色素沉着绒毛结节性滑膜炎的MRI表现

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Pigmented,Villonodular,Synovitis,(PVNS),色素沉着绒毛结节性滑膜炎,Introduction,Pigmented,villonodular,synovitis,(PVNS)comprises a group of idiopathic lesions in,joints,tendon,sheathes and,bursae,.,(,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呈结节状或绒毛状进行性增生。,),Pigmented,vilionodular,synovitis,(PVNS)is an uncommon,usually,monoarticular,disorder and usually found in adults.The most common sites p,redilection is knee-joint(80%),then the,hip,ankle,shoulder,elbow in turn.,(,不常见，好发于成年人，生于膝关节,占,80%,髋关节、踝关节、肩关节、肘关节的发病率依次减少,),Clinical,manifestations,The clinical manifestations is lack of specificity.The main manifestations are progressive swelling of joints and hemorrhagic joint effusion.It shows recurrent joint effusions,which can be misdiagnosed as arthritis.Episodes of complete remission may be found between periods of active 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,血性关节积液较常见，本病可引起反复积液，各活动期之间可见病变发作的缓解。,),The cause of PVNS is not clear,maybe related with tumor,、,trauma and infection.,(,本病的病因尚不明,一般认为与肿瘤、外伤、感染有关。,),Diagnosis,：,imaging findings,X-ray:the routine X-ray shows major symptoms including joint capsule swelling,soft tissue mass in periphery of joint and invasion of bone which edge shows ossified ring,but joint space is normal,no osteoporosis.,X,线表现,:,常规,X,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侵蚀,骨缺损边缘有硬化环,但关节间隙保持正常,无骨质疏松,Diagnosis,：,imaging findings,CT findings:shows joint capsule swelling,thickened,synovium,and obvious joint effusion,CT,表现,:,表现为关节囊肿胀,滑膜增厚,关节腔内明显积液,Diagnosis,：,imaging findings,MR findings is very special and shows thickened,synovitis,and the condition of joint effusion.,MRI,表现具有明显的特征性，能清晰的显示滑膜的增厚和积液的程度。,Because of,hemosiderin,deposition in the,synovitis,lesions,it shows low signal both on T1WI and T2WI.,Partial lesions show bone invasion.,由于病变滑膜组织内含铁血黄素的沉积，故在,T1,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。,Histology and Pathology(,组织病理学,),The histological findings are exuberant,synovial,proliferation with numerous,villi,and folds that sometimes fuse into nodules and form locally aggressive 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 type.,PVNS,在病理上分为局灶型和弥漫型,2,种。,Diffuse type shows exuberant,synovial,villiform,proliferation and,hemosiderin,deposition.Exuberant,villus,can destroy joint capsule and soft tissue,and invade bone by getting through,articular,cartilage,junction of bone and joint or the attachment of,ligment,.,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骨、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,dispersed multinucleated giant cells,foam cells and pigmented,hemosiderin,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,以及含铁血黄素沉着。,Diffuse type,：,T2WI shows multiple low signal nodules in joint and,popliteal,space,high signal also can be seen in partial nodules with joint effusion shows,hyperintense,.,Articular,surface of,tibial,platform was invaded and show mixed signal surrounding by low signal ring.Low signal nodule also can be seen in the,suprapatellar,bursa.,弥漫型,PVNS:T2WI,示关节腔内及腘窝多发低信号结节,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,：,T1WI shows well-distributed low signal mass in,infrapatellar,bursa with a little effusion and joint structures is normal.,局灶型,PVNS,T1WI,示髌下囊内肿块,肿块呈均匀低信号,伴关节腔少量积液,关节骨结构正常,Case 1 35-year-old female patient,，,progressive swelling of knee joints for 5 years,女，,35,岁，膝关节进行性肿胀,5,年,Diffuse type of knee joint:T1WI shows low signal irregular thickened,synovium,on the,anterior and the posterior,cruciate,ligament,.,膝关节弥漫型,PVNS,。,MR T1WI,示前、后交叉韧带表面有不规则增厚的滑膜覆盖,增厚的滑膜呈低信号,T2WI also shows low signal irregular thickened,synovium,on the,anterior and the posterior,cruciate,ligament,.Low signal nodules can be seen in the effusion of,suprapatellar,bursa.T2WI shows mixed signal of multiple bone destruction,surrounding by a rim of,hypointensity,.,T2WI,示前、后交叉韧带表面有不规则增厚的低信号滑膜覆盖,髌上囊积液内见低信号结节,(,图,5),。,T2WI,示股骨、胫骨多发骨破坏,破坏区高低信号混杂,伴周边低信号环,(,图,6),Case 2 40-year-old female patient,diffuse type PVNS,Figure 4:T1WI shows diffusive thickened,synovium,.,Suprapatellar,bursa become large because of cloddy,synovium,.,Infrapatellar,fat pad,disappear instead of,proliferous,synovium,anterior horn of the lateral meniscus,was involved.,Figure 5:T2WI:diffusive,proliferous,synovium,shows low signal because of,hemosiderin,deposition.,MRI T1,加权像,滑膜弥漫性增厚,髌上囊因被团状的滑膜组织占据而扩大,髌下脂肪垫内脂肪缺失,代之以增厚的滑膜组织,外侧前角半月板受累及。图,5 MRI,示,T2,加权像,弥漫增厚的滑膜呈低信号,系含铁血黄素沉积所致。,MRI shows nodule on the surface of anterior,cruciate,ligament and bubble low signal under,articular,surface of,tibial,platform.,Histopathologic,section shows,proliferous,synovial,cell,interstitial(within tissues)show roundness and polygon.Partial cells have,hemosiderin,deposition,multinucleated giant cells can be seen locally.,MRI,示矢状面,T1,、,T2,加权像,前十字韧带表面结节影,胫骨关节面下类圆形低信号骨质缺损。,HE400,滑膜细胞明显增生,间质浸润的组织呈圆形或多角形,部分细胞吞噬含铁血黄素,局部见融合的多核巨细胞。,Case 3,26-year-old male patient,diffuse type of right knee joint,男,26,岁,右膝关节弥漫色素沉着绒毛结节性滑膜炎,Figure 1.T1WI:strati