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腱鞘巨细胞瘤的MRI影像学特征分析

作者:林成武

所属单位:昆山宗仁卿纪念医院(江苏 昆山 215300)

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摘要

目的分析腱鞘巨细胞瘤的MRI 典型影像特征,同时探讨对腱鞘巨细胞 瘤的诊断价值。方法 选取我院2013年3 月-2017年9月我院经手术病理证实的腱鞘 巨细胞瘤患者43例,患者均行MRI扫描, 收集患者影像学资料及临床资料,分析腱 鞘巨细胞瘤在MRI检查中的图像表现及检 出情况。结果 43例腱鞘巨细胞瘤患者在 MRI上均表现为边界清晰的骨旁肌腱软组 织肿块或肌腱旁软组织肿块。其中局限型 巨细胞瘤35例,弥漫型巨细胞瘤8例。24 例患者病灶在T1WI中呈等信号,12例患者 病灶呈现等低信号,7例患者病灶呈现稍 低信号;14例患者病灶在T2WI中呈现混合 信号,9例患者病灶呈现稍高信号,11例 患者病灶呈现明显高信号,9例(20.00%) 患者病灶呈现低信号。行MR增强扫描的共 9例,均表现为肿块均匀或不均匀中度强 化,且强化区域边缘清楚。结论 MRI能良 好显示腱鞘巨细胞瘤的典型影像特征,能 够为临床对疾病的诊治提供可靠依据,帮 助临床医生做出正确判断以及制定治疗方 案。

Objective To investigate the MRI typical imaging characteristics of Giant Cell Tumor of Tendon Sheath(GCTTS), and its diagnostic value on GCTTS. Methods A total of 43 cases with GCTTS confirmed by operation and pathology in our hospital from May 2015 to September 2017 were all given MRI scanning, imaging data and clinical data of patients were collected, imaging characteristics and detection condition of GCTTS in MRI examination were analyzed. Results All the 43 cases of GCTTS showed welldefined parosteal tendon soft tissue mass or soft tissue mass around the tendon. And 35 cases were localized type giant cell tumor, 8 cases were diffuse type giant cell tumor. 24 cases of lesions showed iso-intense signal on T1WI, 12 cases of lesions showed hypointense signal, 7 cases of lesions showed slight hypo-intense signal. 14 cases of lesions showed mixed signal on T2WI, 9 cases of lesions showed slightly hyperintense signal, 11 cases of lesions showed obviously hyperintense signal, 9 cases (20.00%) of lesions showed low signal. There were 9 cases given MR enhancement scan, with homogeneous or heterogeneous density, and enhancement region with clear border. Conclusion MRI can displayed the imaging characteristics of GCTTS clearly, it can provide reliable evidence for clinical diagnosis and treatment, and can help doctors make correct judgment and therapeutic schedule.

【关键词】腱鞘巨细胞瘤;MRI;影像特征

【中图分类号】R738.6;R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2018.09.043

前言

腱鞘巨细胞瘤是一种好发于手指和手部的良性肿瘤,肿块可侵袭 邻近骨骼,足趾部少见。腱鞘巨细胞瘤多见于青年人,其中女性患者 多于男性患者。腱鞘巨细胞瘤的生长速度较为缓慢,多无明显临床症 状表现。临床上对该病通常采取手术切除的方法进行治疗,术后约有 10%的患者复发,但无明显转移现象发生[1-2]。目前临床对腱鞘巨细胞 瘤的主要检查手段为影像学检查和组织病理学检查,而影像检查以MRI 扫描为主。有相关研究表明MRI对软组织的扫描具有较高的分辨率,对 软组织肿块和邻近骨组织的侵蚀破坏情况均能得到良好显示,此外, 还能充分显示病灶对周围骨骼以及肌肉等的累及情况,对腱鞘巨细胞 瘤的组织成分能充分显示[3-4]。为此,本文收集了43例腱鞘巨细胞瘤患 者的影像学资料,分析了其腱鞘巨细胞瘤的MRI典型影像特征,现报道 如下。