Magnetic Resonance Imaging Features and Assessment of Local Extent of Localised Giant Cell Tumour of the Tendon Sheath in Fingers
PY Chu, JPK Tsang, WY Wong, WCS Chan, KW Ng, MK Yuen
Hong Kong J Radiol 2015;18:205-14
DOI: 10.12809/hkjr1515296
Objectives: To determine the magnetic resonance (MR) imaging features of localised giant cell tumour of the tendon sheath in fingers and to evaluate the preoperative diagnostic performance of MR imaging in assessment of the local tumour extent.
Methods: Between January 2003 and December 2013, MR images of patients with surgically resected and histologically proven giant cell tumour of the tendon sheath in fingers in a regional hospital in Hong Kong were retrospectively reviewed. MR imaging appearance and local tumour extent — including invasion of tendon, bone, joint, and tenosynovial space — were evaluated and compared with surgical findings.
Results: The MR signal intensity of giant cell tumour of the tendon sheath in fingers of 29 patients was consistently equal to or lower than that of skeletal muscle on T1- and T2-weighted images. More than half of the lesions (17 tumours, 58.6%) had a high signal intensity on T2-weighted images with fat suppression. All tumours demonstrated a variable degree of enhancement and almost all (12/13 tumours, 92.3%) demonstrated blooming artefacts. The local tumour extent with invasion of tendon, bone, joint, and tenosynovial spaces was consistent with surgical findings in most of the examined cases, with an accuracy of 100%, 93.1%, 100%, and 96.6%, respectively. The degree of tumour encasement of the tendon was the only statistically significant predictor for tenosynovial space invasion (odds ratio = 1.0; p = 0.008). All 29 cases were completely excised with no tumour recurrence after a mean follow-up of 3.4 years (standard deviation, 2.1 years; range, 0.6-8.0 years).
Conclusion: Giant cell tumour of the tendon sheath in the fingers is characteristic on MR images. MR imaging can accurately assess the local tumour extent and may help preoperative surgical planning, enable complete resection, and reduce tumour recurrence.
中文摘要
手指局限性腱鞘巨細胞瘤的磁共振成像特點和腫瘤局部侵犯範圍的評估
朱炳容、曾佩琪、王慧瑜、陳煥章、吳家榮、袁銘強
目的：發現手指局限性腱鞘巨細胞瘤的磁共振（MR）成像特點，以及MR成像在術前評估腫瘤局部侵犯範圍的診斷效用。
方法：回顧分析2003年1月至2013年12月期間，香港一所分區醫院內進行手術切除並經病理學證實為手指腱鞘巨細胞瘤的患者。評估MR成像特點和局部腫瘤範圍（包括受侵犯的肌腱、骨骼、關節和腱鞘間隙），並與手術結果進行比較。
結果：29例手指腱鞘巨細胞瘤的MR信號強度在T1和T2加權圖像上均與骨骼肌信號相等或偏低。超過一半病灶（17個腫瘤，58.6%）在T2加權脂肪抑制圖像表現為高信號。所有腫瘤呈現出不同程度的強化，幾乎所有腫瘤（13個腫瘤中的12個，92.3%）顯示有「開花徵」。大多數病例中，MR圖像顯示的肌腱、骨骼、關節和腱鞘空間的受侵範圍與手術結果一致，準確度依次為100%、93.1%、100%和96.6%。腱鞘被腫瘤包繞的程度是腱鞘間隙受侵唯一一個具統計學顯著性的預測因子（比值比=1.0；p=0.008）。所有29個病例經手術完全切除巨細胞瘤，平均隨訪期3.4年（標準差2.1年；介乎0.6-8.0年）後無復發病例。
結論：手指腱鞘巨細胞瘤的MR成像具有特徵性。MR成像能準確評估腫瘤局部侵犯範圍，有助於制定術前計劃，促使完整切除腫瘤，繼而減少復發。