颞下颌关节色素沉着绒毛结节性滑膜炎的影像诊断
|
摘要
目的探讨颞下颌关节色素沉着绒毛结节性滑膜炎(PVNS)的影像表现,提高术前诊断的准确性。方法回顾性分析5例经手术和病理证实的颞下颌关节周围的PVNS的CT和MRI征象,其中5例行CT扫描,4例行MRI扫描,分析其CT及MRI的表现特点。结果 5例患者中,2例病变发生于右侧,3例发生于左侧。病变表现为以颞下颌关节区域为中心的软组织肿块和周围骨质的破坏,软组织肿块密度与咬肌类似或稍高于咬肌密度;骨质破坏表现为膨胀性骨质破坏、"虫蚀样"骨质破坏及侵袭性骨质破坏。4例行MRI扫描,T1WI及T2WI上病变均以低信号为主,散在片状高信号。结论当颞下颌关节周围的病变表现为以颞下颌关节为中心的软组织肿块伴周围骨破坏,且T1WI及T2WI上病变均以低信号为主时,应考虑颞下颌关节的PVNS。
Objective To explore CT and MRI findings of pigmented villonodular synovitis(PVNS) of the temporomandibular joint,and to improve the preoperative diagnostic accuracy.Methods The CT and MR images of 5 pathologically confirmed cases with PVNS of the temporomandibular joint were analyzed retrospectively.All of them underwent CT scan and 4 of them underwent MRI scan.The location of the lesions,tumor size,shape,density(signal),bone destruction and contrast-enhanced features were analyzed.Results All 5 cases showed lobulated soft tissue masses centering at the temporomandibular joint area with peripheral bone destruction,which 2 of them were on the right side and the remaining3 on the left.On CT images(n=5),the masses density of lesions in 3 cases are similar to that of the masseter,and the other 2 are slightly higher than that.The feature of bone destruction includes expansive bone destruction,moth-eaten bone destruction,and invasive bone destruction.On MRI images(n=4),all cases on T1 WI and T2 WI images all showed characteristic multiple visible low signal nodules and small flaky high signal scattered in the lesions.Conclusion The diagnosis of PVNS should be considered when the temporal lesions are characterized by bone destruction centering at the temporomandibular joint and soft tissue masses with distinctive MR signals.
Objective To explore CT and MRI findings of pigmented villonodular synovitis(PVNS) of the temporomandibular joint,and to improve the preoperative diagnostic accuracy.Methods The CT and MR images of 5 pathologically confirmed cases with PVNS of the temporomandibular joint were analyzed retrospectively.All of them underwent CT scan and 4 of them underwent MRI scan.The location of the lesions,tumor size,shape,density(signal),bone destruction and contrast-enhanced features were analyzed.Results All 5 cases showed lobulated soft tissue masses centering at the temporomandibular joint area with peripheral bone destruction,which 2 of them were on the right side and the remaining3 on the left.On CT images(n=5),the masses density of lesions in 3 cases are similar to that of the masseter,and the other 2 are slightly higher than that.The feature of bone destruction includes expansive bone destruction,moth-eaten bone destruction,and invasive bone destruction.On MRI images(n=4),all cases on T1 WI and T2 WI images all showed characteristic multiple visible low signal nodules and small flaky high signal scattered in the lesions.Conclusion The diagnosis of PVNS should be considered when the temporal lesions are characterized by bone destruction centering at the temporomandibular joint and soft tissue masses with distinctive MR signals.
引文
1林强,王淑艳,刘长林,等.色素沉着绒毛结节性滑膜炎[J].中华放射学杂志,2003,37:566-568.
2 Martin RC,Osborne DL,Edwards MJ,et al.Giant cell tumor of tendon sheath,tenosynovial giant cell tumor,and pigmented villonodular synovitis:defining the presentation,surgical therapy and recurrence[J].Oncol Rep,2000,7:413-419.
3 Darling JM,Goldring SR,Harada Y,et al.Multinucleated cells in pigmented villonodular synovitis and giant cell tumor of tendon sheath express features of osteoclasts[J].Am J Pathol,1997,150:1383-1393.
4 Carlson ML,Osetinsky LM,Alon EE,et al.Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base:Review of 11 cases[J].Laryngoscope,2017,127:2340-2346.
5 Gao QQ,Feng YY,Bu LX,et al.Pigmented villonodular synovitis of the temporomandibular jointreport of one case and review of literatures[J].Shanghai Kou Qiang Yi Xue,2016,25:381-384.
