不同病理类型腱鞘巨细胞瘤的MRI特点

目的 探讨腱鞘巨细胞瘤不同病理类型的MRI特点。方法 回顾性分析33例经手术及病理证实的腱鞘巨细胞瘤的MR图像,并以最新版(2013)WHO软组织肿瘤分类标准将患者分为局限型、弥漫型和恶性;从发病部位、累及范围、形态特点、信号特征、伴随征象及复发情况等方面分析不同类型患者的MR特征。结果 33例腱鞘巨细胞瘤中局限型18例,弥漫型15例,无恶性病例;所有病灶均发生于大小关节内或关节旁,其中局限型中发生于小关节者 14例,大关节者4例;弥漫型中发生于大关节者12例,小关节者3例。局限型中累及关节外者16例,同时累及关节内外者2例;弥漫型中同时累及关节内外者13例,仅累及关节外者2例。局限型中单发16例,多发2例,边界清楚者16例,边界不清者2例;弥漫型中单发2例,多发13例,15例均边界不清。局限型中伴邻近骨质压迫吸收者3例,弥漫型12例;局限型中无复发者,弥漫型中2例复发。结论 不同病理类型的腱鞘巨细胞瘤MRI表现各有一定的特点, MRI对腱鞘巨细胞瘤的诊断及其分型方面具有重要价值。

MRI features of different pathological types of tendon sheath giant cell tumor

Objective To observe MRI manifestations of different pathological types of giant cell tumor of tendon sheath (GCTTS). Methods MRI manifestations of 33 patients with GCTTS confirmed by operation and pathology were retrospectively analyzed. All patients were divided into focal giant cell tumor of tendon sheath (F-GCTTS), diffuse giant cell tumor of tendon sheath (D-GCTTS), and malignant giant cell tumor of tendon sheath (M-GCTTS) according to 2013 WHO classification of soft tissue tumors about GCTTS. Location, range, morphological characteristics, signal features, accompanying signs, and recurrence tendency were analyzed. Results Among 33 cases with GCTTS, 18 cases were F-GCTTS, 15 cases were D-GCTTS, and there was no M-GCTTS. All lesions occurred in joint or nearby the joint. For F-GCTTS, there were 14 cases occurred in small joint, 4 cases occurred in big joint, while for D-GCTTS, 12 cases occurred in big joint, 3 cases occurred in small joint. Among the 18 cases of F-GCTTS, 16 cases just involved the part of extra-articulations, 2 cases involved both extra-articulation and intra-articulation; while for the 15 cases of D-GCTTS, 13 cases involved both extra-articulation and intra-articulation, 2 cases just involved the part of extra-articulation. Among the 18 cases of F-GCTTS, 16 cases were solitary, 2 cases were multiple; and 16 cases had well-defined periphery, 2 cases had ill-defined margin. While for the 15 cases of D-GCTTS, 2 cases were solitary, 13 cases were multiple; 15 cases had ill-defined margin. Three cases accompanied with compression absorption of the adjacent bone in F-GCTTS, and 12 cases in D-GCTTS. There was no recurrence case in F-GCTTS, while there were 2 recurrence cases in D-GCTTS. Conclusion Different pathological types of GCTTS have different MRI manifestations. MRI findings are of great value for diagnosis and classification of GCTTS.