MRI诊断色素沉着绒毛结节滑膜炎的价值和意义

骨关节病的种类很多，涉及多个系统。影像学检查是关节病的重要检查方法之一，临床工作中，如何正确选择影像学检查并作出正确诊断是非常重要的。本期刊登的3篇色素沉着绒毛结节性滑膜炎(pigmented viuonodular synovitis，PVNS)的论文详细介绍了PVNS的影像学诊断价值，特别是突出了M砒的特征性表现在诊断PVNS方面的特异性价值。对这些征象的研究，无疑将进一步提高PVNS的正确诊断率，具有十分重要的临床意义。     

关节色素沉着绒毛结节性滑膜炎MRI诊断价值

目的：探讨MRI在关节色素沉着绒毛结节性滑膜炎（PVNS）诊断中的价值。资料与方法：回顾性分析12例经病理证实的关节PVNS的MRI、X线平片和关节镜等影像资料，比较和评价PVNS的MRI信号特点，关节内结构侵犯、关节外侵犯和骨质侵蚀等征象。结果：12例关节PVNS，8例MRI具有典型的含铁血黄素沉着，T1WI和T2WI呈等低信号。MRI可以准确显示X线平片难以显示的骨质侵蚀、关节内软骨和韧带侵蚀以及关节外侵犯的范围，对关节内关节软骨、半月板和交叉韧带侵蚀的显示和关节镜相当。结论：MRI在PVNS诊断中具有特征性的MRI信号及很高的诊断价值，可以取代诊断性的关节镜检查，MRI可准确评价PVNS在关节内外的侵犯范围，对指导手术、减少复发率具有重要意义。     

色素沉着绒毛结节性滑膜炎的MRI诊断

目的:探讨色素沉着绒毛结节性滑膜炎(PVNS)的MRI表现,提高本病的诊断水平。方法:回顾性分析5例经手术及病理证实的PVNS的MRI资料。结果:5例病变关节均见不同程度的滑膜增生,增生滑膜T1WI呈中等或稍低信号,T2WI为稍高或中等信号,其中可见散在含铁血黄素沉着结节状影,T1WI及T2WI均为低信号。5例病变关节均可见关节积液。2例病变关节有关节软骨及骨质破坏。结论:PVNS在MRI上有典型特征性的表现,可以准确显示其病变范围,做出定性诊断。     

色素沉着绒毛结节性滑膜炎MRI分析

目的：分析色素沉着绒毛结节性滑膜炎的MRI表现。资料与方法：回顾7例经病理证实的色素沉着绒毛结节滑膜炎，总结其MRI表现。结果：色素沉着绒毛结节性滑膜炎主要表现为滑膜不规则结节状增生、增生的滑膜和结节内沉着含铁血黄素、关节积液、邻近骨侵蚀。结论：滑膜不规则结节状增生和含铁血黄素沉着为色素沉着绒毛结节性滑膜炎MRI诊断的主要依据，快速小角度激发扫描优于自旋回波和快速自旋回波扫描。     

色素沉着绒毛结节性滑膜炎6例误诊分析

色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)是一种滑膜增生性疾病,临床并不少见,多数病例表现不典型,容易与其他疾病相混淆而误诊.本文总结分析2003年～2012年经病理确诊的6例PVNS患者临床及影像资料,并结合文献进行分析,以提高对本病的认识和诊断水平. 1 材料与方法 本组6例患者,女4例,男2例,年龄22～73岁,平均41岁.临床主诉单侧膝关节疼痛,肿胀,运动障碍,无明显诱因,病程1～7年,平均25个月,其中2例患者体表可触及结节.6例均行关节腔穿刺分别抽出暗红色或褐黄色液体.     

色素沉着绒毛结节性滑膜炎的影像学诊断

目的 探讨色素沉着绒毛结节性滑膜炎(PVS)的影像学表现,提高对该病的诊断水平.方法回顾性分析12例经手术及病理证实的 PVS 影像学资料.结果 12例患者X线平片检查示软组织肿胀8例,5例CT检查示3例可见软骨下骨质破坏.12例患者MRI检查均见具有特征性的表现,全部表现为滑膜不规则结节状增生,内含顺磁性的含铁血黄素沉着,韧带累及5例,半月板累及1例,髌下脂肪垫累及3例,软骨及软骨下骨质侵蚀3例,关节腔积液9例.结论 PVS具有较典型影像学表现,MRI能作出明确诊断.     