6 Pianosi K,Rigby M,Hart R,et al.Pigmented Villonodular Synovitis of the Temporomandibular Joint:A Unique Presentation[J].Plast Reconstr Surg Glob Open,2016,4:e674.
7方利华,平金良,刘逢佳,等.颞下颌关节区关节外弥漫性色素沉着绒毛结节性滑膜炎:1例报告及文献复习[J].上海口腔医学,2007,16:106-108.
8 Jaffe HL,Lichtenstein L,Sutro CJ.Pigmented villonodular synovitis,bursitis and tenosynovitis[J].Arch Pathol,1941:31,731-765.
9 Cascone P,Rinna C,Ungari C,et al.Pigmented villonodular synovitis of the temporomandibular joint[J].The Journal of craniofacial surgery,2005,16:712-716.
10李尚仲,闫新峰,齐承恩.色素沉着绒毛结节性滑膜炎的治疗进展[J].山东医药,2015,37:104-106.
11 Llauger J,Palmer J,Rosón N,et al.Pigmented villonodular synovitis and giant cell tumors of the tendon sheath:radiologic and pathologic features[J].Ajr American Journal of Roentgenology,2013,172:1087-1091.
12 Giannakopoulos H,Chou JC,Quinn PD.Pigmented villonodular synovitis of the temporomandibular joint[J].Ear Nose Throat J,2013,92:E10-E13.
13 Son SM,Park YS,Choi CH,et al.Extra-articular tenosynovial giant cell tumor of diffuse type in the temporal area with brain parenchymal invasion:a case report[J].Br J Neurosurg,2018,32:688-690.
14 Vaca M,Polo R,Martinez-San-Millan J,et al.Pigmented Villonodular Synovitis of the Temporomandibular Joint With Petrous Bone Invasion[J].Otol Neurotol,2017,38:e58-e59.
15 Baj A,Beltramini G,Moneghini L,et al.Pigmented villonodular synovitis of temporomandibular joint:pathological aspects and surgical treatment[J].Minerva Stomatol,2015,64:213-218.
16 Pandey S,Pandey AK.Pigmented villonodular synovitis with bone involvement[J].Archives of Orthopaedic&Traumatic Surgery,1981,98:217-223.
17 Matsubara T,Ishikawa H,Kurosaka M,et al.Bone involvement in pigmented villonodular synovitis.A case report(author's transl)[J].Ryumachi,1982,22:143-150.
18 Le WJ,Li MH,Yu Q,et al.Pigmented villonodular synovitis of the temporomandibular joint:CT imaging findings[J].Clin Imaging,2014,38:6-10.
19 Kim IK,Cho HY,Cho HW,et al.Pigmented villonodular synovitis of the temporomandibular joint-computed tomography and magnetic resonance findings:a case report[J].J Korean Assoc Oral Maxillofac Surg,2014,40:140-146.
20 Kim KW,Han MH,Park SW,et al.Pigmented villonodular synovitis of the temporomandibular joint:MR findings in four cases[J].European Journal of Radiology,2004,49:229-234.
21刘颖,郑卓肇.关节内局限型色素沉着绒毛结节性滑膜炎MRI表现[J].中国医学影像技术,2010,26:529-531.
22 Anbinder AL,Geraldo BMC,Guimaraes RF,et al.Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint:A Rare Case Report[J].Braz Dent J,2017,28:647-652.
23陈卫鹏,林海韬,姚沛旭,等.磁敏感加权成像在MRI诊断色素沉着绒毛结节性滑膜炎中的价值[J].中国医学影像学杂志,2016,24:540-543.
24 Verma RK,Bakshi J,Mahesha V.Giant cell reparative granuloma of parotid region-A case report[J].Egyptian Journal of Ear Nose Throat&Allied Sciences,2012,13:103-105.
25付岩宁,金鑫,金花兰,等.CT和MRI分析颞骨巨细胞修复性肉芽肿[J].中国医学影像学杂志,2016,24:430-432.
26 Oukabli M,Chibani M,Ennouali H,et al.Temporomandibular joint primitive tumors and pseudo tumors[J].Rev Stomatol Chir Maxillofac Chir Orale,2013,114:9-14.
2 Martin RC,Osborne DL,Edwards MJ,et al.Giant cell tumor of tendon sheath,tenosynovial giant cell tumor,and pigmented villonodular synovitis:defining the presentation,surgical therapy and recurrence[J].Oncol Rep,2000,7:413-419.
3 Darling JM,Goldring SR,Harada Y,et al.Multinucleated cells in pigmented villonodular synovitis and giant cell tumor of tendon sheath express features of osteoclasts[J].Am J Pathol,1997,150:1383-1393.
