Yacoe M E, Bergman A G, Ladd A L, Hellman B H
Department of Radiology, Stanford University Medical Center, CA 94305.
AJR Am J Roentgenol. 1993 Apr;160(4):813-7. doi: 10.2214/ajr.160.4.8456670.
Dupuytren's contracture is a common fibrosing disorder of the hand which often results in progressive and debilitating flexion contractures of the fingers. Recurrence after surgical release is common and may be related, in part, to the cellularity of the lesion. We describe the MR appearance of Dupuytren's contracture and correlate signal characteristics with the degree of cellularity of the lesion.
A total of 11 hands in 10 patients were studied. All patients had surgical resection after MR imaging (median interval, 3 days). The surgical and pathologic findings were correlated with the MR findings. The signal characteristics of the lesions were correlated with the histologic findings.
We found that MR imaging was accurate for detecting Dupuytren's contracture and depicting its extent. The lesions include subcutaneous nodules, usually at the level of the distal palmar crease, and cords that lie parallel and superficial to the flexor tendons. The cords had a uniformly low signal intensity (similar to the signal intensity of tendon) on both T1- and T2-weighted images in 18 of 22 cases, whereas the remaining four cases had a low to intermediate signal intensity on T1-weighted images (a slightly higher signal intensity than that of tendon) and a low signal intensity on T2-weighted images. Histologically, the cords were hypocellular and composed of dense collagen. Most nodules had an intermediate signal intensity (similar to that of muscle) on both T1- and T2-weighted images (10 of 13 cases), usually stippled with focal areas of lower signal intensity. Histologically, these nodules were mostly cellular. Three of the nodules had a low signal intensity on both T1- and T2-weighted images and were hypocellular histologically.
We conclude that MR imaging can be used to define palmar involvement in Dupuytren's contracture. The signal characteristics of the lesions correlate with the degree of cellularity of the lesions as seen histologically. The ability to assess preoperatively the cellularity of lesions of Dupuytren's contractures may be of prognostic significance, because highly cellular lesions tend to have higher rates of recurrence after surgery than do hypocellular lesions.
杜普伊特伦挛缩症是一种常见的手部纤维变性疾病，常导致手指进行性、致残性屈曲挛缩。手术松解后复发很常见，部分原因可能与病变的细胞密度有关。我们描述了杜普伊特伦挛缩症的磁共振成像（MR）表现，并将信号特征与病变的细胞密度程度相关联。
对10例患者的11只手进行了研究。所有患者在MR成像后均接受了手术切除（中位间隔时间为3天）。将手术和病理结果与MR结果相关联。将病变的信号特征与组织学结果相关联。
我们发现MR成像对于检测杜普伊特伦挛缩症并描绘其范围是准确的。病变包括皮下结节，通常位于手掌远端横纹水平，以及与屈肌腱平行且位于其浅层的条索。在22例中的18例中，这些条索在T1加权像和T2加权像上均具有均匀的低信号强度（类似于肌腱的信号强度），而其余4例在T1加权像上具有低至中等信号强度（略高于肌腱的信号强度），在T2加权像上具有低信号强度。组织学上，条索细胞稀少，由致密的胶原组成。大多数结节在T1加权像和T2加权像上均具有中等信号强度（类似于肌肉）（13例中的10例），通常散在分布有低信号强度的局灶区域。组织学上，这些结节大多细胞丰富。其中3个结节在T1加权像和T2加权像上均具有低信号强度，组织学上细胞稀少。
我们得出结论，MR成像可用于确定杜普伊特伦挛缩症的手掌受累情况。病变的信号特征与组织学所见的病变细胞密度程度相关。术前评估杜普伊特伦挛缩症病变细胞密度的能力可能具有预后意义，因为细胞丰富的病变术后复发率往往高于细胞稀少的病变。