髋关节色素沉着绒毛结节性滑膜炎的MRI诊断

目的：探讨髋关节色素沉着绒毛结节性滑膜炎的MRI表现。方法：对8例髋关节PVNS患者行常规MRI检查,结合术后病理结果进行对照分析。结果：8例MRI均显示滑膜不同程度肿胀、增厚以及关节间隙软组织肿胀,增生的滑膜组织于T1WI上呈等信号～低信号,T2WI上呈低信号夹杂混杂信号。结论：PVNS的MRI表现具有一定的特征性,MRI可显示病变的范围和程度,能准确反映关节内外受侵情况,对本病的临床诊治具有较高价值。     

色素沉着绒毛结节性滑膜炎的MRI表现

目的 探讨色素沉着绒毛结节性滑膜炎的MRI表现特征和MRI诊断价值。方法 回顾分析经手术和病理证实的5例色素沉着绒毛结节性滑膜炎的MRI图像，全部病例采用SE序列和注射钆喷酸葡胺增强扫描。结果 1例局限型表现为关节囊结节状不规则增厚；4例弥漫型表现为关节旁葡萄串状囊性或囊实性包块，内有不规则结节，结节在T1、T2WI表现为低信号，囊液T2WI呈高低混杂信号、T1WI呈等信号，包块半包匀节囊及邻近骨生长；增强扫描绒毛结节及囊壁均匀强化，囊液信号变低。结论 色素沉着绒毛结节性滑膜炎具特征性MRI表现，MRI可作出确诊。     

色素沉着绒毛结节性滑膜炎的临床与影像学诊断

目的：探讨色素沉着绒毛结节性滑膜炎（PVS）的影像学表现特点。方法：回顾性分析经病理诊断10例PVS的临床和影像学表现。结果：PVS临床表现各异；X线平片表现为关节肿胀，可有结节状块影，局限性骨质缺损和骨皮质下小囊变；CT扫描显示关节肿胀内的软组织密度块影和骨质破坏，增强扫描有较均匀的强化征；MRI检查能清晰显示关节滑膜不规则状增生和在T1和T2加权像上的低信号结节。结论：PVS的临床诊断较困难，普通X线检查常能提示部分病人的诊断，CT扫描有较高的分辨率和某些特征性，MRI检查具有优良的软组织分辨率，可多参数、任意方向成像，能清楚显示关节内软组织结构，并可反应出病理组织学特征，能提供可靠的影像诊断依据，是临床诊断PVS的最佳无创性检查方法。     

色素沉着绒毛结节性滑膜炎的影像学表现

目的:探讨色素沉着绒毛结节性滑膜炎(PVNS)的影像学表现,以提高对该病的影像学诊断水平及鉴别诊断的能力。方法:回顾性分析11例经病理证实的PVNS影像学资料并进行总结。11例均行X线检查,其中2例同时行关节空气造影检查;CT平扫7例;10例行MRI检查,其中1例加增强扫描。结果:11例均为单关节发病,其中膝关节8例、踝关节2例、髋关节1例。主要影像学表现为:①关节囊肿胀及结节状软组织肿块:11例均显示关节囊肿胀,4例X线平片(36.3%)、5例CT(71.4%)及10例MRI(100%)显示结节状软组织肿块;②软骨下边缘清楚的骨侵蚀伴硬化缘6例:其中X线显示2例、CT显示6例、MRI显示5例;③滑膜增厚10例:4例CT(57.1%)、10例MRI(100%)显示滑膜增厚;其中弥漫性增厚8例,单纯局限性增厚2例;④关节腔积液及关节间隙的改变:关节腔积液9例(81.8%),关节间隙狭窄4例(36.3%);⑤多发结节的MRI信号改变:结节均呈长T1短T2信号者5例;信号混杂者3例;另2例既有长T1长T2信号,也有长T1短T2信号。结论:PVNS的影像学表现具有一定的特征,影像学检查(特别是MRI检查)大多能够做出正确诊断。     

An unusual presentation of peroneal neuropathy secondary to pigmented villonodular synovitis: a case report

Pigmented villonodular synovitis (PVS) is a benign proliferative disorder of unknown origin that affects synovial joints, most commonly the knee. The joint knee can be affected by localized or diffuse form. Diffuse PVS, the aggressive form of the disease is much more problematic, especially when it extends extra-articularly, and is associated with high recurrence rates. Although this disease is categorized as an inflammatory process rather than a neoplasm, it may be locally destructive and involve muscles, tendons, bone and skin. Neural involvement of the disease is rather rare, and only limited knowledge about neuropathy due to PVS we have yet. The presentation of the disease in our patient is a peroneal neuropathy which is the first reported case in English language literature of PVS of the knee seen with extra-articular tissue involvement.     

Magnetic resonance imaging of pigmented villonodular synovitis: a report of two cases

The magnetic resonance imaging characteristics of two surgically proven cases of pigmented villonodular synovitis are reported. On the short TR/TE pulse sequences, the synovium has an intermediate signal intensity. Long TR/TE pulse sequences show the synovium containing areas of increased signal interspersed with decreased signal. Hemosiderin deposition is believed to account for the areas of decreased signal; the increased signal results from fluid and inflamed synovium.     

