Limited usefulness of classic MR findings in the diagnosis of tenosynovial giant cell tumor
Limited usefulness of classic MR findings in the diagnosis of tenosynovial giant cell tumor
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DOI：
10.1007/s00256-020-03694-4
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发表时间：
2021-01-07
影响因子：
2.1
通讯作者：
Layfield, Lester J.
中科院分区：
文献类型：
--
作者：
Crim, Julia;Dyroff, Samantha L.;Layfield, Lester J.
目的探讨肌腱滑膜巨细胞瘤MRI显示含铁血黄素、瘤内脂肪信号及邻近滑膜组织的频率。材料与方法对31例伴有MRI表现的肌腱滑膜巨细胞瘤进行回顾性分析。检查图像中病变的大小、形态、起源、骨质侵蚀、MRI信号特征、对比度增强和鲜花状伪影，比较前瞻性报告和回顾报告。结果8例为弥漫性结节，23例为局限性结节。3例位于皮下组织，4例位于肌腱鞘外邻近肌腱。所有病灶均表现为低T1、T2加权信号。86%的弥漫性病变和27%的结节性病变在梯度回波成像上可见斑片状伪影。在评估开花时，观察者间的变异性为40%。97%的病例在H&E或铁染色上可见铁。脂肪信号强度仅在3%的病例中可见，但48%的病例中可见黄色瘤细胞。86%的弥漫性肿瘤和62%的结节状肿瘤的前瞻性放射学鉴别诊断中包含正确的诊断。结论GRE MRI对结节状腱鞘巨细胞瘤的诊断敏感性较低，在弥漫性肿瘤中并不普遍。在对开花的评估中，观察者间有很高的变异性。病变内脂肪信号不是一个有用的征象，可能发生在缺少腱鞘的肌腱附近，可能发生在皮下位置。
Objective To determine the frequency with which MRI of tenosynovial giant cell tumor demonstrates hemosiderin, visible intralesional fat signal, and proximity to synovial tissue.Material and methods This is a retrospective study of 31 cases of tenosynovial giant cell tumors which had concomitant MRI. Images were examined for lesion size, morphology, origin, bone erosions, MRI signal characteristics, contrast enhancement, and blooming artifact, comparing prospective and retrospective reports. Histology was reviewed for the presence of hemosiderin and xanthoma cells.Results Eight lesions were diffuse and 23 were localized nodules. Three lesions were located in subcutaneous tissue and 4 adjacent to tendons beyond the extent of their tendon sheath. All lesions exhibited areas of low T1- and T2-weighted signal. Blooming artifact on gradient echo imaging was present in 86% of diffuse and only 27% of nodular disease. There was interobserver variability of 40% in assessing blooming. Iron was visible on H&E or iron stain in 97% of cases. Fat signal intensity was seen in only 3% of cases, although xanthoma cells were present on in 48%. The correct diagnosis was included in the prospective radiology differential diagnosis in 86% of diffuse cases and 62% of nodular cases.Conclusion Blooming on GRE MRI has low sensitivity for nodular tenosynovial giant cell tumors and is not universal in diffuse tumors. There was high interobserver variability in assessment of blooming. Intralesional fat signal is not a useful sign and may occur adjacent to tendons which lack a tendon sheath and may occur in a subcutaneous location.