髋关节滑膜肉瘤的影像学表现

目的：分析髋关节滑膜肉瘤的影像学特点,提高诊断的准确性。方法：髋关节周围软组织滑膜肉瘤患者6例,其中4例行DR（digital radiography）拍片,1例行CT检查,6例患者均行MRI（underwent magnetic resonancei maging）检查。回顾分析相关影像学资料,总结其影像学特点。结果：DR表现为髋关节不规则骨质破坏。CT表现为髋关节周围密度不均匀软组织肿块,内中可见斑点状钙化影,邻近骨质不规则破坏。MRI表现为髋关节周围软组织肿块,边界不清;T1WI呈低信号,T2WI呈高、低混杂信号,脂肪抑制序列T2WI呈混杂高信号。结论：发现髋关节周围软组织肿块并邻近骨质不规则破坏,要考虑滑膜肉瘤的可能性。DR、CT、MRI三者相结合有助于髋关节滑膜肉瘤的诊断。     

滑膜肉瘤的影像学诊断

目的 探讨滑膜肉瘤的影像学特征.方法 搜集经病理证实的滑膜肉瘤22例,所有病例均行X线检查,其中同时行CT检查者18例,行MR检查者20例,3种检查都进行者15例.分析其X线、CT及MRI表现,总结影像学特征.结果 22例滑膜肉瘤均临近关节,16例位置深在.X线及CT表现为略高密度软组织肿块,5例肿块内有钙化,7例邻近有骨质破坏.MRI T1WI呈略低信号,T2WI呈高信号,13例肿块内有坏死、囊变区,9例肿瘤内可见条形低信号间隔,增强后肿瘤10/13例呈显著且不均匀强化.结论 滑膜肉瘤具有一定的影像学特征,MRI是诊断滑膜肉瘤的首选方法.     

软组织恶性纤维组织细胞瘤的临床影像学诊断

目的:回顾性分析26例恶性纤维组织细胞瘤(MFH)的临床影像学表现,讨论其影像学诊断。方法:搜集经手术病理及免疫组化证实的MFH 26例,男15例,女11例,40岁21例,占80.77%。病史3个月~5年。7例摄有X线平片。CT平扫17例,增强扫描8例。MR平扫15例,增强扫描8例。病灶大多位于大腿、小腿、前臂和臀部。23例位于深部软组织,3例位于表浅软组织。结果:21例(80.77%)呈不规则长圆形或长条形软组织肿块,直径5cm。3例X线平片表现为软组织肿块伴邻近骨质侵蚀性破坏,2例伴有骨膜增生。CT平扫多呈等、低或略低密度,仅1例高密度。CT增强均表现为明显不均匀强化,病灶边界均不清,累及邻近肌肉。CT上2个病灶内可见弧形钙化,其病灶直径均5.0cm。13例可见邻近骨骼破坏或骨膜增生。MR平扫15例,T1WI多呈等或低信号,合并出血4例。T2WI多呈高信号或混杂信号,10例病灶周围可见片状水肿信号。MR增强扫描8例,均呈明显不均匀强化,2例边界清楚,邻近肌肉受压推移,12例边界不清,邻近肌肉侵犯。6例可见邻近骨骼受侵。结论:发生于中老年人,位于下肢、前臂深部软组织的巨大肿块,尤其是呈长圆形分叶状或不规则长条状软组织肿块,边界不清,伴有邻近骨质破坏或骨膜反应,增强扫描呈明显不均匀强化者,应首先考虑恶性纤维组织细胞瘤。     

软组织滑膜肉瘤的CT和MRI诊断

目的：探讨软组织滑膜肉瘤的影像学表现。方法：回顾性分析17例经手术病理证实的软组织滑膜肉瘤患者的临床及影像学资料,分析其影像学征象。结果：大部分滑膜肉瘤影像表现为邻近关节边界较为清楚的团块状或分叶状软组织肿块,肿瘤体积一般较大（〉5 cm,88%）。CT平扫可见肿瘤大部分密度与肌肉密度相似,其内可见范围不等的低密度区,1例见团块状钙化,2例见斑点状钙化,主要位于肿块的周边。较大的肿瘤（〉5 cm）在MR T1WI上与肌肉信号相比呈不均匀等信号或稍高信号,在T2WI上表现为以高信号或稍高信号为主的混杂信号,5例肿块内可见低信号分隔;较小的肿瘤（〈5 cm）在各序列上均表现出信号的均匀性;增强扫描大部分肿瘤呈明显不均匀强化。结论：软组织滑膜肉瘤的影像学表现具有一定的特征性,CT和MRI综合评价有助于提高滑膜肉瘤的诊断准确性。     

