Skeletal Radiology

, Volume 34, Issue 4, pp 185–195 | Cite as

Villonodular synovitis (PVNS) of the spine

  • Kambiz Motamedi
  • Mark D. Murphey
  • John F. Fetsch
  • Mary A. Furlong
  • Tinhoa N. Vinh
  • William B. Laskin
  • Donald E. Sweet
Scientific Article



To describe the imaging features of spinal pigmented villonodular synovitis (PVNS).

Design and patients

We retrospectively reviewed 15 cases of pathologically proven spinal PVNS. Patient demographics and clinical presentation were reviewed. Radiologic studies were evaluated by consensus of two musculoskeletal radiologists for spinal location, spinal segments affected, lesion center, detection of facet origin and intrinsic characteristics on radiography (n =11), myelography (n =7), CT (n =6) and MR imaging (n =6).


Women (64%) were more commonly affected than men (36%) with an average age of 28 years. Clinical symptoms were pain (45%), neurologic (9%) or both (36%). Lesions most frequently affected the cervical spine (53%) followed by the thoracic (27%) and lumbar regions (20%). The majority of lesions (93%) were centered in the posterior elements with frequent involvement of the pedicle (67%), neural foramina (73%), lamina (67%) and facets (93%). No lesions showed calcification. Determination of a facet origin by imaging was dependent on imaging modality and lesion size. A facet origin could be determined in 45% of cases by radiography vs 67% of patients by CT (n=6) and MR (n=6). Large lesions (greater than 3 cm in at least one dimension) obscured the facet origin in all cases with CT and/or MR imaging (44%,n=4). Small lesions (less than 3 cm in any dimension) demonstrated an obvious facet origin in all cases by CT and/or MR imaging (56%,n=5). Low-to-intermediate signal intensity was seen in all cases on T2-weighted MR images resulting from hemosiderin deposition with “blooming effect” in one case with gradient echo MR images.


PVNS of the spine is rare. Large lesions obscure the facet origin and simulate an aggressive intraosseous neoplasm. Patient age, a solitary noncystic lesion centered in the posterior elements, lack of mineralization and low-to-intermediate signal intensity on all MR pulse sequences may suggest the diagnosis in these cases. Small lesions demonstrate a facet origin on CT or MR imaging. This limits differential considerations to synovial-based lesions and additional features of a solitary focus, lack of underlying disease or systemic arthropathy, no calcification as well as low-to-intermediate signal intensity on all MR images should allow spinal PVNS to be suggested as the likely diagnosis.


Spine Arthritis Synovitis Facet joints CT MR Radiography PVNS 



The authors gratefully acknowledge the support of Anika Ismel Torruella for manuscript preparation. In addition, we thank the residents, without whom this project would not have been possible, who attend the Armed Forces Institute of Pathology’s radiologic-pathology courses (past, present, and future) for their contribution to our series of patients.


