Trehan Samir K, Athanasian Edward A, DiCarlo Edward F, Mintz Douglas N, Daluiski Aaron
Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY.
Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY.
J Hand Surg Am. 2015 Mar;40(3):542-5. doi: 10.1016/j.jhsa.2014.12.002. Epub 2015 Jan 30.
To determine whether the diagnosis of hand glomus tumors by magnetic resonance imaging (MRI) is associated with tumor size, tumor pathology, tumor location, and/or clinical suspicion.
We reviewed our pathology database for patients with hand glomus tumors diagnosed between 2006 and 2013 and included those patients who had preoperative MRI at our institution. We excluded patients with recurrent and persistent tumors. Magnetic resonance imaging reports were reviewed for clinical history, tumor location, and associated bone erosion. Pathology reports were reviewed for diagnosis and tumor size. We classified MRI studies as positive (glomus tumor diagnosis), negative (no mention of glomus tumor as possible diagnosis), or indeterminate (glomus tumor mentioned as possible differential diagnosis). Fisher exact test was used to compare positive studies and those that were nondiagnostic (ie, either negative or indeterminate).
Of the 46 patients who had pathologically confirmed hand glomus tumors, 38 had preoperative MRI studies. A total of 24 MRI studies were positive, 5 were indeterminate, and 7 were negative. Five patients had atypical pathology, 1 had a multifocal tumor, and 2 had extra-digital hand glomus tumors. Failure to diagnose glomus tumors on MRI was associated with atypical pathology, atypical location (ie, not located in the subungual region), absence of bone erosion, and lack of clinical suspicion. Tumor size was not associated with MRI diagnosis.
In this series of 36 hand glomus tumors, one-third of MRI studies were nondiagnostic. Occurrence of nondiagnostic MRIs was more likely when glomus tumors were pathologically and/or anatomically atypical, without bone erosion, and with no or unrelated clinical history provided. These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
确定通过磁共振成像（MRI）诊断手部血管球瘤是否与肿瘤大小、肿瘤病理、肿瘤位置和/或临床怀疑有关。
我们查阅了2006年至2013年间诊断为手部血管球瘤患者的病理数据库，并纳入了在我们机构进行术前MRI检查的患者。我们排除了复发性和持续性肿瘤患者。回顾MRI报告以获取临床病史、肿瘤位置和相关的骨质侵蚀情况。回顾病理报告以获取诊断和肿瘤大小信息。我们将MRI研究分为阳性（血管球瘤诊断）、阴性（未提及血管球瘤作为可能诊断）或不确定（提及血管球瘤作为可能的鉴别诊断）。采用Fisher精确检验比较阳性研究和非诊断性研究（即阴性或不确定）。
在46例经病理证实的手部血管球瘤患者中，38例进行了术前MRI检查。共有24例MRI研究为阳性，5例为不确定，7例为阴性。5例患者有非典型病理，1例有多发性肿瘤，2例有指外手部血管球瘤。MRI未能诊断血管球瘤与非典型病理、非典型位置（即不在甲下区域）、无骨质侵蚀以及缺乏临床怀疑有关。肿瘤大小与MRI诊断无关。
在这一系列36例手部血管球瘤中，三分之一的MRI研究为非诊断性。当血管球瘤在病理和/或解剖学上不典型、无骨质侵蚀且未提供或提供无关临床病史时，更有可能出现非诊断性MRI。这些发现凸显了临床怀疑在血管球瘤诊断中持续存在的重要性。
研究类型/证据水平：诊断性IV级。