滑膜肉瘤的临床影像学诊断(附33例报告)

目的:总结33例滑膜肉瘤的临床影像学表现特点,探讨其诊断依据。方法:搜集经手术病理证实的滑膜肉瘤33例,其中男性20例,女性13例,病史1个月~5年,主要症状为局部软组织肿块。33例均摄有X线平片;21例行CT检查,其中14例同时行增强扫描。18例行MR平扫,15例行增强扫描。结果:33例X线表现为局部软组织肿块,5例(15.15%)可见斑点状钙化灶,2例(6.06%)可见大片状钙化。21例CT平扫均表现为低密度类圆形或分叶状软组织肿块,6例边界清楚,周围肌肉受推压变薄;15例边界不清,周围肌肉与病灶间无清楚边界。病灶最大径2.10~18.60cm。9例伴有邻近骨质侵蚀性溶骨性破坏,破坏边缘锐利,无硬化边;6例(28.57%)软组织肿块内可见斑点状或斑片状钙化灶;2例(9.52%)可见大片状不均匀钙化。7例包绕邻近关节生长。14例行CT增强扫描,病灶呈明显不均匀逐渐强化,其中12例(57.14%)可见到大小不一的囊状无强化区。18例T1WI均表现为不均匀低信号或略低信号,T2WI上呈不均匀高信号,11例(61.11%)出现高、中、低"三重信号"征。病灶最大径2.40~20.10cm。8例边界清楚;10例侵犯邻近肌肉,边界不清,周围出现明显水肿信号。4例病灶中可见短T1长T2出血信号;2例(11.11%)病灶囊变区内可见明显的液-液平面。15例MR增强扫描表现为病灶明显不均匀强化,其中10例(66.67%)病灶内含有大小不一、无强化的囊状结构。7例包绕邻近关节生长的病灶,侵蚀性骨质破坏表现较CT明显。结论:滑膜肉瘤具有一定的临床影像学特征,但需要与多种软组织肿瘤进行鉴别。     

四肢软组织横纹肌肉瘤的影像学分析

目的探讨四肢软组织横纹肌肉瘤的影像学特征及提高对其诊断水平。资料与方法回顾性分析6例经病理证实的四肢横纹肌肉瘤的影像学表现。5例行MRI增强扫描,2例行CT增强扫描。结果 1例发生于上肢,5例发生于下肢,5例边界较清晰。在MRI上与肌肉相比,T1WI上以等信号为主,2例内部可见线条状留空信号,T2WI呈不均匀高信号,T2WI抑脂序列上呈较均匀的高信号,注射Gd-DTPA增强扫描,3例病灶呈不均匀明显强化,2例病灶强化较均匀;4例可见明显包膜形成,瘤周未见水肿。2例在CT检查中显示病变与肌肉相比在平扫可见等、低密度成分,以前者为主,1例相邻骨质可见溶骨性破坏且瘤内可见散在不规则钙化影,增强扫描轻度及明显强化各1例。结论四肢软组织横纹肌肉瘤无明显影像学特征,若在检查中发现四肢软组织肿块且强化明显时,横纹肌肉瘤应纳入鉴别诊断中,最终确诊依靠病理检查。     

骨单发性骨髓瘤的影像学表现

目的:分析骨单发性骨髓瘤的影像学表现特点,提高对此病的认识。方法:对8例手术或活检病理证实为单发性骨髓瘤的影像学表现进行分析。结果:所有病灶均为单骨发病,发生于胸椎2例,股骨2例,肋骨2例,髂骨1例,锁骨1例,2例确诊2～3年后发生多发性骨髓瘤。2例发生胸椎者呈溶骨性破坏及压缩性骨折改变;发生于锁骨和肋骨等表现为膨胀性骨质破坏,其中发生于肋骨者骨质破坏周围见较大软组织肿块影;发生于股骨者骨质破坏较局限,边界较清楚,病变周围骨质硬化不明显,有不同程度骨膜反应,周围软组织肿块不明显。MR检查病灶边界清楚,T1WI稍低信号,脂肪抑制T2WI高信号,明显均匀强化。结论:骨单发性骨髓瘤常发生于男性,发病年龄比多发性骨髓瘤小,全身症状不明显,病变部位不同表现也各不相同,但病变边界均清楚。CT和MRI能更清楚地显示单发性骨髓瘤,MRI还可无创性评估骨髓浸润,发现X线平片和CT所不能显示的病变。     

