Computed tomography and magnetic resonance imaging of diffuse pigmented villonodular synovitis: report of a case

We describe the computed tomographic (CT) and magnetic resonance imaging (MRI) features of a surgically proven case of diffuse pigmented villonodular synovitis (PVNS) of the knee in a 34-year-old woman. A complex mass consisting of solid and multicystic components was clearly demonstrated by CT and MRI. The solid part showed homogeneous hypodense attenuation relative to adjacent muscles on CT scans, but it showed inhomogeneous signal intensity on spin echo T1- and T2-weighted images (WI). The solid component enhanced homogeneously on CT scans but heterogeneously on MR images. Multiseptated enhancement of the cystic component on both CT and MR images were displayed. All of the above features were better demonstrated on MRI. Multiple marked hypointense round and patchy areas, and also a few areas isointense to subcutaneous fat within the lesion were also found on T1WI, proton density WI and T2WI. These characteristic MRI features of PVNS correlated well with its histologic structures: depositions of hemosiderin and fat in the proliferative synovial villi and bloody cystic content. These features may help to distinguish PVNS from other disease entities arising from the synovium.