色素沉着绒毛结节性滑膜炎 ppt.ppt

可显示关节内渗出、回波不均的团块和增厚的滑膜,也可显示骨质侵蚀改变, 超声的上述所见还可见于其他滑膜炎性疾病,如类风湿性关节炎等,因此无特异性； MR影像上的信号表现取决于： 病变内的脂质、含铁血红素、纤维基质、血管翳、液体和细胞等各种成分的比例[20]。 本病MR信号的特点是:病变在T1、T2WI和质子加权像上均为低或等信号; 在长TR和长TE的T2WI上的低信号区是由于含铁血红素的铁磁易感效应及其T1和T2弛豫时间短所致[7,16],这种的信号所见在梯度回波或高场强MR影像上更为明显； 有些病变在T2WI上可见有高信号区,其反映的是炎性水肿、脂肪成分[16]或含脂成分的巨噬细胞组织结构[7] 增强MR影像可见病变周边的滑膜组织呈环状均匀性增强,或病变内可见分隔状增强[16]。 一般认为X线平片检查方法简易,且鉴别其他疾病的能力较强,故常规可首选X线平片进行检查, 选择MR检查有助于明确本病的诊断 本病的最终确诊依靠： 滑膜活检及其病理证实 本病有多种治疗方法, 其中包括外科直视下切除、关节镜下切除、放射治疗和联合疗法等[7] History A 51-year-old man presented to his orthopedic surgeon with a 2-week history of pain and swelling in his right knee. The patient reported that 2 weeks before he had repeatedly kneeled and squatted while gardening in his yard. Physical examination revealed a large, right knee joint effusion and a painful active range of motion. The patient underwent radiography and magnetic resonance (MR) imaging for further evaluation. Figure 1. Lateral radiograph of the right knee demonstrates a large joint effusion (arrows) and a posterior soft-tissue mass (arrowheads). Figure 2. (a, b) Coronal T1-weighted spin-echo (650/14) (a) and GRE DESS (18/7) (b) MR images show multiple foci of low signal intensity within the joint (arrows). These foci represent hemosiderin-laden synovial tissue. Note that blooming is seen with marked loss of signal intensity on the GRE DESS image. (c, d) Corresponding posterior T1-weighted (c) and GRE DESS (d) MR images, at the level of the popliteal cyst, show similar findings. Note the markedly decreased signal intensity along the surface and septa within the popliteal cyst (arrows). (e) Sagittal T2-weighted image (6410/87) shows multiple frondlike foci of low signal intensity within the suprapatellar effusion (arrows), with marked signal loss along the surface of the popliteal cyst (arrowheads). 主要是指关节、滑囊以及腱鞘内的滑膜呈结节状或绒毛状进行性增生 Granowitz等[8]根据滑膜受累的范围和形态将病变又分为局限型和弥漫型,以此区分病名中的结节和绒毛。 另外,本病还有其他名称,如黄色瘤(xanthoma)、黄色肉芽肿(xanthogranuloma)、慢性出血性绒毛滑膜炎( chronic hemorrhagic v