MRI在膝关节痛风结节与腱鞘巨细胞瘤鉴别诊断中的应用价值  

The diagnostic value of MRI in differentiating between tophus and giant cell tumors of the tendon sheath in the knee

作　　者：边海成 田娜 宋春霖 李西瑞 杨晓楠 柴荣鑫 徐文坚[1] 崔久法[1] 郝大鹏[1] Bian Haicheng;Tian Na;Song Chunlin;Li Xirui;Yang Xiaonan;Chai Rongxin;Xu Wenjian;Cui Jiufa;Hao Dapeng(Department of Radiology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Endocrinology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院放射科,青岛266003 [2]青岛大学附属医院内分泌科,青岛266003

出　　处：《中华放射学杂志》2025年第3期321-327,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(82472067);山东省自然科学基金(ZR2024MH016)。

摘　　要：目的探讨MRI征象在膝关节痛风结节与腱鞘巨细胞瘤鉴别诊断中的价值。方法该研究为病例对照研究,回顾性分析2018年9月至2024年9月青岛大学附属医院膝关节痛风结节和腱鞘巨细胞瘤患者的临床和MRI资料,分别为23、22例。分析T 1WI、脂肪抑制T 2WI和质子密度加权成像,记录MRI特征包括病变信号及其均质性、病变边界、病变最大径、病变部位(滑膜腔内外)、病变是否位于韧带/肌腱走行区、是否累及韧带/肌腱实质、邻近骨质侵蚀、骨髓水肿、滑膜增生、关节积液及关节周围软组织是否肿胀。采用独立样本t检验、χ^(2)检验或Fisher确切概率法比较两者MRI征象的差异。计算差异有统计学意义的特征鉴别两种疾病的效能,采用多因素logistic回归分析确定独立预测因素。结果膝关节痛风结节与腱鞘巨细胞瘤患者间在病变最大径、病变部位(滑膜腔内外)、病变是否位于韧带/肌腱走行区、是否累及韧带/肌腱实质、邻近骨质侵蚀、骨髓水肿及关节周围软组织肿胀的差异有统计学意义(P均<0.05),其他征象差异无统计学意义(P均>0.05)。病变部位(滑膜腔内外)和韧带/肌腱实质受累鉴别两种疾病的灵敏度、特异度最高,分别为0.78、0.95和0.78、1.00。多因素logistic回归分析显示,病变部位(滑膜腔内外)是区分膝关节痛风结节与腱鞘巨细胞瘤的独立预测因素(OR=31.48,95%CI 1.58~625.69,P=0.024)。结论病变部位(滑膜腔内外)和韧带/肌腱实质受累有助于区分膝关节痛风结节与腱鞘巨细胞瘤,病变部位(滑膜腔内外)是两者独立预测因素。ObjectiveTo evaluate the diagnostic value of MRI findings in differentiating between tophus and giant cell tumors of the tendon sheath(GCTTS)in the knee.MethodsThe study was a case-control study.The clinical and MRI data of patients diagnosed with knee tophus or GCTTS was retrospectively analyzed at the Affiliated Hospital of Qingdao University from September 2018 to September 2024.The study included 23 cases of tophus and 22 cases of GCTTS.MRI sequences,including T 1WI,fat-suppressed T 2WI,and proton density weighted imaging,were evaluated.Parameters including lesion signal intensity and homogeneity,margin,maximum diameter,location(inside or outside the synovial cavity),ligament/tendon involvement,ligament/tendon parenchymal changes,adjacent bone erosion,bone marrow edema,synovial hyperplasia,joint effusion,and periarticular soft tissue swelling were recorded.Independent sample t-tests,χ^(2)tests,or Fisher exact tests were used to compare MRI findings between the two groups.Multivariate logistic regression was performed to identify independent predictive factors.ResultsSignificant differences in terms of maximum diameter,location(inside or outside the synovial cavity),ligament/tendon involvement,ligament/tendon parenchymal changes,adjacent bone erosion,bone marrow edema,and periarticular soft tissue swelling between the two groups were found(all P<0.05).No significant differences for other parameters were observed(all P>0.05).Lesion location and ligament/tendon parenchymal involvement demonstrated the highest sensitivity and specificity for distinguishing the two diseases.The sensitivity and specificity values for lesion location were 0.78 and 0.95.The sensitivity and specificity values for ligament/tendon involvement were 0.78 and 1.00.Multivariate logistic regression identified lesion location(inside or outside the synovial cavity)as an independent predictor for differentiating tophus from GCTTS(OR=31.48,95%CI 1.58-625.69,P=0.024).ConclusionThe location of the lesion(inside or outside the synovial cavity)and

关 键 词：痛风 腱鞘巨细胞瘤 磁共振成像 膝关节 

分 类 号：R68[医药卫生—骨科学]