儿童滑膜肉瘤CT、MRI表现

目的分析儿童滑膜肉瘤(synovial sarcoma,SS)的CT和MRI表现,探讨CT和MRI对滑膜肉瘤的诊断价值。方法回顾性分析7例经手术病理证实的滑膜肉瘤患者的临床和影像学资料。结果 7例SS发生于四肢及躯干深部软组织内,呈圆形或卵圆形,边界清晰,瘤体较大,6例病灶最大直径为3.4～17.8 cm,平均8.2 cm,仅1例病灶最大径小于2 cm。CT平扫呈等或稍低密度的软组织肿块,6例病灶内可见坏死区,3例病灶边缘合并有钙化。MRI平扫肿瘤实性部分T_1WI呈等或稍低信号,T_2WI病灶呈稍高或高信号,部分病灶内部可见分隔样低信号。CT增强和MRI增强表现相仿,多呈明显不均匀强化。结论 SS影像学表现具有一定特征性,CT和MRI综合评价有助于提高滑膜肉瘤的诊断,确诊仍需依靠病理学检查。     

骨原发淋巴母细胞淋巴瘤2例

正患者1女,50岁。因"腰臀部疼痛伴左大腿后侧放射痛、麻木20天"入院。CT:平扫示T12椎体轻度压缩变扁呈楔形变,椎体及双侧附件骨质密度不均匀,见斑片状溶骨性破坏,周围见软组织肿块影,肿块突入椎管内,脊髓受压,增强扫描病灶明显均匀强化。CT考虑为恶性骨肿瘤。MR:T12椎体稍变扁,其椎体及双侧附件信号异常,T1WI呈低信号,T2WI呈稍高信号(图1),周围见软组织块影,并见突入椎管     

滑膜肉瘤的MR表现(附8例报告)

目的:分析滑膜肉瘤的MRI表现,旨在提高对滑膜肉瘤磁共振影像特征的认识。方法:回顾分析8例经手术病理证实的滑膜肉瘤临床及MR影像资料。结果:8例患者男2例,女6例,年龄22～46岁,中位年龄37.4岁。①8例滑膜肉瘤MR表现为关节邻近的软组织肿块影,与相邻骨骼肌信号比较,肿瘤T1WI呈等信号,T2WI呈高信号。②7例滑膜肉瘤有明显强化,其中5例强化较均匀、2例不均匀强化伴有明显坏死和囊变;另有1例滑膜肉瘤仅轻微强化、病灶内见钙化、相邻骨质有破坏。③5例可见瘤内分隔征象;1例为多发病灶并见肿瘤包绕肌腱。结论:MR检查能够准确地发现肿瘤,敏感的显示其部位、形态、内部坏死和间隔征象以及对周围软组织、骨骼的侵犯,对肿瘤定性有较高的诊断价值。     

髋周骨肿瘤及肿瘤样病变影像学诊断

目的评价髋周骨肿瘤及肿瘤样病变的影像学表现。资料与方法回顾性分析82例经穿刺活检或手术病理证实的髋周骨肿瘤及肿瘤样病变的影像学表现。全部病例均行X线平片检查,42例行CT检查,24例行MRI检查。结果骨囊肿13例,动脉瘤样骨囊肿16例,骨巨细胞瘤6例,软骨母细胞瘤2例(合并动脉瘤样骨囊肿1例),骨母细胞瘤1例,骨样骨瘤3例,骨化性纤维瘤2例,非骨化性纤维瘤3例,骨纤维异常增殖症6例,嗜酸性肉芽肿3例,骨肉瘤4例,软骨肉瘤3例,恶性骨母细胞瘤1例,淋巴瘤2例,转移瘤17例。良性骨肿瘤17例(占20.7%),肿瘤样病变38例(占46.4%),原发恶性骨肿瘤10例(占12.2%),转移瘤17例(占20.7%)。结论髋周是良性骨肿瘤及肿瘤样病变的好发部位,X线平片+CT或X线平片+MRI是较好的综合检查手段。     

