Bellelli A, De Luca F, Maresca G, Nardis P
Radiologia e Diagnostica per Immagini, Ospedale San Pietro Fatebenefratelli, Roma.
Radiol Med. 1996 Oct;92(4):346-50.
Intraarticular ganglion cysts are uncommon findings: only 30 cases have been reported since the first paper by Caan in 1924 and they were all associated with cruciate ligaments. Many different cystic or pseudocystic lesions are found in articular knee conditions: the most common cystic lesions are popliteal cysts (Baker's cysts), followed by synovial pseudocysts of the posterior cruciate ligament, meniscal cysts and, finally, ganglion cysts of the cruciate ligaments. In our series of 1600 knee MR exams carried out in our MR department since June, 1994, we have found 8 ganglion cysts of the cruciate ligaments. MR studies are always performed on a dedicated 0.2-T permanent magnet (Artoscan, Esaote Biomedica, Genoa, Italy). Five patients were operated on with arthroscopy. The ganglion cysts affected the anterior cruciate ligaments in 4 cases and the posterior cruciate ligaments in 4 cases. The symptoms were mainly pain radiating to the medial side and worsening in forced flexion or extension. The diagnostic suspicion was meniscal tears in 4 patients, chondral lesions in 3 and a loose intraarticular body in one patient. The shape and structure of ganglion cysts in the cruciate ligaments are clearly depicted with MRI. The ganglion cysts in the anterior cruciate ligaments are usually spindle-shaped and within the ligament, while those in the posterior cruciate ligaments have a well-defined outline, with multilocular appearance, and they are usually localized along the ligament, most often on the dorsal aspect. MR signal studies show intermediate signal intensity on SE T1-weighted images and markedly increased signal intensity on SE T2-weighted images. These typical patterns may change depending on lesion content, for instance in the presence of hemoglobin due to an associated angioma. The origin of ganglion cysts in the cruciate ligaments is still unknown, even though many theories have been suggested, including a synovial herniation in ligament fibers, the ectopic inclusion of synovial tissue, a posttraumatic connectival degeneration and, finally, the proliferation of totipotent mesenchymal cells. From a histologic point of view, "synovial ganglion" is a much better definition than "synovial ganglion cyst", because the typical wall of real synovial cysts is missing. The MR patterns are typical of the morphological features described and of the presence of high protein fluid content.
自1924年卡恩发表第一篇论文以来，仅报告了30例，且均与交叉韧带相关。在膝关节疾病中发现了许多不同的囊性或假性囊性病变：最常见的囊性病变是腘窝囊肿（贝克囊肿），其次是后交叉韧带的滑膜假性囊肿、半月板囊肿，最后是交叉韧带的腱鞘囊肿。在我们自1994年6月以来在磁共振成像（MR）科室进行的1600例膝关节MR检查中，我们发现了8例交叉韧带腱鞘囊肿。MR研究总是在一台专用的0.2特斯拉永磁体（Artoscan，意大利热那亚的依索塔生物医学公司）上进行。5例患者接受了关节镜手术。腱鞘囊肿累及前交叉韧带4例，后交叉韧带4例。症状主要为向内侧放射的疼痛，在强迫屈伸时加重。4例患者的诊断怀疑为半月板撕裂，3例为软骨损伤，1例为关节内游离体。交叉韧带腱鞘囊肿的形态和结构在MRI上清晰可见。前交叉韧带的腱鞘囊肿通常呈纺锤形，位于韧带内，而后交叉韧带的腱鞘囊肿轮廓清晰，呈多房状，通常沿韧带分布，最常见于背侧。MR信号研究显示，在自旋回波（SE）T1加权图像上呈中等信号强度，在SE T2加权图像上信号强度明显增加。这些典型模式可能会因病变内容物而改变，例如由于相关血管瘤存在血红蛋白时。尽管提出了许多理论，包括韧带纤维中的滑膜疝、滑膜组织的异位包涵、创伤后结缔组织变性以及全能间充质细胞的增殖，但交叉韧带腱鞘囊肿的起源仍然未知。从组织学角度来看，“滑膜腱鞘”比“滑膜腱鞘囊肿”是一个更好的定义，因为真正滑膜囊肿的典型壁并不存在。MR模式是所描述的形态特征以及高蛋白液体含量存在的典型表现。
