色素沉著絨毛結(jié)節(jié)性滑膜炎的MRI表現(xiàn)

1、Pigmented villonodularSynovitis(PVns)色素沉著絨毛結(jié)節(jié)性滑膜炎1.IntroductionPigmented villonodular synovitis(PVNS) comprises agroup of idiopathic lesions in joints, tendon sheathes andburs ae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)性的旱結(jié)節(jié)狀或線毛狀進(jìn)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不常見(jiàn),好發(fā)于成年人,生于膝關(guān)節(jié),占80%,髖關(guān)節(jié)、踝關(guān)肩關(guān)節(jié)、肘關(guān)節(jié)的發(fā)病率依次減少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,液較常見(jiàn),本病可引起反復(fù)積液,各活動(dòng)期The cause of PVNS is not clear, maybe related with tumortrauma a

4、nd infection(本病的病因尚不明,一般認(rèn)為與腫瘤、外傷、感染有關(guān)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父線表現(xiàn)常規(guī)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

5、侵蝕,骨缺損邊硬化環(huán),但關(guān)節(jié)間隙保持正常,無(wú)骨質(zhì)4.Diagnosis: imaging findingsCT findings: shows jointcapsule swelling,thickened synovium andobvious joint effusionCT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5.Diagnosis: imaging findingsMR findings is very special and shows thickenedsynovitis and the condition of joint effusionMR表現(xiàn)具有明顯的特征性,能

6、清晰的顯示滑膜的增厚和積液的程度。Because of hemosidenin deposition in the synovitislesions, it shows low signal both on T1WI and T2WIPartial lesions show bone invasion由于病變滑膜組織內(nèi)含鐵血黃素的沉積,故在T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)。6.Histology and Pathology(組織病理學(xué))The his tological findings are exuberant synovialproliferatio

7、n with numerous villi and folds thatsometimes fuse into nodules and form locallyaggressive 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 typePNS在病理上分為局灶型和彌漫型2種。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(guò)關(guān)節(jié)軟胃、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, dispersedm

9、ultinucleated giant cells, foam cells and pigmentedhemosiderin 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彌漫型PVNS:T2W示關(guān)節(jié)腔內(nèi)及胭窩多發(fā)低信號(hào)結(jié)節(jié),部分結(jié)節(jié)內(nèi)見(jiàn)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(jiàn)低信號(hào)結(jié)節(jié).Focal type: TIWI shows well-distributed low signal mass in infrapatellar bursa with a littlend joint strue局灶型PVNS,TwI示髕下囊內(nèi)腫塊,腫塊呈均勻低信號(hào),伴關(guān)節(jié)腔少量積液,關(guān)節(jié)骨結(jié)構(gòu)正9.Case 1 35-year-old female patient, progressiveswelling 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: TIWIshows low signal irre