膝关节色素沉着绒毛结节性滑膜炎的MRI影像分析

目的:分析膝关节色素沉着绒毛结节性滑膜炎(PVNS)的MRI影像表现,提高对本病的认识。方法:回顾性分析13例经病理证实的膝关节色素沉着绒毛结节滑膜炎,总结其MRI表现特点。结果:13例患者中弥漫型9例,局限型4例。PVNS主要表现为滑膜不规则结节状增生或弥漫性增生,增生的滑膜和结节内沉着含铁血黄素(T1WI、T2WI双低信号)。关节内外结构可受侵。结论:PVNS所致的滑膜增生和含铁血黄素沉着在MRI上具有特征性的表现和信号,对诊断本病具有重要意义。     

Pigmented villonodular synovitis of the hip: review of radiographic features in 58 patients

Clinical and radiographic findings were retrospectively reviewed in a multicentric survey of 58 patients with histologically proven pigmented villonodular synovitis (PVNS) of the hip. The most common clinical features were mechanical pain (47 cases) and limitation of joint motion (47 cases). On plain films, a classic form with large and multiple lucencies was found in 36 cases, followed by an osteoarthritis-like form (9 cases), an arthritis-like form (8 cases), normal radiographic appearance (3 cases), osteonecrosis of the femoral head (one case) and joint destruction with acetabular protrusion (one case). Bilateral involvement of the hips was probable in two patients. In contrast to the knee, the hip showed a high prevalence of bony lesions and joint space narrowing. Although an uncommon disease, PVNS of the hip has to be considered when arthritis is associated with uncharacteristic clinical or radiographic findings.     

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。     

膝关节色素沉着绒毛结节性滑膜炎的MRI表现

目的：探讨膝关节色素沉着绒毛结节性滑膜炎的MRI表现。方法：回顾性分析8例经手术及病理证实的膝关节PVNS的MRI影像资料。结果：MRI表现中弥漫型6例,局灶型2例。PVNS主要表现为滑膜不规则结节状增生或弥漫性增生,增生的滑膜内含铁血黄素沉着（T2WI低信号）、邻近半月板和（或）骨侵蚀、关节腔积液等。结论：MRI是本病理想的检查方法。     

关节镜手术辅助放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效分析

目的分析采用关节镜手术辅助放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效。方法 10例膝关节弥漫型色素沉着绒毛结节性滑膜炎患者,采用关节镜下病变切除,术后辅助放疗,通过12~36个月的随访,观察治疗效果。结果 10例随访患者,术前Lysholm膝关节功能评分为（53.5±11.6）分,术后随访Lysholm膝关节功能评分为（85.7±10.7）分。结论关节镜手术辅助放射治疗对弥漫型膝关节色素沉着绒毛结节性滑膜炎是一种有效的方法。     

Tuberculosis of the hip as the presenting sign of HIV and simulating pigmented villonodular synovitis

A 36-year old man, with no prior known exposure to human immunodeficiency virus (HIV) or tuberculosis, presented with monoarticular pain and a decreased range of motion in his left hip. Radiography and magnetic resonance imaging revealed bony erosive lesions, juxta-articular cysts, a large effusion, and juxta-articular edema. The initial clinical and radiographic diagnosis was pigmented villonodular synovitis (PVNS) of the left hip. However, what was initially felt to be a chronic proliferative inflammatory process was later determined to be tuberculous arthritis. This case emphasizes the importance of including tuberculous arthritis in the differential diagnosis of patients with monoarticular destructive joint disease radiologically suggestive of PVNS.     

Malignancy in pigmented villonodular synovitis

Malignant pigmented villonodular synovitis is an extremely rare and controversial disease. We describe malignant change in pigmented villonodular synovitis of the ankle in a patient with an unusually long clinical history. Symptoms began at age 21, metastatic disease developed at age 85, and the patient died 1 year later. The histologic appearance of the malignant tumor differed from that in most reported cases, in that spindle-shaped cells predominated. Lymph node metastasis also developed, a feature uncommon to soft tissue sarcomas.     

