色素沉着绒毛结节性滑膜炎的MRI表现

(不常见，好发于成年人，生于膝关节, 占80 % ,髋关节、踝关 不常见，好发于成年人，生于膝关节, ,髋关节、踝关 节、肩关节、肘关节的发病率依次减少) 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.
Diagnosis： Diagnosis：imaging findings
CT findings: shows joint capsule swelling, thickened synovium and obvious joint effusion CT 表现: 表现为关节囊 表现: 肿胀,滑膜增厚, 肿胀,滑膜增厚,关节腔 内明显积液
Case 1 35-year-old female patient， progressive 35-yearpatient， swelling of knee joints for 5 years 35岁 膝关节进行性肿胀5 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
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。HE×400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。
Histology and Pathology(组织病理 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. intra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。 在病理上分为局灶型和弥漫型2
Diagnosis： 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 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 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。
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 增殖的绒毛可破坏关节囊, 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, 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, 类脂质积聚的泡沫细胞,以及含铁血黄素沉着。
Case 2 40-year-old female patient, diffuse type PVNS 40-year-
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。
(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, 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。) 病变发作的缓解。)
The cause of PVNS is not clear, maybe related with tumor、 tumor、 trauma and infection.
(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。) 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 predilection is predilection kneeknee-joint(80%),then the hip ,ankle, shoulder, elbow in turn.
(本病的病因尚不明,一般认为与肿瘤、外伤、感染有关。) 本病的病因尚不明,一般认为与肿瘤、外伤、感染有关。)
Diagnosis： Diagnosis：imaging findings
X-ray: the routine X-ray shows major Xsymptoms 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 线表现: 常规X 包括关节囊肿胀、关节周围软组织肿 块及邻近骨骼的侵蚀, 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, 硬化环,但关节间隙保持正常,无骨质 疏松
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 sh百度文库ws 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)
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
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.