髋周单发局灶性骨纤维异常增殖症的影像学诊断

目的探讨髋周单发局灶性骨纤维异常增殖症（骨纤）的影像学表现及其诊断价值。资料与方法回顾性分析经手术病理证实的12例髋周单发局灶性骨纤的影像学表现,所有病例均行X线平片和CT检查,1例行MRI检查。结果12例均为单骨单发局灶性病灶,分别位于股骨颈4例,转子间区2例,转子下区3例和髋臼顶3例。4例股骨颈病灶呈凸向外上方的半圆形;2例转子间区和2例转子下区病灶呈与股骨长轴一致的纵椭圆形,1例转子下区病灶为圆形;3例髋臼顶部病灶呈圆形。病变均伴有硬化缘。CT上病灶内为高于肌肉的软组织密度,密度不均匀,内可见斑点状、絮状钙质样高密度影。MRT1WI上类似肌肉信号,T2WI上信号介于肌肉和正常骨髓之间,增强扫描T1WI呈较明显均匀强化。结论髋周单发局灶性骨纤形态规则,伴有清楚硬化缘,内含高于肌肉的软组织密度和斑点状、絮状钙质样高密度影为其特征,CT能对其作出正确的术前诊断。     

膝关节腔内游离体病变的影像学诊断

目的：总结分析膝关节腔内游离体病变的影像学表现。方法：回顾性分析24例经病理证实的膝关节腔内游离体病变的影像学表现,观察病变的形态及结构特征。结果：滑膜骨软骨瘤病5例,滑膜软骨肉瘤1例,色素沉着绒毛结节性滑膜炎2例,神经营养性膝关节病1例,骨性关节病7例,剥脱性骨软骨炎4例,血肿钙化2例,关节囊滑液钙化2例。影像学主要表现为关节间隙及或关节囊内单发或多发游离体并相邻骨质的不同程度改变或无骨质改变,伴或不伴关节积液。结论：膝关节腔内含游离体的某些病变具有特征性影像征象,可明确诊断,影像征象不典型者需结合临床病史及多种影像表现综合分析。     

滑膜软骨瘤病的影像学表现及其病理基础

目的：探讨滑膜软骨瘤病（SC）影像学表现及其病理基础。方法：回顾性分析经关节镜及病理证实的16例SC患者的影像资料,并与病理结果对照。结果：16例SC中累及膝关节12例（双膝关节同时累及1例）,累及踝关节2例,累及髋关节2例。16例均可见滑膜肥厚、关节内游离体及关节积液;增厚滑膜T1WI、FFE呈等或稍低信号,T2WI呈稍高信号;未钙化游离体T1WI、T2WI均呈中等信号,钙化游离体T1WI、T2WI均呈低信号,骨化游离体T1WI呈高信号、T2WI呈中等信号。部分病例见骨髓水肿、交叉韧带、半月板损伤及关节周围软组织肿胀。结论：MRI能够提供比较全面的影像学信息,可提高SC的诊断符合率,指导临床治疗。     

强直性髋关节炎平片与MRI分析

目的：分析强直性髋关节炎骨盆骨质疏松的细微结构和骨坏死的病理性征象。方法：收集北亚骨科医院强直性脊柱炎患者100例，其中8例行MR成像检查。分析髋部骨质疏松的特殊性和骨坏死征象以及关节软骨破坏程度。结果：髋部多发区域性骨小梁丢失、减少发生率最高85％，骶髂关节侵蚀破坏或骨性强直为100％，股骨头灶性骨坏死，吸收后表现单囊或多囊状破坏或有小死骨34％，关节破坏狭窄54％，股骨头关节软骨边缘滑膜骨化突出33％，耻骨联合吸收或硬化24％，坐骨结节骨化43％。结论：强直性髋关节炎主要表现为区域性迁移骨疏松和股骨头多发灶性骨坏死。     

Primary synovial chondrosarcoma of the hip joint in a 45-year-old male: case report and literature review

Synovial chondrosarcoma is a rare tumor, seen most commonly arising from antecedent synovial chondromatosis, the more common benign entity. The distinction between the two can be difficult on the basis of clinical, imaging, and histologic criteria. The authors report a case of pathologically proven synovial chondrosarcoma of the hip in a 45-year-old male initially treated for presumed synovial chondromatosis. The case is made more unusual by the fact that no evidence of co-existent synovial chondromatosis was noted at histology. The literature as regards synovial chondrosarcoma, both de novo and secondary cases, is reviewed.     

