Imaging Features of Pigmented Villonodular Synovitis with Emphasis on Sonographic Findings

J. Lin MD, W.J. Weadock, MD, T.J. Quinn MD, J.A. Jacobson MD, D.A. Jamadar MBBS, J.H. Ellis MD

University of Michigan, Ann Arbor, Michigan

Take Home Points

  1. Routine radiography and CT of PVNS often demonstrate non-marginal pressure erosions with sclerotic margins as well as nodular soft tissue masses, which are rarely calcified. The joint space is typically preserved in PVNS and reactive bone formation is characteristically absent.

  2. MR imaging characteristics of PVNS are nodular, synovial masses which are low signal on T1-weighted and T2-weighted imaging. The magnetic susceptibility of hemosiderin causes increased conspicuity of the lesions (blooming effect). Diffuse, intense contrast enhancement is typical.

  3. Sonography of PVNS shows non-specific focal or nodular synovial thickening with increased flow on color and power Doppler imaging. A joint effusion is typically present as well.

  4. CT provides an accurate means of guidance for biopsy of PVNS lesions when a tissue diagnosis is required.

  5. Sonography may be utilized to monitor the effects of treatment of PVNS.



References:

  1. Lin J, Jacobson JA, Jamadar DA, Ellis JH. Pigmented villonodular synovitis and related lesions: The spectrum of imaging findings. AJR 1999;172:191-197.
  2. Hughes TH, Sartoris DJ, Schweitzer ME, Resnick DL. Pigmented villonodular synovitis: MRI characteristics. Skeletal Radiol 1995;24:7-12.
  3. Bravo SM, Winalski CS, Weissman BN. Pigmented villonodular synovitis. Radiol Clin North Am 1996;34:311-326.