT。

Objective To study the manifestations and diagnostic value of CT and MRI on enlarged iliopsoas bursa Methods CT and MRI films of 23 patients with enlarged iliopsoas buras were studied retrospectively All these patients were positively diagnosed by aspiration of synovial fluid or surgical operation Results Enlarged iliopsoas bursas in all the 23 cases appeared at the level of or part of the acetabulum sections in only one side, ranging from 2 0 cm to 6 5 cm The area (transverse diameter×vertical diameter) at the largest section was from 1 0 cm×1 0 cm to 2 8 cm×3 8 cm All of them appeared as round, oval or upside down water drop like cyst and located posterolateral to external iliac blood vessels and or femoral blood vessels, medial to iliopsoas muscle (tendon), and anterior to hip joint capsule In 16 cases, external iliac blood vessels and or femoral blood vessels were pushed forward and or inward In 10 cases, there was an arched compression corresponding to the bursa in the medial edge of the iliopsoas muscle In 15 cases, the bursas were surrounded or covered by muscle bundles, which became thinner and thinner downwards and disappeared at last The bursas in 3 cases extended upwards along the aectabulum and internal surface of the ilium base, protruding into iliopsoas muscle In 8 cases, the bursas went downwards and located anterolaterally to pectineal muscle, 5 of which presenting as an upside down water drop On CT films all 23 cases showed hypodense lesions with CT value from 12 to 46 HU In 11 cases, the thin cystic wall was demonstrated, while in the other 12 cases, it was difficult to identify the cystic wall In 5 out of 7 cases with contrast enhanced CT, the cystic wall demonstrated a little increased density In 8 cases examined by MRI, enlarged iliopsoas bursa appeared as low signal on T 1WI and water like high signal on T 2WI They also appeared as round or oval cyst with sharp rim on coronal section, and passed up and down along the iliopsoas muscle (tendon) Conclusion CT and MRI can make a positive diagnosis for all patients with enlarged iliopsoas bursa