Greenspan A, Azouz E M, Matthews J, Décarie J C
Department of Radiology, University of California, Davis Medical Center, Sacramento 95817, USA.
Skeletal Radiol. 1995 Nov;24(8):583-90. doi: 10.1007/BF00204857.
This study was undertaken to describe the imaging characteristics of synovial hemangioma, with the goal of improving the disappointing rate (22%) of clinical diagnosis of this condition. A review of the literature and the differential diagnosis of intra-articular lesions, including synovial osteochondromatosis and pigmented villonodular synovitis, are also presented.
The subjects of the study were 8 patients (4 males, 4 females; age range: 5-47 years; mean age: 19 years) with histologically confirmed synovial hemangioma involving the knee (n = 7) or wrist (n = 1). We retrospectively examined the imaging studies performed in these patients, including plain radiography (n = 8), magnetic resonance imaging (MRI; n = 4), angiography (n = 3), arthrography (n = 2), and contrast-enhanced computed tomography (CT; n = 2).
Plain radiographs showed a soft tissue density suggesting either joint effusion or a mass in all patients. Phleboliths and bone erosions on plain films in four patients with extra-articular soft tissue involvement pointed to the correct diagnosis. Angiography, showing fine-caliber, smooth-walled vessels, contrast pooling in dilated vascular spaces, and early visualization of venous structures, was diagnostic in two patients. Neither arthrography nor CT yielded specific enough findings. MRI was consistently effective in allowing the correct diagnosis to be made preoperatively, showing an intra-articular or juxta-articular mass of intermediate signal intensity on T1-weighted images and of high signal intensity of T2- or T2*-weighted images with low-signal channels or septa within it. A fluid-fluid level was found in two patients with a cavernous-type lesion.
Despite the limited nature of this study, it shows clearly that MRI is the procedure of choice whenever an intra-articular vascular lesion such as synovial hemangioma is suspected. Nonetheless, phleboliths and evidence of extra-articular extension of plain radiographs point to angiography as an effective procedure of first resort because it can be combined with embolotherapy.
本研究旨在描述滑膜血管瘤的影像学特征，以提高该病令人失望的临床诊断率（22%）。同时还对文献进行了综述，并对关节内病变的鉴别诊断进行了阐述，包括滑膜骨软骨瘤病和色素沉着绒毛结节性滑膜炎。
本研究的对象为8例组织学确诊为滑膜血管瘤的患者（4例男性，4例女性；年龄范围：5 - 47岁；平均年龄：19岁），其中累及膝关节7例，累及腕关节1例。我们回顾性地检查了这些患者进行的影像学检查，包括X线平片（8例）、磁共振成像（MRI；4例）、血管造影（3例）、关节造影（2例）和增强计算机断层扫描（CT；2例）。
X线平片显示所有患者均有提示关节积液或肿块的软组织密度影。4例累及关节外软组织的患者，其平片上的静脉石和骨质侵蚀提示了正确的诊断。血管造影显示管径细小、壁光滑的血管，造影剂在扩张的血管间隙内聚集，静脉结构早期显影，2例患者通过血管造影得以确诊。关节造影和CT均未产生足够特异的表现。MRI始终能有效地在术前做出正确诊断，在T1加权像上显示关节内或关节旁中等信号强度的肿块，在T2或T2*加权像上显示高信号强度，内部有低信号通道或间隔。2例海绵状病变患者发现了液 - 液平面。
尽管本研究存在局限性，但它清楚地表明，每当怀疑有滑膜血管瘤等关节内血管病变时，MRI是首选的检查方法。尽管如此，平片上的静脉石和关节外扩展的证据表明血管造影是有效的首选检查方法，因为它可以与栓塞治疗相结合。
