素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)課件

1、Pigmented Villonodular Synovitis (PVNS)色素沉著絨毛結(jié)節(jié)性滑膜炎 素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)1Pigmented Villonodular SynovitIntroduction Pigmented villonodular synovitis (PVNS) comprises a group of idiopathic lesions in joints,tendon sheathes and bursae. (色素沉著絨毛結(jié)節(jié)性滑膜炎主要是指關(guān)節(jié)、滑囊以及腱鞘內(nèi)的滑膜特發(fā)性的呈結(jié)節(jié)狀或絨毛狀進(jìn)行性增生。) Pigmented vilionodu

2、lar synovitis (PVNS) is an uncommon, usually monoarticular disorder and usually found in adults. The most common sites predilection is knee-joint(80%),then the hip ,ankle, shoulder, elbow in turn. (不常見，好發(fā)于成年人，生于膝關(guān)節(jié), 占80 % ,髖關(guān)節(jié)、踝關(guān)節(jié)、肩關(guān)節(jié)、肘關(guān)節(jié)的發(fā)病率依次減少)素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)2Introduction Pigmented villClinical

3、 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 ac

4、tive disease. (本病的臨床表現(xiàn)缺乏特異性.臨床主要表現(xiàn)為受累關(guān)節(jié)進(jìn)行性腫脹,血性關(guān)節(jié)積液較常見，本病可引起反復(fù)積液，各活動(dòng)期之間可見病變發(fā)作的緩解。) The cause of PVNS is not clear, maybe related with tumor、trauma and infection. (本病的病因尚不明,一般認(rèn)為與腫瘤、外傷、感染有關(guān)。)素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)3Clinical manifestations ThDiagnosis：imaging findings X-ray: the routine X-ray shows major sym

5、ptoms 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 線表現(xiàn): 常規(guī)X 線平片上主要征象包括關(guān)節(jié)囊腫脹、關(guān)節(jié)周圍軟組織腫塊及鄰近骨骼的侵蝕,骨缺損邊緣有硬化環(huán),但關(guān)節(jié)間隙保持正常,無骨質(zhì)疏松素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)4Diagnosis：imaging findings Diagnos

6、is：imaging findings CT findings: shows joint capsule swelling, thickened synovium and obvious joint effusion CT 表現(xiàn): 表現(xiàn)為關(guān)節(jié)囊腫脹,滑膜增厚,關(guān)節(jié)腔內(nèi)明顯積液素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)5Diagnosis：imaging findings CTDiagnosis：imaging findings MR findings is very special and shows thickened synovitis and the condition of joint eff

7、usion. MRI 表現(xiàn)具有明顯的特征性，能清晰的顯示滑膜的增厚和積液的程度。 Because of hemosiderin deposition in the synovitis lesions, it shows low signal both on T1WI and T2WI. Partial lesions show bone invasion. 由于病變滑膜組織內(nèi)含鐵血黃素的沉積，故在T1加權(quán)像和T2加權(quán)像均呈低信號(hào)，這是特征性的征象。部分病變可侵蝕骨結(jié)構(gòu)。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)6Diagnosis：imaging findings MRHistology and Pa

8、thology(組織病理學(xué)) The histological findings are exuberant synovial proliferation with numerous villi and folds that sometimes fuse into nodules and form locally aggressive intra-articular masses. 組織學(xué)表現(xiàn)為活躍增生的滑膜呈絨毛狀或皺襞樣，常形成結(jié)節(jié)狀侵襲性的關(guān)節(jié)內(nèi)腫物。 PVNS can be divided into focal type and diffuse type. PVNS 在病理上分為局灶型

9、和彌漫型2 種。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)7Histology and Pathology(組織病理學(xué)) 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

10、 attachment of ligment. 彌漫型主要為滑膜廣泛增厚、絨毛狀增生和含鐵血黃素沉著,增殖的絨毛可破壞關(guān)節(jié)囊,侵犯周邊軟組織并通過關(guān)節(jié)軟骨、骨與關(guān)節(jié)交界部或沿韌帶附著處侵犯骨組織 Focal type shows mounds of synovial cells, dispersed multinucleated giant cells , foam cells and pigmented hemosiderin deposition. 局灶型為密集成堆的滑膜細(xì)胞,間以散在的多核巨細(xì)胞和有類脂質(zhì)積聚的泡沫細(xì)胞,以及含鐵血黃素沉著。 素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)8 Diff

11、use type shows exuberanDiffuse 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

