摘要
【目的】探讨髋关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的X线及MRI表现。【方法】回顾性分析19例经手术及病理证实的髋关节PVNS的X线及MRI资料并进行总结。19例髋关节病变均行MRI检查,其中增强扫描9例;X线平片检查10例。【结果】(1)X线表现:10例中有6例表现为关节囊肿胀,2例关节周围可见稍高密度肿块影,所有病例均有程度不一的关节间隙变窄,2例未见骨质异常,8例见不同程度关节边缘、头颈交界处及粗隆部浅表性缺损或深在的类圆形、不规则状骨质缺损以及骨性关节面下囊样透亮区,病灶边缘均有硬化边。4例关节边缘可见骨赘形成,3例同时伴骨质疏松。(2)MRI表现:19例中弥漫型17例,局灶型2例。17例弥漫型中5例见关节腔积液,所有病例关节滑膜均呈不同程度弥漫性增生肥厚,其中13例其内可见多发散在点状或小结节灶,T1WI和T2WI均呈低信号,14例示髋臼、股骨头、头颈交界处及粗隆部出现不同程度骨质侵蚀及凹陷缺损,骨缺损区的信号与增生肥厚的滑膜信号大致相同,其中8个病灶周围绕以低信号环,关节骨性关节面下亦可见囊性变,呈中等稍低T1WI、T2WI信号,邻近骨髓腔内可见弥漫性反应水肿,于T2WI/STIR呈片状高信号,8例增强扫描显示关节内外的滑膜及骨内病灶均明显强化,2例局灶型PVNS均表现为股骨颈外侧单发性肿块,T1WI呈中等稍低信号,T2WI呈中等稍高信号,内见多发点状及小结节状灶,在T1WI和T2WI均呈低信号,其中1例邻近股骨颈外缘见弧状缺损。【结论】髋关节色素沉着绒毛结节性滑膜炎的MRI表现具有一定特征性,对PVNS有定性诊断价值;而X线平片对本病的诊断有一定提示作用,但在准确诊断上有一定限度。
Objective To investigate the X-ray photographic and magnetic resonance imaging (MRI) features of hip pigmented villonodular synovitis (PVNS). Methods A retrospective analysis was carried out in 19 patients with hip PVNS confirmed by operation and pathological examination. The X-ray plain photography in 10 patients and MRI features in 19 patients (of which 9 received enhanced scan) were analyzed. Results (1) The results of X-ray photography were as follows: Of 10 patients, 6 showed swollen joint capsule, 2 had higher-density masses around the joint; joint space narrowing was found in all of the 10 patients; except 2 patients, 8 showed various degrees of bone erosion in the margin area of the joint, in the intertrochanteric area and around neck , and showed capsule-like clear focus area with sclerotic margin in the joint surface of the bone; bonespur was found in the edge of the joints of 4 patients, of which 3 were complicated with osteoporosis. (2) The manifestations of MRI features: of 19 patients with hip PVNS, 17 were differentiated as the diffused and 2 as the focalized. All of 17 diffused hip PVNS showed different degrees of diffuse hyperplasia of synovium, 5 of them had intra-articular effusion, 13 showed multiple-diffused nodular synovial changes with low signals of T1WI and T2WI, 14 showed different degrees of bony erosion and depression in acetabulum, in the head of the femur and around the neck, which signals were similar to those with synovial hyperplasia. Of the 14 patients, 8 foci presented circular low signals, capsule-like clear images under the bony joint surface with medium to low signals of T1WI and T2WI, and diffused swelling close to medullar cavities with sheet-like high signals of T2WI/STIR. The results of contrastenhanced scanning for 8 of the 14 patients showed enhanced signals in the joint synovium and focus area of joint bones. Two focalized PVNS patients showed single mass on the outer flank of the femoral neck with medium to low T1WI signal and with medium to hi
出处
《广州中医药大学学报》
CAS
2009年第3期311-314,共4页
Journal of Guangzhou University of Traditional Chinese Medicine