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Magnetic resonance imaging findings of synovial sarcoma in children: location-dependent differences

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Abstract

Background

While overall survival for children is greater than that for adults, synovial sarcoma remains an aggressive neoplasm with a potentially poor prognosis, and its magnetic resonance imaging (MRI) findings in children are not well described.

Objective

We aimed to characterize the spectrum of MRI findings of synovial sarcoma in children with respect to anatomical location and outcome.

Materials and methods

Children with histologically confirmed synovial sarcoma and preoperative MRI performed within the past 11 years (2009–2020) were included. Two radiologists retrospectively reviewed each MRI to categorize location, signal characteristics and associated findings. Chi-square and Fisher exact tests were used to assess associations with locations and outcomes.

Results

This study included 23 children (13 girls, 10 boys; mean age: 12.7±4.2 years) with 7 axial, 8 proximal and 8 distal appendicular lesions. Kappa ranged from 0.53 to 1. MRI findings differed significantly between locations with axial lesions measuring larger (P=0.01) and more likely to contain fluid levels (P=0.02), triple sign (P=0.02), inhomogeneous signal (T1-weighted images, P=0.003; T2-weighted images, P=0.02, contrast-enhanced images, P=0.03) with all lesions containing partially solid composition (P=0.03). At a median follow-up of 14 months (interquartile range: 7–33 months), 39% relapsed. Predictors of relapse (P<0.05) included metastasis at presentation, larger lesions, axial lesions and MRI findings of fluid level, T1-weighted hyperintensity, inhomogeneous signal (T1- and T2-weighted images) and poorly circumscribed margins.

Conclusion

A significant association was found between location and MRI findings in our cohort of children with synovial sarcoma. Axial lesions were more likely to be larger, appear heterogeneous and be associated with a worse outcome.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Amy B. Farkas, Michael K. Nguyen, Tanvi P. Venkatesh, Abhay S. Srinivasan & Jie C. Nguyen

  2. Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Soroush Baghdadi & Alexandre Arkader

  3. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Alexandre Arkader, Abhay S. Srinivasan & Jie C. Nguyen

Authors
  1. Amy B. Farkas
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  2. Soroush Baghdadi
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  3. Alexandre Arkader
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  4. Michael K. Nguyen
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  5. Tanvi P. Venkatesh
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Correspondence to Jie C. Nguyen.

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Conflicts of interest

Alexandre Arkader and Jie C. Nguyen receive research grant support from the Radiologic Society of North America (RSNA) and the Children’s Cancer Research Fund (CCRF), which is unrelated to the current project.

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Farkas, A.B., Baghdadi, S., Arkader, A. et al. Magnetic resonance imaging findings of synovial sarcoma in children: location-dependent differences. Pediatr Radiol 51, 2539–2548 (2021). https://doi.org/10.1007/s00247-021-05142-4

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  • DOI: https://doi.org/10.1007/s00247-021-05142-4

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