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Synovial sarcoma: frequency of nonaggressive MR characteristics
M F Blacksin1, J R Siegel, J Benevenia
1Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103, USA.
Purpose:
Our objective was to examine the MR characteristics of synovial sarcoma and determine the frequency of a nonaggressive imaging appearance.
Method:
Fifteen patients with histologically confirmed cases of synovial sarcoma and prior MR examinations were seen. Retrospective analysis of imaging features included assessment of size, margins, homogeneity, internal architecture, T1- and T2-weighted signal intensities, and bone invasion.
Results:
Five of 15 patients (33%) had well circumscribed, homogeneous lesions with a mean length of 4.8 cm. The T1-weighted signal intensity was either isointense to muscle or greater in signal intensity than muscle. The T2-weighted images demonstrated signal intensity equal to or greater than fat. The remaining 10 lesions were larger (mean length of 11.3 cm) with mild to complex levels of inhomogeneity and margins that varied from well circumscribed to infiltrating.
Conclusion:
There are two sets of MR features seen with synovial sarcoma. Small lesions of -5 cm can demonstrate a nonaggressive appearance with well circumscribed margins and homogeneous signal intensity. These tumors could be confused with benign lesions, resulting in inappropriate surgical intervention like excisional biopsies through transverse incisions. This would make future surgery more difficult. Larger lesions tend to be more heterogeneous in signal intensity.
Insights
Synovial sarcoma can present with nonaggressive MRI features, particularly smaller lesions (<5 cm) that appear well-circumscribed and homogeneous. Larger tumors often show heterogeneous characteristics, aiding in diagnosis.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Synovial sarcoma is a rare soft tissue malignancy.
- Accurate pre-operative diagnosis is crucial for appropriate management.
- Magnetic Resonance (MR) imaging plays a key role in soft tissue tumor evaluation.
Purpose of the Study:
- To characterize the MR appearance of synovial sarcoma.
- To determine the prevalence of a nonaggressive imaging presentation in synovial sarcoma.
Main Methods:
- Retrospective analysis of MR examinations from 15 patients with confirmed synovial sarcoma.
- Evaluation of imaging features including size, margins, homogeneity, internal architecture, signal intensity (T1 and T2 weighted), and bone invasion.
Main Results:
- 33% of lesions (5/15) were small (<5 cm), well-circumscribed, and homogeneous, with specific T1 and T2 signal intensities.
- Larger lesions (10/15, mean length 11.3 cm) exhibited increased heterogeneity and variable margins.
Conclusions:
- Synovial sarcoma can present with two distinct MR imaging patterns.
- Small, homogeneous lesions may mimic benign masses, potentially leading to suboptimal surgical approaches.
- Larger lesions are typically more heterogeneous, aiding in differentiation.
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