  1. 1.
    Al-Nakshabandi NA, Ryan AG, Choudur H, et al. Pigmented villonodular synovitis. Clin Radiol 2004; 59:414–420.Google Scholar
  2. 2.
    Flandry F, Hughston JC. Pigmented villonodular synovitis. J Bone Joint Surg Am 1987; 69:942–949.PubMedGoogle Scholar
  3. 3.
    Jaffe H, Lichtenstein L. Pigmented villonodular synovitis, bursitis and tenosynovitis. Arch Pathol 1941; 31:731–765.Google Scholar
  4. 4.
    Bravo SM, Winalski CS, Weissman BN. Pigmented villonodular synovitis. Radiol Clin North Am 1996; 34:311–326, x-xi.PubMedGoogle Scholar
  5. 5.
    Llauger J, Palmer J, Roson N, Cremades R, Bague S. Pigmented villonodular synovitis and giant cell tumors of the tendon sheath: radiologic and pathologic features. AJR Am J Roentgenol 1999; 172:1087–1091.PubMedGoogle Scholar
  6. 6.
    Ly JQ, Carlson CL, LaGatta LM, Beall DP. Giant cell tumor of the peroneus tendon sheath. AJR Am J Roentgenol 2003; 180:1442.PubMedGoogle Scholar
  7. 7.
    Lin J, Jacobson JA, Jamadar DA, Ellis JH. Pigmented villonodular synovitis and related lesions: the spectrum of imaging findings. AJR Am J Roentgenol 1999; 172:191–197.PubMedGoogle Scholar
  8. 8.
    Balsara ZN, Stainken BF, Martinez AJ. MR image of localized giant cell tumor of the tendon sheath involving the knee. J Comput Assist Tomogr 1989; 13:159–162.PubMedGoogle Scholar
  9. 9.
    Huang GS, Lee CH, Chan WP, Chen CY, Yu JS, Resnick D. Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients. AJR Am J Roentgenol 2003; 181:539–543.PubMedGoogle Scholar
  10. 10.
    Jelinek JS, Kransdorf MJ, Shmookler BM, Aboulafia AA, Malawer MM. Giant cell tumor of the tendon sheath: MR findings in nine cases. AJR Am J Roentgenol 1994; 162:919–922.PubMedGoogle Scholar
  11. 11.
    Kransdorf M, Murphey M. Imaging of soft tissue tumors. Philadelphia: Saunders, 1997; 57–101.Google Scholar
  12. 12.
    Bruecks AK, Macaulay RJ, Tong KA, Goplen G. November 2000:13 year old girl with back pain and leg weakness. Brain Pathol 2001; 11:263–264.PubMedGoogle Scholar
  13. 13.
    Bui-Mansfield LT, Youngberg RA, Coughlin W, Chooljian D. MRI of giant cell tumor of the tendon sheath in the cervical spine. J Comput Assist Tomogr 1996; 20:113–115.CrossRefPubMedGoogle Scholar
  14. 14.
    Bullough PG. Pigmented villonodular synovitis and synovial cysts of the spine [comment]. AJNR Am J Neuroradiol 1992; 13:167–168.Google Scholar
  15. 15.
    Campbell AJ, Wells IP. Pigmented villonodular synovitis of a lumbar vertebral facet joint. J Bone Joint Surg Am 1982; 64:145–146.PubMedGoogle Scholar
  16. 16.
    Clark LJ, McCormick PW, Domenico DR, Savory L. Pigmented villonodular synovitis of the spine. Case report. J Neurosurg 1993; 79:456–459.PubMedGoogle Scholar
  17. 17.
    Clerc D, Berge E, Benichou O, Paule B, Quillard J, Bisson M. An unusual case of pigmented villonodular synovitis of the spine: benign aggressive and/or malignant? Rheumatology (Oxford) 1999; 38:476–477.Google Scholar
  18. 18.
    Gezen F, Akay KM, Aksu AY, Beduk A, Seber N. Spinal pigmented villonodular synovitis: a case report. Spine 1996; 21:642–645.CrossRefPubMedGoogle Scholar
  19. 19.
    Giannini C, Scheithauer BW, Wenger DE, Unni KK. Pigmented villonodular synovitis of the spine: a clinical, radiological, and morphological study of 12 cases. J Neurosurg 1996; 84:592–597.PubMedGoogle Scholar
  20. 20.
    Graham EJ, Kuklo TR, Kyriakos M, Rubin DA, Riew KD. Invasive pigmented villonodular synovitis of the atlantoaxial joint: a case report. J Bone Joint Surg Am 2002; 84:1856–1860.Google Scholar
  21. 21.
    Karnezis TA, McMillan RD, Ciric I. Pigmented villonodular synovitis in a vertebra. A case report. J Bone Joint Surg Am 1990; 72:927–930.PubMedGoogle Scholar
  22. 22.
    Khoury GM, Shimkin PM, Kleinman GM, Mastroianni PP, Nijensohn DE. Computed tomography and magnetic resonance imaging findings of pigmented villonodular synovitis of the spine. Spine 1991; 16:1236–1237.PubMedGoogle Scholar
  23. 23.
    Parmar HA, Sitoh YY, Tan KK, Teo J, Ibet SM, Hui F. MR imaging features of pigmented villonodular synovitis of the cervical spine. AJNR Am J Neuroradiol 2004; 25:146–149.PubMedGoogle Scholar
  24. 24.
    Pulitzer DR, Reed RJ. Localized pigmented villonodular synovitis of the vertebral column. Arch Pathol Lab Med 1984; 108:228–230.PubMedGoogle Scholar
  25. 25.
