颞颌关节区腱鞘巨细胞瘤的MRI表现
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摘要
目的:探讨颞颌关节区腱鞘巨细胞瘤(GCTTS)的MRI表现。方法:回顾性分析经手术病理证实的14例颞颌关节区GCTTS的MRI资料,所有病例均行颌面部常规3.0T MRI平扫及增强扫描,其中8例行磁共振动态增强(DCE-MRI)扫描,2例行~1H-MRS检查。结果:14例GCTTS均呈弥漫性生长,伴明显骨质破坏,以膨胀性、溶骨性破坏为主,6例同时伴膨胀性、溶骨性骨质破坏,并出现颞颌关节间隙增宽及颅底组织的侵犯。14例GCTTS中,在T_1W I上呈等低信号10例(10/14)、等信号3例(3/14)、混杂高信号1例(1/14);在T_2WI上病灶呈稍高信号6例(6/14)、低信号5例(5/14),混杂信号3例(3/14)。注射Gd-DTPA增强后,9例呈轻中度强化,4例呈明显强化,1例未见明显强化。DCE-MRI结果显示,7例时间-信号强度曲线(TIC)为速升平台型,1例为持续上升型。2例~1H-MRS扫描均在3.2ppm处可见明显Cho峰。结论:颞颌关节区GCTTS表现为弥漫性、侵袭性生长;T_1WI上以等/等低信号为主,T_2WI上信号多样,可呈低、高及混杂信号;注入Gd-DTPA增强后可出现轻中度强化、明显强化;TIC以速升平台型为主。
Objective:To evaluate the MRI features of giant cell tumour of tendon sheath(GCTTS) in temporomandibular joint area.Methods:MRI of 14 patients with surgical and pathological proved GCTTS were analyzed in retrospective.All patients underwent plain and contrast-enhancement MRI scan of the maxillofacial region,and 8 of them underwent dynamic contrast-enhancement MRI scan(DCE-MRI),while 2 of them underwent ~1H-MR spectroscopy scan.Results:In MR images,all of the 14 cases of GCTTS showed diffuse growth pattern with significant bone destructions which were mainly expansive and osteolytic.6 of them with expansive and osteolytic bone destruction showed widened temporomandibular joint space and skull base destruction.In T_1 weighted images,10 cases were hypo-intensity(10/14),3 cases were iso-intensity(3/14) and 1 case was heterogeneous hyperintensity.In T_2 weighted images,6 cases were slightly hyper-intensity(6/14),5 cases were hypo-intensity(5/14) and 3 cases were heterogeneous intensity.After GD-DTPA enhancement,9 cases showed mild to moderate enhancement,4 cases showed obvious enhancement and 1 case showed no insignificant enhancement.According to DCE-MRI,7 cases showed time-intensity-curves(TIC) as a rapid rise followed by a plateau,and 1 case showed TIC as a continuously slow rise type.According to ~1H-MRS images of 2 cases,a distinctly Cho crest peak appeared at 3.22 ppm in both of them.Conclusion:Imaging findings of GCTTS in the temporomandibular joint areas could be diffuse and aggressive growth pattern,mainly iso-or iso-to hypointensity in T_1WI and varies in T_2WI which could be hypo-,iso-,hyper-or mixed.In DCE-MRI,GCTTS could be slightly,moderately or fiercely enhanced.TIC mainly showed as curves with a rapid rise followed by a plateau.
Objective:To evaluate the MRI features of giant cell tumour of tendon sheath(GCTTS) in temporomandibular joint area.Methods:MRI of 14 patients with surgical and pathological proved GCTTS were analyzed in retrospective.All patients underwent plain and contrast-enhancement MRI scan of the maxillofacial region,and 8 of them underwent dynamic contrast-enhancement MRI scan(DCE-MRI),while 2 of them underwent ~1H-MR spectroscopy scan.Results:In MR images,all of the 14 cases of GCTTS showed diffuse growth pattern with significant bone destructions which were mainly expansive and osteolytic.6 of them with expansive and osteolytic bone destruction showed widened temporomandibular joint space and skull base destruction.In T_1 weighted images,10 cases were hypo-intensity(10/14),3 cases were iso-intensity(3/14) and 1 case was heterogeneous hyperintensity.In T_2 weighted images,6 cases were slightly hyper-intensity(6/14),5 cases were hypo-intensity(5/14) and 3 cases were heterogeneous intensity.After GD-DTPA enhancement,9 cases showed mild to moderate enhancement,4 cases showed obvious enhancement and 1 case showed no insignificant enhancement.According to DCE-MRI,7 cases showed time-intensity-curves(TIC) as a rapid rise followed by a plateau,and 1 case showed TIC as a continuously slow rise type.According to ~1H-MRS images of 2 cases,a distinctly Cho crest peak appeared at 3.22 ppm in both of them.Conclusion:Imaging findings of GCTTS in the temporomandibular joint areas could be diffuse and aggressive growth pattern,mainly iso-or iso-to hypointensity in T_1WI and varies in T_2WI which could be hypo-,iso-,hyper-or mixed.In DCE-MRI,GCTTS could be slightly,moderately or fiercely enhanced.TIC mainly showed as curves with a rapid rise followed by a plateau.
引文
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[9] O'Connell JX,Fanburg JC,Rosenberg AE.Giant cell tumor of tendon sheath and pigmented villonodular synovitis:immunophenotype suggests a synovial cell origin[J].Hum Pathol,1995,26(7):771-775.