Idiopathic synovial chondromatosis in two unusual sites: inferior radioulnar joint and ischial bursa

Synovial chondromatosis is a rare disorder of unknown cause characterized by multiple calcific bodies in the vicinity of the affected joint. It is most commonly seen in the knee, hip, elbow, and shoulder. We describe three cases of synovial chondromatosis in two extremely uncommon sites, the inferior radioulnar joint and the ischial bursa, and review the literature on the subject. The characteristic radiographic appearance, even if in an uncommon location, should prompt the radiologist to suggest the correct diagnosis preoperatively.     

Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty

Purpose

Percutaneous synovial biopsy has recently been reported to have a high diagnostic value in the preoperative identification of periprosthetic infection of the hip. We report our experience with this technique in the evaluation of patients undergoing revision hip arthroplasty, comparing results of preoperative synovial biopsy with joint aspiration in identifying an infected hip arthroplasty by bacteriological analysis.

Materials and methods

We retrospectively reviewed the results of the 110 most recent revision hip arthroplasties in which preoperative synovial biopsy and joint aspiration were both performed. Revision surgery for these patients occurred during the period from September 2005 to March 2012. Using this study group, results from preoperative cultures were compared with preoperative laboratory studies and the results of intraoperative cultures. Synovial aspiration was done using an 18- or 20-gauge spinal needle. Synovial biopsy was done coaxially following aspiration using a 22-gauge Chiba needle or 21-gauge Sure-Cut needle. Standard microbiological analysis was performed on preoperative synovial fluid aspirate and synovial biopsy. Intraoperative tissue biopsy bacteriological analysis results at surgical revision were accepted as the “gold standard” for the presence or absence of infection.

Results

Seventeen of 110 (15 %) of patients had intraoperative culture-positive periprosthetic infection. Of these 17 cases, there were ten cases where either the synovial fluid aspiration and/or the synovial biopsy were true positive (sensitivity of 59 %, specificity of 100 %, positive predictive value of 100 % and accuracy of 94 %). There were seven cases where aspiration and biopsy results were both falsely negative, but no false-positive results. Similar results were found for synovial fluid aspiration alone. The results of synovial biopsy alone resulted in the identification of seven infected joints with no false-positive result (sensitivity of 41 %, specificity of 100 %, positive predictive value of 100 %, and accuracy of 91 %).

Conclusions

Standard microbiological analyses performed on percutaneous synovial biopsy specimen during the preoperative evaluation of patients undergoing revision hip arthroplasty did not improve detection of culture-positive periprosthetic infection as compared to synovial fluid aspiration alone.     

Amyloid arthropathy of the hip joint: MR demonstration of presumed amyloid lesions in 152 patients with long-term hemodialysis

The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39 %). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54 %), decreased signal intensity in 11 patients (18 %), and both increased and decreased signal intensity in 17 patients (28 %). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis. Received 5 August 1997; Revision received 22 October 1997; Accepted 11 February 1998     

儿童臀部硬纤维瘤的影像表现

目的:探讨臀部硬纤维瘤的超声、CT、MRI表现特征。材料和方法:搜集10例经手术病理证实的儿童臀部硬纤维瘤病例,均行超声、CT平扫及增强扫描,5例行MRI检查,分析其影像学特点。结果:臀部硬纤维瘤主要累及臀部肌肉、筋膜、骨膜等,呈浸润性生长,易复发。超声表现为不规则低回声肿块。CT表现为低密度软组织肿块(9例),等高密度肿块(1例),强化程度不等。MRI表现为臀部肿块,T1WI等低信号,T2WI多为稍高信号夹杂斑片低信号(3例),或等低信号(2例),增强后可见不均匀强化。结论:超声、CT及MRI检查可显示硬纤维瘤的大小、形态;MRI能从多个切面显示肿瘤范围以及周围组织受侵情况,并可推断组织成分,为临床治疗提供重要信息。