12、signal nodule also can be seen in the suprapatellar bursa.彌漫型PVNS:T2WI 示關(guān)節(jié)腔內(nèi)及腘窩多發(fā)低信號(hào)結(jié)節(jié),部分結(jié)節(jié)內(nèi)見高信號(hào)區(qū),關(guān)節(jié)腔積液呈高信號(hào)。脛骨關(guān)節(jié)面破壞,呈混雜信號(hào),周圍伴低信號(hào)環(huán)。髕上囊亦見低信號(hào)結(jié)節(jié).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 示髕下囊內(nèi)腫塊,腫塊呈均

13、勻低信號(hào),伴關(guān)節(jié)腔少量積液,關(guān)節(jié)骨結(jié)構(gòu)正常素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)9Diffuse type：T2WI shows multiCase 1 35-year-old female patient， progressive swelling of knee joints for 5 years女，35歲，膝關(guān)節(jié)進(jìn)行性腫脹5年Diffuse type of knee joint:T1WI shows low signal irregular thickened synovium on the anterior and the posterior cruciate ligament. 膝關(guān)節(jié)

14、彌漫型PVNS。MR T1WI 示前、后交叉韌帶表面有不規(guī)則增厚的滑膜覆蓋,增厚的滑膜呈低信號(hào)素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)10Case 1 35-year-old female patT2WI 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 o

15、f multiple bone destruction, surrounding by a rim of hypointensity.T2WI 示前、后交叉韌帶表面有不規(guī)則增厚的低信號(hào)滑膜覆蓋,髕上囊積液內(nèi)見低信號(hào)結(jié)節(jié)(圖5) 。T2WI 示股骨、脛骨多發(fā)骨破壞,破壞區(qū)高低信號(hào)混雜,伴周邊低信號(hào)環(huán)(圖6) 素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)11T2WI also shows low signal irCase 2 40-year-old female patient, diffuse type PVNS Figure 4 :T1WI shows diffusive thickened syno

16、vium. 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 加權(quán)像, 滑膜彌漫性

17、增厚, 髕上囊因被團(tuán)狀的滑膜組織占據(jù)而擴(kuò)大, 髕下脂肪墊內(nèi)脂肪缺失, 代之以增厚的滑膜組織, 外側(cè)前角半月板受累及。圖5 MRI 示T2 加權(quán)像, 彌漫增厚的滑膜呈低信號(hào), 系含鐵血黃素沉積所致。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)12Case 2 40-year-old female patMRI shows nodule on the surface of anterior cruciate ligament and bubble low signal under articular surface of tibial platform. Histopathologic section sh

18、ows proliferous synovial cell, interstitial (within tissues) show roundness and polygon. Partial cells have hemosiderin deposition, multinucleated giant cells can be seen locally.MRI 示矢狀面T1、T2 加權(quán)像, 前十字韌帶表面結(jié)節(jié)影, 脛骨關(guān)節(jié)面下類圓形低信號(hào)骨質(zhì)缺損。HE400滑膜細(xì)胞明顯增生, 間質(zhì)浸潤的組織呈圓形或多角形, 部分細(xì)胞吞噬含鐵血黃素, 局部見融合的多核巨細(xì)胞。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)

19、13MRI shows nodule on the surfacCase 326-year-old male patient, diffuse type of right knee joint 男, 26歲,右膝關(guān)節(jié)彌漫色素沉著絨毛結(jié)節(jié)性滑膜炎Figure 1.T1WI: stratified singular signal in the popliteal fossa shows slightly high centre and iso-low rim. Irregular banded low signal can be seen in the suprapatellar bursa an

20、d infrapatellar fat pad. Obviously low signal can be seen below the articular surface of tibia.圖1 右膝關(guān)節(jié)矢位T1W I示腘窩內(nèi)見異常信號(hào),呈中心稍高,周邊等、低信號(hào)的分層狀排列,髕上囊及髕下脂肪囊內(nèi)見形態(tài)不規(guī)則的片帶狀低信號(hào)影,脛骨前上緣關(guān)節(jié)面下見小囊狀明顯低信號(hào)影。Figure 2. fat-suppressed T2WI:stratified singular signal in the popliteal fossa shows obviously high centre and iso-