Imaging of pigmented villonodular synovitis

Pigmented villonodular synovitis (PVNS) is a rare, benign, idiopathic proliferative disorder of the synovium that results in villous and/or nodular formation in joints, tendon sheaths, and bursae. The disease can be localized or diffuse. Patients with this condition typically present with symptoms of mild discomfort and associated stiffness of the involved joint; however, the spectrum of presentations is broad. Diagnosis of PVNS can be clinically difficult, and plain radiographs are usually nonspecific. Magnetic resonance (MR) imaging is a highly diagnostic modality in characterizing PVNS when it contains hemosiderin deposits exhibiting low signal intensity on all MR image pulse sequences. This article discusses the presentation, pathology, differential diagnosis, diagnostic modalities as well as various treatment options of PVNS.     

膝关节色素沉着绒毛结节性滑膜炎1例

患者男性，35岁。右膝关节肿胀，疼痛多年，近期加重。查体：右膝明显肿胀。关节活动受限，右膝内侧上方及Guo徊窝处均可扪及大小不等的软组织肿块．边界不清．无压痛，有软韧感。关节穿刺见血性积液。     

色素沉着绒毛结节性滑膜炎的MRI与病理对照分析

目的　研究色素沉着绒毛结节性滑膜炎 (PVNS)MRI表现的病理基础及其在扩散加权像 (DWI)上异常信号改变的机制。方法　分析 7例PVNS的MRI表现 ,计算DWI上异常信号灶的表观扩散系数 (ADC) ,并与手术病理结果进行对照分析。结果　 7例PVNS中弥漫型 5例 (膝关节4例 ,肩关节 1例 )。MRI主要表现为关节滑膜广泛增生 ,呈长T1 、长T2 信号 ,其内见含铁血黄素沉着 ,呈长T1 、短T2 信号 ;4例见膝关节腔积液 ,呈长T1 、长T2 信号 ;半月板破坏 3例 ,前、后交叉韧带破坏 2例 ,呈结节状长T1 、长T2 信号 ;4例见关节内软骨和邻近骨质明显破坏 (膝关节 3例 ,肩关节 1例 ) ,1例股骨骨质呈小囊状破坏。局限型 2例 (膝关节、髋关节各 1例 ) ,主要表现为滑膜结节状增生 ,其内亦可见含铁血黄素沉着 ,呈长T1 、短T2 信号。 1例见关节腔内少许积液 ,邻近股骨骨质小囊状破坏。DWI上关节积液、滑膜增生及邻近骨质破坏表现为异常高信号 ,其平均ADC值分别为 2 .750× 1 0 - 3mm2 /s,0 .52 2× 1 0 - 3mm2 /s,0 .559× 1 0 - 3mm2 /s。结论　滑膜绒毛结节状增生及其内点状或结节状含铁血黄素沉着是PVNS的典型表现 ,在MRI上具有一定的特征性 ;DWI有助于区分PVNS病变的不同组织成分 ;病变组织的ADC值下降 ,其对鉴别诊断的意义有待进一     

Pigmented villonodular synovitis of the knee in a child: a case report

Pigmented villonodular synovitis is a rare proliferative process, especially in children. Pigmented villonodular synovitis can affect the synovial joint, tendon sheaths, and bursa membranes. Within synovial joint involvement, it is commonly seen in the knee joint but hip, ankle, shoulder, wrist, and other joints can be involved. The appearance characteristic is found on a magnetic resonance imaging scan. Complete excision and synovectomy are the usual treatment. In this article, we report a case of pigmented villonodular synovitis of the knee in a 12- year-old girl who underwent total synovectomy after the diagnosis was confirmed by biopsy. Three years after surgery, neither recurrence nor joint degeneration was found. The osteochondral defect at the tibial plateau was filled with calcium phosphate bone paste.     

Localized pigmented villonodular synovitis of the knee: diagnostic challenge and arthroscopic treatment: a report of three cases

The localized form of pigmented villonodular synovitis (LPVS) is a lesion characterized by focal involvement of the synovial membrane. The knee is the most commonly affected joint. We report three cases of LPVS of the knee which were not diagnosed upon clinical evaluation. The aim is to bring the attention of clinicians to this pathological entity, which is often regarded as extremely rare and is therefore not considered in the early differential diagnosis of various knee derangements. Diagnostic and therapeutic arthroscopy was performed. The lesions were completely resected and patohistological findings confirmed the diagnosis of LPVS. All of our three patients have remained asymptomatic at 8, 10, and 12-month follow-ups.