色素沉着绒毛结节性滑膜炎的MRI表现

1、Pigmented villonodularSynovitis(PVns)色素沉着绒毛结节性滑膜炎1.IntroductionPigmented villonodular synovitis(PVNS) comprises agroup of idiopathic lesions in joints, tendon sheathes andburs ae色素沉着绒毛结节性滑膜炎主要是指关节、滑囊以及腱鞘内的滑膜特发性的旱结节状或线毛状进行性增生。)Pigmented vilionodular synovitis(PVNS) is anuncommon, usually monoarticula

2、r disorder and usuallyfound in adults. The most common sites predilection isknee-joint(80%), then the hip, ankle, shoulder, elbow in不常见,好发于成年人,生于膝关节,占80%,髋关节、踝关肩关节、肘关节的发病率依次减少2.Clinical manifestationsThe clinical manifestations is lack of specificity. The mainmanifestations are progressive swelling

3、of joints andhemorrhagic joint effusion. It shows recurrent jointof complete remission may be found between periods?effusions, which can be misdiagnosed as arthritis. Episodeactive disease本病的临床表现缺乏特异性临床主要表现为受累关节进行性肿胀,液较常见,本病可引起反复积液,各活动期The cause of PVNS is not clear, maybe related with tumortrauma a

4、nd infection(本病的病因尚不明,一般认为与肿瘤、外伤、感染有关3.Diagnosis: imaging findingsray: the routine X-ray shows majorms including joint capswelling, soft tissue mass in periphery ofjoint and invasion of bone which edgeshows ossified ring, but joint space isnormal, no osteoporosis父线表现常规线平片上主要征象包括关节囊肿胀、关节周围软组织肿块及邻近骨骼的

5、侵蚀,骨缺损边硬化环,但关节间隙保持正常,无骨质4.Diagnosis: imaging findingsCT findings: shows jointcapsule swelling,thickened synovium andobvious joint effusionCT表现:表现为关节囊肿胀,滑膜增厚,关节腔内明显积液5.Diagnosis: imaging findingsMR findings is very special and shows thickenedsynovitis and the condition of joint effusionMR表现具有明显的特征性,能

6、清晰的显示滑膜的增厚和积液的程度。Because of hemosidenin deposition in the synovitislesions, it shows low signal both on T1WI and T2WIPartial lesions show bone invasion由于病变滑膜组织内含铁血黄素的沉积,故在T加权像和T2加权像均呈低信号,这是特征性的征象。部分病变可侵蚀骨结构。6.Histology and Pathology(组织病理学)The his tological findings are exuberant synovialproliferatio

7、n with numerous villi and folds thatsometimes fuse into nodules and form locallyaggressive intra-articular masses组织学表现为活跃增生的滑膜呈绒毛状或皱襞样,常形成结节状侵袭性的关节内肿物PVNS can be divided into focal type and diffuse typePNS在病理上分为局灶型和弥漫型2种。7.Diffuse type shows exuberant synovial, villiform proliferation andhemosiderin

8、 deposition. Exuberant villus can destroy jointcapsule and soft tissue, and invade bone by getting througharticular cartilage, junction of bone and joint or the attachmentomen弥漫型主要为滑膜广泛增厚、绒毛状增生和含铁血黄素沉着增殖的绒毛可破坏关节囊,侵犯周边软组织并通过关节软胃、骨与关节交界部或沿韧带附着处侵犯骨组织Focal type shows mounds of synovial cells, dispersedm

9、ultinucleated giant cells, foam cells and pigmentedhemosiderin deposition局灶型为密集成堆的滑膜细胞,间以散在的多核巨细胞和有类脂质积聚的泡沫细胞以及含铁血黄素8.Diffuse type: T2WI shows multiple low signal nodules in joint and popliteal space, high signalalso can be seen in partial nodules with joint effusion shows hyperintense Articular sur

10、face oftibial platform was invaded and show mixed signal surrounding by low signal ring. Low signalnodule also can be seen in the suprapatellar bursa弥漫型PVNS:T2W示关节腔内及胭窝多发低信号结节,部分结节内见高信号区,关节腔积液呈高信号。胫骨关节面破坏,呈混杂信号,周围伴低信号环。髌上囊亦见低信号结节.Focal type: TIWI shows well-distributed low signal mass in infrapatellar bursa with a littlend joint strue局灶型PVNS,TwI示髌下囊内肿块,肿块呈均匀低信号,伴关节腔少量积液,关节骨结构正9.Case 1 35-year-old female patient, progressiveswelling of knee joints for 5 years女,35岁,膝关节进行性肿胀5年Diffuse type of knee joint: TIWIshows low signal irre