21、low rim. Irregular banded high signal can be seen in the suprapatellar bursa and infrapatellar fat pad. Mixed signal can be seen below the articular surface of tibia.圖2右膝關(guān)節(jié)矢位壓脂T2W I示腘窩內(nèi)異常信號(hào),呈中心明顯高、周邊等、低信號(hào)的分層狀排列,髕上囊及髕下脂肪囊內(nèi)見形態(tài)不規(guī)則的片帶狀高信號(hào)影,脛骨前上緣關(guān)節(jié)面下見小囊狀高、低混雜信號(hào)影。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)14Case 326-year-old male

22、patien figure3. fat-suppressed T1WI after contrast enhanced: the center of the lesion in the popliteal space shows moderate enhanced, the rim of the lesion、 suprapatellar bursa、 infrapatellar fat pad and popliteal space were obviously enhanced. Obviously annular enhanced lession also be seen below t

23、he articular surface of tibia 壓脂T1W I增強(qiáng)掃描示腘窩內(nèi)病灶,中心部分呈中度增強(qiáng),周邊及髕上囊及髕下脂肪囊、腘窩內(nèi)見形態(tài)不規(guī)則的片帶狀明顯增強(qiáng),脛骨前上緣關(guān)節(jié)面下見環(huán)狀明顯增強(qiáng)。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)15 figure3. fat-suppressed T1WICase 422-year-old male patient,the PVNS of left hip joint男性, 22歲,右髖關(guān)節(jié)色素沉著絨毛結(jié)節(jié)性滑膜炎The nodular lesion of right hip joint shows hyper-hypo intense-si

24、gnal on T2WI and iso/hypo mixed-signal on T1WI.The right femoral head was compressive deformation and show multiple nodular low signal on T2WI and T1WI. 右髖關(guān)節(jié)軸位T2WI示右髖關(guān)節(jié)內(nèi)見結(jié)節(jié)狀高、低混雜信號(hào),相應(yīng)區(qū)域股骨頸受壓變形,股骨頭內(nèi)見多發(fā)結(jié)節(jié)狀低信號(hào)影.軸位T1W I示右髖關(guān)節(jié)內(nèi)見結(jié)節(jié)狀等低混雜信號(hào)相應(yīng)區(qū)域股骨頸受壓變形,股骨頭內(nèi)見多發(fā)結(jié)節(jié)狀低信號(hào)影.素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)16Case 422-year-old male

25、patientFigure6 .enhanced T1WI: the nodular lesion of the right hip joint shows obviously enhanced.軸位T1W I增強(qiáng)掃描示右髖關(guān)節(jié)內(nèi)結(jié)節(jié)狀異常信號(hào)明顯增強(qiáng)。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)17Figure6 .enhanced T1WI: the noCase 5 A 43-year-old man presented with pain in the back of the neck radiating to the right upper limb. The pain had progres

26、sed over a period of 3 months. There was no weakness of the lower limbs or incontinence of bladder or bowel.43歲男性，頸背部疼痛并放射至右上肢，進(jìn)行性加重3個(gè)月，下肢無癥狀，無大小便失禁FIG 1. Lateral radiograph of the cervical spine shows a soft tissue mass destroying the posterior elements of the lower cervical spine (arrow). There ar

27、e no foci of calcifications seen within this mass. 圖1：頸椎側(cè)位片示軟組織腫塊破壞頸椎后下部結(jié)構(gòu)，腫塊內(nèi)無鈣化點(diǎn)。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)18Case 5 A 43-year-old man prFIG 2. Sagittal T1-weighted images before (A) and after (B) contrast dministrationshow an expansile mass lesion involving the posterior elements of C5 and C6 vertebra. Thi

28、s mass shows homogeneous enhancement after contrast material administration.It is seen to displace the thecal sac anteriorly.圖2.矢狀位T1WI增強(qiáng)前后示膨脹性的腫塊侵犯驚5、6椎體及其附件，腫塊呈均勻強(qiáng)化，向前推壓硬膜囊。素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)19FIG 2. Sagittal T1-weighted imAxial T1-weighted postcontrast image with fat suppression shows the exact de

29、lineation of the mass with an anteriorly displaced thecal sac (arrow).軸位增強(qiáng)壓脂T1WI示界限明確的腫塊向前推壓硬膜囊。Histopathologic section of pigmented villonodular synovitis depicting sheetlike growth within the main tumor mass, which is comprised of mononuclear cells and multinucleated giant cells within the collagenized stroma. Hematoxylin and eosin.組織病理學(xué)示變形增殖的滑膜細(xì)胞，間以散在的的單核細(xì)胞和多核巨細(xì)胞。（HE染色）素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)20Axial T1-weighted postcont