HistoryA 50-year-old woman with chronic knee pain.50岁女性，慢性膝关节疼痛。
1.Which of the following is the most likely diagnosis?
最有可能的诊断是什么？
Amyloid 淀粉样变
Gout 痛风
Hemophilic arthropathy 血友病性关节炎
Nodular synovitis 结节性滑膜炎
Synovial chondromatosis 滑膜软骨瘤病
Findings and Diagnosis
FindingsAxial and coronal T1 and axial, coronal, and sagittal T2 fat-saturated MR images show thickening of the deep medial collateral ligament and thickening of the posterolateral joint recess with soft tissue demonstrating low T1 and low T2 signal.横断位及冠状位T1WI，矢状位、冠状位、横断位T2WI脂肪抑制序列示：内侧副韧带深层增厚，增厚的后外侧关节囊内见长T1短T2软组织信号。Differential Diagnosis
2.Definitive treatment for this condition is synovectomy.
该病的首选治疗方法为滑膜切除术。
True
False
3.This disease process is classically polyarticular.
该病典型表现为多关节发病。
True
False
4.Focal areas of increased intralesional signal on T1-weighted images are thought to represent which of the following?
病灶中心T1WI局限性高信号可能与下列哪项有关？
Lipid-laden macrophages 富含脂质的巨噬细胞
Melanin 黑色素
Blood products 血液产物
Slow blood flow 血流缓慢所致
5.PVNS lesions on histology demonstrate all of the following EXCEPT:
PVNS病理上可见的征象不包括下列哪项？
Synovial cell proliferation 滑膜细胞增生
Neutrophils 中性粒细胞
Hemosiderin deposition 含铁血黄素沉积
Multinucleated giant cells 多核巨细胞
选择题答案：
Nodular synovitis
True
False
Lipid-laden macrophages
Neutrophils
Discussion
Proliferative villonodular synovitis (PVNS) may present as focal nodular masses or with villonodular proliferation of entire synovium and joint recesses.绒毛增生性滑膜炎（PVNS）可表现为局灶性肿块，也可表现为整个滑膜和关节囊的弥漫性绒毛结节性增生。
Intra-articular PVNS most commonly occurs in the knee.关节内PVNS最常发生于膝关节。
Gradient-echo imaging may demonstrate “blooming” phenomenon of hemosiderin-laden nodules.由于结节内富含含铁血黄素，GRE序列可见“开花伪影”，即磁敏感伪影。
There may be a large effusion on radiograph or MRI, which may appear dense if there is repeated bleeding.X线或MRI可能见大范围水肿，如果有反复出现，可表现为密度增高。
Low signal on T1- and T2-weighted images with some variability in T2 weighting.T1WI、T2WI低信号，T2WI信号可不均匀。
Treatment is resection with synovectomy.治疗方法为滑膜切除术。
Important to report all regions of involvement, including all recesses.诊断中需报告所有病灶的累及范围，包括整个关节囊。
Incomplete resection has a high recurrence rate.如果滑膜切除不完全，复发率很高。
