膝关节滑膜病变的MR诊断及鉴别诊断  

MR Diagnosis and Differential Diagnosis of the Synovial Diseases in the Knee Joint

作　　者：马立恒[1] 彭振鹏[2] 张朝晖[2] 陈应明[2] 肖萍[3] 孟悛非[2] 刘斯润[4] 

机构地区：[1]澳门镜湖医院放射科 [2]中山大学附属第一医院放射科 [3]中山大学附属第一医院病理科 [4]暨南大学附属第一医院放射科

出　　处：《中国医学计算机成像杂志》2011年第1期59-64,共6页Chinese Computed Medical Imaging

摘　　要：目的:探讨膝关节滑膜病变的MR诊断及鉴别诊断。方法:收集33例经病理确诊的膝关节滑膜病变的磁共振检查资料,以T1WI上邻近正常肌肉组织的MR信号为参照,将膝关节滑膜病变分为含T2WI低信号的病变和不含T2WI低信号的病变,回顾性分析其MR表现,并结合相应的大体及组织学所见,探讨MR对膝关节滑膜病变的诊断价值。结果:含T2WI低信号的病变包括局灶型腱鞘巨细胞瘤3例、色素性绒毛结节性滑膜炎13例和滑膜结核5例;不含T2WI低信号的病变包括类风湿关节炎4例、慢性滑膜炎3例、关节内非特异性炎症4例和慢性化脓性滑膜炎1例。所有病例MR成像的共同特征为滑膜不均匀增厚,部分呈结节状或绒毛状改变,但其病变分布、信号特点及邻近结构受累程度具有一定的差异性。结论:以T1WI上邻近正常肌肉组织的MR信号为参照,将膝关节滑膜病变分为含T2WI低信号的病变和不含T2WI低信号的病变有利于明晰诊断思路。对于含T2WI低信号的病变,可利用MR不同序列信号特点反映组织不同生化成分的特性进行鉴别诊断。Purpose： To evaluate the MRI diagnosis and differential diagnosis of the synovial diseases in the knee joint.Methods：The materials of thirty-three patients with synovial disease in the knee joint confirmed by histopathology were collected.To evaluate the MR Imaging of the synovial disease in the knee joint,the synovial lesions were classified as lesions containing hypointense structures and containing no hypointense structures on T2WI,which were according to the adjacent muscular intensity on T1WI.Then the MR images of the lesions were reviewed retrospectively combined with the histopathological findings.Results： Among the lesions containing hypointense structures on T2WI,3 were localized type of giant cell tumour of tendon sheat,13 were pigmented villonodular synovitis, 5 were synovial tuberculosis.Among the lesions containing no hypointense structures on T2WI,4 were rheumatoid arthritis,3 were chronic synovitis,4 were intraarticular nonspecific inflammation,1 were chronic suppurative synovitis.The common characteristics of the MR images were appeared as inhomogeneous thickening of the synovium,some of which appeared as nodular and villonodular.However,there were differences in the distribution,the signal characteristics of the lesion and the involvement of the adjacent structure.Conclusion： It can simplify the diagnostic clue to classify the synovial lesions of the knee joint as lesions containing hypointense structures and containing no hypointense structures on T2WI according to the adjacent muscular intensity on T1WI.For the lesions containing hypointense structures on T2WI,the use of different MR sequences which can reveal different biochemical components may be useful to distinguish the synovial lesions of the knee joint.

关 键 词：膝关节 滑膜 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R684[医药卫生—诊断学]