Zhao S-S, Cheng J-L, Gao E-Y, Bai J, Zhang Y
The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(6):2571-2579. doi: 10.26355/eurrev_202303_31794.
This study investigated radiographic images and the differential diagnosis of intracranial diffuse tenosynovial giant cell tumor (D-TGCT) in order to better understand the disease and improve the rate of preoperative diagnosis.
Images and clinical data of patients with D-TGCT were retrospectively analyzed. Routine Computer Tomography (CT), routine Magnetic Resonance Imaging (MRI), and contrast-enhanced MRI were performed for nine cases. Susceptibility-weighted imaging (SWI) was also performed for one case.
We reviewed nine patients (6 males and 3 females) aged between 24 and 64 years, with a mean age of 47.33 ± 14.92 years. The most frequent complaints were hearing loss (5/9, 55.6%), pain (4/9, 44%), masticatory symptoms (2/9, 22.2%), and mass (4/9, 44.4%), with a mean duration of 22 ± 21.43 months. All cases were centered on the base of the skull, and showed hyper-density soft-tissue mass with osteolytic bone destruction on CT. The tumor signal mainly showed iso-intensity or hypo-intensity on T1WI compared with that in the brain parenchyma in all patients. On T2WI, nine lesions mainly showed hypo-intensity. Among these nine lesions, three displayed cystic region showing hyper-intensity on T2WI and hypo-intensity on T1WI (Figure 2A, 2B) in the lesion. Nine lesions showed hypo-intensity on DWI sequences. SWI images presented low signal in two cases, showing the "flowering effect". Nine patients showed heterogeneous enhancement, and two patients had meningeal thickening.
Intracranial D-TGCT is extremely rare, but must be differentiated from other tumors. Osteolytic bone destruction in the area of the skull base with hyper-density soft-tissue mass and hypo-intensity on T2WI images are indicative of D-TGCT.
本研究对颅内弥漫性腱鞘巨细胞瘤（D-TGCT）的影像学表现及鉴别诊断进行了研究，以更好地了解该疾病并提高术前诊断率。
回顾性分析D-TGCT患者的影像学资料和临床数据。对9例患者进行了常规计算机断层扫描（CT）、常规磁共振成像（MRI）及增强MRI检查，对1例患者进行了磁敏感加权成像（SWI）检查。
我们共纳入9例患者（6例男性，3例女性），年龄在24至64岁之间，平均年龄为47.33±14.92岁。最常见的症状为听力下降（5/9，55.6%）、疼痛（4/9，44%）、咀嚼症状（2/9，22.2%）和肿块（4/9，44.4%），平均病程为22±21.43个月。所有病例均以颅底为中心，CT表现为高密度软组织肿块伴骨质溶解破坏。所有患者肿瘤在T1WI上与脑实质相比主要呈等信号或低信号。在T2WI上，9个病灶主要呈低信号。其中9个病灶中有3个在病灶内显示T2WI呈高信号、T1WI呈低信号的囊性区域（图2A、2B）。9个病灶在扩散加权成像（DWI）序列上呈低信号。SWI图像在2例中呈低信号，表现为“开花效应”。9例患者均表现为不均匀强化，2例患者有脑膜增厚。
颅内D-TGCT极为罕见，但必须与其他肿瘤相鉴别。颅底区域骨质溶解破坏伴高密度软组织肿块及T2WI图像上呈低信号提示D-TGCT。