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(pigmented villonodular synovitis，PVNS)的MRI表现。方法 23例PVNS中膝关节9例，髋关节9例，踝关节3例，肘关节1例，腕关节1例，均经手术和病理证实。23例PVNS均行X线和MR检查，其中4例行CT检查。分析PVNS的影像学表现，着重总结PVNS的MR影像学特点。结果 X线表现：23例均可见关节及软组织肿胀，7例关节内外可出现较致密结节状或分叶状软组织肿块影，19例可见邻近关节骨质侵蚀性小缺损。CT表现：4例中3例可见关节内外结节状或分叶状软组织肿块，增强扫描可见结节样强化，1例CT仅显示关节囊增厚，关节内积液。MRI表现：23例病变部位增生肥厚的滑膜在T1WI上呈中等或中等稍低信号，在T2WI上呈中等稍高信号，其内可见多发散在结节，呈T1WI、T2WI低信号灶；增生肥厚的滑膜在快速梯度回波(FFE)T2WI序列上呈明显结节样低信号。23例病变关节均可见不同程度的关节积液。19例有骨质破坏，表现为凹陷性类圆形骨质缺损，骨缺损区T1、T2WI呈中等信号灶，周围有硬化边，呈T1WI、T2WI低信号。相邻骨髓腔内可见弥漫性反应性水肿灶，呈片状高T2信号。结论 MRI能准确显示PVNS的病变范围和程度，对PVNS有定性诊断价值。     

膝关节色素沉着绒毛结节性滑膜炎的MRI诊断

目的　探讨MRI对膝关节色素沉着绒毛结节性滑膜炎 (PVNS)的诊断价值。方法　回顾性分析 14例经手术及病理证实的PVNS的MRI表现。结果　 14例患者中滑膜增厚 (14 / 14 ) ;关节积液 (12 / 14 ) ;关节内软组织结节 (14 / 14 ) ,其中T1WI、T2 WI及FL2D序列上结节均为明显低信号 (11/ 14 ) ,T1WI结节等信号 (3 / 14 ) ,T2 WI等信号结节中有少量低信号 (2 / 14 ) ;半月板破坏(4 / 14 ) ;后交叉韧带受累 (1/ 14 ) ;关节内脂肪垫受侵 (11/ 14 ) ;关节软骨并软骨下骨质受侵 (11/ 14 ) ;关节间隙狭窄 (4 / 14 )、增宽 (2 /14 ) ;窝囊肿 (5 / 14 )。结论　色素沉着绒毛结节性滑膜炎的MRI表现具有明显的特征性 ,为本病理想的检查方法     

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。     

MRI of the knee in diffuse pigmented villonodular synovitis

Magnetic resonance imaging (MRI) was performed on 11 patients with surgically proven pigmented villonodular synovitis (PVNS) of the knee. PVNS was diagnosed on the basis of presence of hemosiderin, joint effusion, and hyperplastic synovium without significant joint destruction. MRI provided a detailed map of the distribution of the disease within the joint, emphasizing the common occurrence of the disease behind the cruciate ligaments and in synovial cysts in the popliteal fossa. MRI aided in preoperative planning and postoperative follow-up for residual and recurrent disease. Nine additional cases of joint hemorrhage, hemophilia, desmoplastic tumors, and synovial chondromatosis were included to delineate differential diagnostic criteria.     

Pigmented villonodular synovitis of the knee: computed tomographic appearances

Five patients with pigmented villonodular synovitis (PVNS) of the knee demonstrate the value of preoperative, contrast medium-enhanced CT scanning. The technique is shown to be particularly useful in locating recurrent lesions and in demonstrating that popliteal and posterior calf masses are due to PVNS affecting the knee joint itself. In two of the five patients PVNS was not considered a possibility before the CT scan, and none had evidence of bone erosion on plain radiographs. In none of the patients was the unenhanced CT scan able to demonstrate evidence of decreased radiolucency due to fat within the tumour or density greater than the adjacent skeletal muscle, indicating haemosiderin deposits.     

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(PVNS)的影像学表现。方法:回顾性分析14例经手术及病理证实的PVNS患者的X线平片、CT、MRI等影像学资料。结果:14例X线检查者均见关节囊肿胀,其中8例骨质受侵蚀,1例可见软组织肿块。8例CT检查均示关节囊肿胀,其中6例可见关节腔积液及周围骨质受侵蚀,2例见软组织肿块影,2例增强扫描者均可见强化的滑膜结节和增厚的滑膜。10例MR检查者弥漫型8例,局限型2例,均可见到关节囊肿胀及数量不等的增生滑膜绒毛结节,其中9例在增生滑膜内可见含铁血黄素沉着,呈长T1、短T2低信号,8例关节腔积液及骨质受侵蚀,3例见软组织肿块,3例增强扫描者示增厚的滑膜和结节明显强化。结论:MRI对色素沉着绒毛结节性滑膜炎诊断及鉴别诊断具有重要价值,是一种简单、无创、有效的检查手段。     