4 Carlson ML,Osetinsky LM,Alon EE,et al.Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base:Review of 11 cases[J].Laryngoscope,2017,127:2340-2346.
5 Gao QQ,Feng YY,Bu LX,et al.Pigmented villonodular synovitis of the temporomandibular jointreport of one case and review of literatures[J].Shanghai Kou Qiang Yi Xue,2016,25:381-384.
6 Pianosi K,Rigby M,Hart R,et al.Pigmented Villonodular Synovitis of the Temporomandibular Joint:A Unique Presentation[J].Plast Reconstr Surg Glob Open,2016,4:e674.
7方利华,平金良,刘逢佳,等.颞下颌关节区关节外弥漫性色素沉着绒毛结节性滑膜炎:1例报告及文献复习[J].上海口腔医学,2007,16:106-108.
8 Jaffe HL,Lichtenstein L,Sutro CJ.Pigmented villonodular synovitis,bursitis and tenosynovitis[J].Arch Pathol,1941:31,731-765.
9 Cascone P,Rinna C,Ungari C,et al.Pigmented villonodular synovitis of the temporomandibular joint[J].The Journal of craniofacial surgery,2005,16:712-716.
10李尚仲,闫新峰,齐承恩.色素沉着绒毛结节性滑膜炎的治疗进展[J].山东医药,2015,37:104-106.
11 Llauger J,Palmer J,Rosón N,et al.Pigmented villonodular synovitis and giant cell tumors of the tendon sheath:radiologic and pathologic features[J].Ajr American Journal of Roentgenology,2013,172:1087-1091.
12 Giannakopoulos H,Chou JC,Quinn PD.Pigmented villonodular synovitis of the temporomandibular joint[J].Ear Nose Throat J,2013,92:E10-E13.
13 Son SM,Park YS,Choi CH,et al.Extra-articular tenosynovial giant cell tumor of diffuse type in the temporal area with brain parenchymal invasion:a case report[J].Br J Neurosurg,2018,32:688-690.
14 Vaca M,Polo R,Martinez-San-Millan J,et al.Pigmented Villonodular Synovitis of the Temporomandibular Joint With Petrous Bone Invasion[J].Otol Neurotol,2017,38:e58-e59.
15 Baj A,Beltramini G,Moneghini L,et al.Pigmented villonodular synovitis of temporomandibular joint:pathological aspects and surgical treatment[J].Minerva Stomatol,2015,64:213-218.
16 Pandey S,Pandey AK.Pigmented villonodular synovitis with bone involvement[J].Archives of Orthopaedic&Traumatic Surgery,1981,98:217-223.
17 Matsubara T,Ishikawa H,Kurosaka M,et al.Bone involvement in pigmented villonodular synovitis.A case report(author's transl)[J].Ryumachi,1982,22:143-150.
18 Le WJ,Li MH,Yu Q,et al.Pigmented villonodular synovitis of the temporomandibular joint:CT imaging findings[J].Clin Imaging,2014,38:6-10.
19 Kim IK,Cho HY,Cho HW,et al.Pigmented villonodular synovitis of the temporomandibular joint-computed tomography and magnetic resonance findings:a case report[J].J Korean Assoc Oral Maxillofac Surg,2014,40:140-146.
20 Kim KW,Han MH,Park SW,et al.Pigmented villonodular synovitis of the temporomandibular joint:MR findings in four cases[J].European Journal of Radiology,2004,49:229-234.
21刘颖,郑卓肇.关节内局限型色素沉着绒毛结节性滑膜炎MRI表现[J].中国医学影像技术,2010,26:529-531.
22 Anbinder AL,Geraldo BMC,Guimaraes RF,et al.Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint:A Rare Case Report[J].Braz Dent J,2017,28:647-652.
23陈卫鹏,林海韬,姚沛旭,等.磁敏感加权成像在MRI诊断色素沉着绒毛结节性滑膜炎中的价值[J].中国医学影像学杂志,2016,24:540-543.
24 Verma RK,Bakshi J,Mahesha V.Giant cell reparative granuloma of parotid region-A case report[J].Egyptian Journal of Ear Nose Throat&Allied Sciences,2012,13:103-105.
25付岩宁,金鑫,金花兰,等.CT和MRI分析颞骨巨细胞修复性肉芽肿[J].中国医学影像学杂志,2016,24:430-432.
26 Oukabli M,Chibani M,Ennouali H,et al.Temporomandibular joint primitive tumors and pseudo tumors[J].Rev Stomatol Chir Maxillofac Chir Orale,2013,114:9-14.