[10] Akahane T,Mori N,Yoshida K.Giant cell tumor of the tendon sheath extending around the patellar tendon and invading the knee joint and tibia:a case report[J].Oncol Lett,2014,8(6):2800-2802.
[11] Khart S,Neumann CH,Steinbach LS,et al.MRI of giant cell tumor of the tendon sheath of the hand:a report of three cases[J].Eur Radiol,1995,5(2):467-470.
[12] Assili S,Fathi KA,Aghaghazvini L,et al.Dynamic contrast magnetic resonance imaging (DCE-MRI) and diffusion weighted MR imaging (DWI) for differentiation between benign and malignant salivary gland tumors[J].J Biomed Phys Eng,2015,5(4):157-168.
[13] 艾松涛,孙明华,余强,等.手足局限性腱鞘巨细胞瘤的MRI表现[J].放射学实践,2008,23(5):543-546.
[14] Shen Y,Ma C,Wang L,et al.Surgical management of giant cell tumors in temporomandibular joint region involving lateral skull base:a multidisciplinary approach[J].J Oral Maxillofac Surg,2016,74(11):2295-2311.
[15] Takashima S,Noguchi Y,Okumura T,et al.Dynamic MR imaging in the head and neck[J].Radiology,1993,189(3):813-821.
[16] Rateb K,Hassen BG,Leila A,et al.Giant cell tumor of soft tissues:a case report of extra-articular diffuse-type giant cell tumor of the quadriceps[J].Int J Surg Case Rep,2017,31:245-249.
[17] Maheshwari AV,Muro-Cacho CA,Pitcher JD Jr.Pigmented villonodular bursitis/diffuse giant cell tumor of the pes anserine bursa:a report of two cases and review of literature[J].Knee,2007,14(5):402-407.
[18] Mitnick JS,Pinto RS.Computed tomography in the diagnosis of eosinophilic granuloma[J].J Comput Assist Tomogr,1980,4(6):791-793.
[2] Nicoli TK,Saat R,Kontio R,et al.Multidisciplinary approach to management of temporal bone giant cell tumor[J].J Neurol Surg Rep,2016,77(3):e144-e149.
[3] Sheppard DG,Kim EE,Yasko AW,et al.Giant-cell tumor of the tendon sheath arising from the posterior cruciate ligament of the knee:a case report and review of the literature[J].Clin Imaging,1998,22(6):428-430.
[4] Freeman J,Oushy S,Schowinsky J,et al.Invasive giant cell tumor of the lateral skull base:a systematic review,Meta-analysis and case illustration[J].World Neurosurg,2016,96:47-57.
[5] De Beuckeleer L,De Schepper A,De Belder F,et al.Magnetic resonance imaging of localized giant cell tumour of the tendon sheath (MRI of localized GCTTS)[J].Eur Radiol,1997,7(2):198-201.
[6] Kitagawa Y,Ito H,Amano Y,et al.MR imaging for preoperative diagnosis and assessment of local tumor extent on localized giant cell tumor of tendon sheath[J].Skeletal Radiol,2003,32(11):633-638.
[7] 谢安,刘建滨,范立新,等.腱鞘巨细胞瘤MRI表现及信号特点[J].放射学实践,2012,27(9):990-993.
[8] 汤莉,周隽,张惠箴,等.腱鞘巨细胞瘤的临床病理特征及研究进展[J].临床与实验病理学杂志,2012,28(6):666-669.
[9] O'Connell JX,Fanburg JC,Rosenberg AE.Giant cell tumor of tendon sheath and pigmented villonodular synovitis:immunophenotype suggests a synovial cell origin[J].Hum Pathol,1995,26(7):771-775.
[10] Akahane T,Mori N,Yoshida K.Giant cell tumor of the tendon sheath extending around the patellar tendon and invading the knee joint and tibia:a case report[J].Oncol Lett,2014,8(6):2800-2802.
[11] Khart S,Neumann CH,Steinbach LS,et al.MRI of giant cell tumor of the tendon sheath of the hand:a report of three cases[J].Eur Radiol,1995,5(2):467-470.
[12] Assili S,Fathi KA,Aghaghazvini L,et al.Dynamic contrast magnetic resonance imaging (DCE-MRI) and diffusion weighted MR imaging (DWI) for differentiation between benign and malignant salivary gland tumors[J].J Biomed Phys Eng,2015,5(4):157-168.
[13] 艾松涛,孙明华,余强,等.手足局限性腱鞘巨细胞瘤的MRI表现[J].放射学实践,2008,23(5):543-546.
[14] Shen Y,Ma C,Wang L,et al.Surgical management of giant cell tumors in temporomandibular joint region involving lateral skull base:a multidisciplinary approach[J].J Oral Maxillofac Surg,2016,74(11):2295-2311.
[15] Takashima S,Noguchi Y,Okumura T,et al.Dynamic MR imaging in the head and neck[J].Radiology,1993,189(3):813-821.
[16] Rateb K,Hassen BG,Leila A,et al.Giant cell tumor of soft tissues:a case report of extra-articular diffuse-type giant cell tumor of the quadriceps[J].Int J Surg Case Rep,2017,31:245-249.
[17] Maheshwari AV,Muro-Cacho CA,Pitcher JD Jr.Pigmented villonodular bursitis/diffuse giant cell tumor of the pes anserine bursa:a report of two cases and review of literature[J].Knee,2007,14(5):402-407.
[18] Mitnick JS,Pinto RS.Computed tomography in the diagnosis of eosinophilic granuloma[J].J Comput Assist Tomogr,1980,4(6):791-793.
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