Tuberculous arthritis of the knee joint mimicking pigmented villonodular synovitis

Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and non-specific imaging findings. Specifically, monoarticular tuberculosis of the knee may mimic pigmented villonodular synovitis (PVNS). The present report describes a young patient with tuberculous arthritis of the knee. Proper diagnosis was delayed due to magnetic resonance imaging findings, such as hemosiderin deposits and a nodular mass around the knee joint, suggesting the diffuse type of PVNS. These findings suggest that the first step in the diagnosis of tuberculous knee arthritis is to have a high index of suspicion.     

膝关节色素沉着绒毛结节性滑膜炎MRI分析

目的:分析膝关节色素沉着绒毛结节性滑膜炎(PVNS)的MRI表现与诊断价值。材料和方法:回顾性分析9例经病理证实的色素沉着绒毛结节滑膜炎,总结其MRI表现特点。结果:局限型3例,弥漫型6例。PVNS主要表现为滑膜不规则结节状增生或弥漫性增生,增生的滑膜内含铁血黄素沉着(T2WI低信号)、邻近半月板和(或)骨侵蚀、关节腔积液等。结论:MRI能为早期诊断膝关节PVNS提供依据,并积极指导手术。     

Pigmented villonodular synovitis: MRI characteristics

The magnetic resonance imaging (MRI) scans of 26 patients with histopathologically proven pigmented villonodular synovitis (PVNS), involving joints but excluding tendon sheaths, were reviewed retrospectively. The purpose of this study is to define the spectrum and frequency of MRI characteristics for PVNS using conventional spin echo (in two cases before and after intravenous administration of gadopentate dimeglumine) and also gradient echo techniques. A cystic variety is presented, the MRI appearances of which have not been found in a review of the literature.     

色素沉着绒毛结节性滑膜炎诊断与治疗——附11例临床报道

对 11例弥漫型色素沉着绒毛结节性滑膜炎患者的临床资料进行了回顾性的随访。总结出MRI与B超是有效的诊断方法。MRI中T2像上低信号密度影是色素沉着绒毛结节性滑膜炎的特异性表现。在治疗方面 ,介绍了关节镜下次全滑膜切除术的方法 ,并对关节镜手术与切开手术进行比较。指出关节镜手术创伤小 ,并发症少 ,术中探查全面 ,术后容易康复的优点。推荐关节镜下次全滑膜切除术辅以术后放疗作为治疗弥漫型色素沉着绒毛结节性滑膜炎的有效方法。     

Subacromial bony erosion: a rare presentation of pigmented villonodular synovitis of the shoulder

Pigmented villonodular synovitis (PVNS) rarely affects the shoulder. We describe two cases of PVNS arising from the shoulder joint, which caused rotator cuff tears and sub-acromial bony erosion, and which were treated arthroscopically. Sub-acromial erosion is frequently associated with various glenohumeral joint disorders, but it has not been reported in association with PVNS. We believe PVNS should also be considered in the differential diagnosis of patients who present with sub-acromial erosion.     

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。     

Pigmented villonodular synovitis and giant cell tumor of the tendon sheath: scintigraphic findings in 10 cases

The purpose of this report was to determine the pattern of thallium (T1-201) uptake in pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (GCTTS) and to evaluate for features that might help to distinguish these lesions from malignant disease. Scintigraphic images from patients subsequently found to have pigmented villonodular synovitis confirmed by histopathologic analysis were assessed. The patients had been evaluated with T1-201 scintigraphy for a suspicious musculoskeletal lesion. All 6 patients with PVNS had significant T1-201 uptake on the early images with retention on the delayed images. The T1-201 activity was in a juxta-articular location and generally conformed to the synovial cavity with scattered irregular nodular components. Of 4 cases of giant cell tumor of the tendon sheath, all had T1-201 uptake on the early images, and 3 cases (75%) also had uptake on the delayed images. T1-201 uptake is observed almost invariably in pigmented villonodular synovitis on both early and delayed images and can simulate the findings of malignant disease. Features that should raise suspicion of PVNS include close proximity to a joint, especially with distribution corresponding to that of the synovial cavity. When T1-201 activity is detected in a lesion in the hand or foot, giant cell tumor of the tendon sheath should be considered. Magnetic resonance imaging will often aid in the differentiation by demonstrating features of hemosiderin degradation products.