CAJ | 학술논문

目的：探讨实时组织弹性成像（RTE）对腱鞘巨细胞瘤（GCTTS）分型的诊断价值。方法先依据术中及病理肿块是否侵犯周围组织将GCTTS分为A型和B型，B型又据是否累及邻近关节分为Ⅰ期和Ⅱ期。再将RTE分级与分型对比分析，应用受试者工作特征曲线（ROC曲线）分析分型与分级的相关性。结果 A型28例，位于腱鞘或关节周围，包膜完整，未侵犯周围组织；B型19例，未见完整包膜，侵犯周围组织；其中Ⅰ期13例，GCTTS与肌腱及周围组织界限不清，或腱鞘周围可见卫星灶；Ⅱ期6例，肿块弥漫侵袭并进入相邻关节腔，有或无骨质受压破坏。 ROC曲线下面积为0．886，RTE诊断分界点为3～4级，区分A型与B型的诊断敏感性为78．9％，特异性为92．9％。结论 RTE分级能较好地界定GCTTS是否侵犯周围组织，有较高的诊断价值，能前瞻性地指导治疗和改善预后。
목적：탐토실시조직탄성성상（RTE）대건초거세포류（GCTTS）분형적진단개치。방법선의거술중급병리종괴시부침범주위조직장GCTTS분위A형화B형，B형우거시부루급린근관절분위Ⅰ기화Ⅱ기。재장RTE분급여분형대비분석，응용수시자공작특정곡선（ROC곡선）분석분형여분급적상관성。결과 A형28례，위우건초혹관절주위，포막완정，미침범주위조직；B형19례，미견완정포막，침범주위조직；기중Ⅰ기13례，GCTTS여기건급주위조직계한불청，혹건초주위가견위성조；Ⅱ기6례，종괴미만침습병진입상린관절강，유혹무골질수압파배。 ROC곡선하면적위0．886，RTE진단분계점위3～4급，구분A형여B형적진단민감성위78．9％，특이성위92．9％。결론 RTE분급능교호지계정GCTTS시부침범주위조직，유교고적진단개치，능전첨성지지도치료화개선예후。
Objective To evaluate the value of compression-dependant real-time tissue elastography (RTE) in the clinical classification of giant cell tumors of tendon sheath (GCTTS). Methods According to the intraoperative and pathological observations and the degree of lump infringe the surrounding tissue,GCTTS were divided into 2 types:type A and type B,type B were divided into 2 stages:stageⅠand stageⅡ. The corelation of RTE grading with clinical classification was retrospectively analyzed. Results Type A 28 cases,the lesions were located around the tendon sheath and joint with intact capsule and no infringe upon the surrounding tissue,type B 19 cases,the lesions invaded the surrounding tissue without complete capsule,stageⅠ 13 cases,the boundary between lesion,tendon and surrounding tissue was not clear,or satellite stove presented surrounding tendon sheath,stageⅡ6 cases,the lesion invaded into the adjacent articular cavity diffusely with or without bone destruction.The area under the ROC curve was 0.886 with sensitivity of 78.9%and specificity of 92.9%,taking level 3 and level 4 as the RTE grading cut-off point . Conclusion RTE grading can define whether GCTTS infringe the surrounding tissue well,provide useful informations for diagnosis,and prospectively guide the treatment and improve prognosis.