    Savitz MH. Pigmented villonodular synovitis. J Neurosurg 1994; 80:956–958.Google Scholar
  26. 26.
    Titelbaum DS, Rhodes CH, Brooks JS, Goldberg HI. Pigmented villonodular synovitis of a lumbar facet joint. AJNR Am J Neuroradiol 1992; 13:164–166.Google Scholar
  27. 27.
    Weidner N, Challa VR, Bonsib SM, Davis CH, Jr., Carrol TJ, Jr. Giant cell tumors of synovium (pigmented villonodular synovitis) involving the vertebral column. Cancer 1986; 57:2030–2036.PubMedGoogle Scholar
  28. 28.
    Furlong MA, Motamedi K, Laskin WB, et al. Synovial-type giant cell tumors of the vertebral column: a clinicopathologic study of 15 cases, with a review of the literature and discussion of the differential diagnosis. Hum Pathol 2003; 34:670–679.CrossRefPubMedGoogle Scholar
  29. 29.
    Chevrot A, Vallee C. Imaging of degenerative disk diseases. Curr Opin Radiol 1992; 4:103–114.Google Scholar
  30. 30.
    Gorey MT, Hyman RA, Black KS, Scuderi DM, Cinnamon J, Kim KS. Lumbar synovial cysts eroding bone. AJNR Am J Neuroradiol 1992; 13:161–163.Google Scholar
  31. 31.
    Savitz MH, Katz SS, Goldstein H, Worcester D. Hypertrophic synovitis of the lumbar facet joint in two cases of herniated intervertebral disc. Mt Sinai J Med 1982; 49:434–437.PubMedGoogle Scholar
  32. 32.
    Savitz MH, Katz SS, Goldstein HB, Worcester D. Hypertrophic synovitis of the facet joint forming a para-articular mass in cases of herniated intervertebral disc. Spine 1987; 12:509–510.PubMedGoogle Scholar
  33. 33.
    Sachdev VP, Savitz MH, Hindi AI, Goldstein HB. Synovial cysts of the lumbar facet joint. Mt Sinai J Med 1991; 58:125–128.PubMedGoogle Scholar
  34. 34.
    Unni KK. Pigmented villonodular synovitis (comment). J Neurosurg 1994; 80:958.Google Scholar
  35. 35.
    McCormick PW. Pigmented villonodular synovitis (comment). J Neurosurg 1994; 80:957–958.Google Scholar
  36. 36.
    Flemming DJ, Murphey MD, Carmichael BB, Bernard SA. Primary tumors of the spine. Semin Musculoskelet Radiol 2000; 4:299–320.CrossRefPubMedGoogle Scholar
  37. 37.
    Lucas DR, Unni KK, McLeod RA, O’Connor MI, Sim FH. Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol 1994; 25:117–134.CrossRefPubMedGoogle Scholar
  38. 38.
    Kroon HM, Schurmans J. Osteoblastoma: clinical and radiologic findings in 98 new cases. Radiology 1990; 175:783–790.PubMedGoogle Scholar
  39. 39.
    McLeod RA, Dahlin DC, Beabout JW. The spectrum of osteoblastoma. Am J Roentgenol 1976; 126:321–325.Google Scholar
  40. 40.
    Shives TC, McLeod RA, Unni KK, Schray MF. Chondrosarcoma of the spine. J Bone Joint Surg Am 1989; 71:1158–1165.PubMedGoogle Scholar
  41. 41.
    Camins MB, Duncan AW, Smith J, Marcove RC. Chondrosarcoma of the spine. Spine 1978; 3:202–209.PubMedGoogle Scholar
  42. 42.
    Hermann G, Sacher M, Lanzieri CF, Anderson PJ, Rabinowitz JG. Chondrosarcoma of the spine: an unusual radiographic presentation. Skeletal Radiol 1985; 14:178–183.Google Scholar
  43. 43.
    Bjornsson J, Wold LE, Ebersold MJ, Laws ER. Chordoma of the mobile spine. A clinicopathologic analysis of 40 patients. Cancer 1993; 71:735–740.PubMedGoogle Scholar
  44. 44.
    de Bruine FT, Kroon HM. Spinal chordoma: radiologic features in 14 cases. AJR Am J Roentgenol 1988; 150:861–863.PubMedGoogle Scholar
  45. 45.
    Firooznia H, Golimbu C, Rafii M, Reede DL, Kricheff, 2nd, Bjorkengren A. Computed tomography of spinal chordomas. J Comput Tomogr 1986; 10:45–50.CrossRefPubMedGoogle Scholar
  46. 46.
    Koci TM, Mehringer CM, Yamagata N, Chiang F. Aneurysmal bone cyst of the thoracic spine: evolution after particulate embolization. AJNR Am J Neuroradiol 1995; 16:857–860.Google Scholar
  47. 47.
    Kumar R, Guinto FC, Jr., Madewell JE, David R, Shirkhoda A. Expansile bone lesions of the vertebra. Radiographics 1988; 8:749–769.PubMedGoogle Scholar
  48. 48.
    Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG. From the archives of the AFIP. Primary tumors of the spine: radiologic pathologic correlation. Radiographics 1996; 16:1131–1158.PubMedGoogle Scholar
  49. 49.
    Beltran J, Noto AM, Chakeres DW, Christoforidis AJ. Tumors of the osseous spine: staging with MR imaging versus CT. Radiology 1987; 162:565–569.PubMedGoogle Scholar
  50. 50.
    Schwimer SR, Bassett LW, Mancuso AA, Mirra JM, Dawson EG. Giant cell tumor of the cervicothoracic spine. AJR Am J Roentgenol 1981; 136:63–67.PubMedGoogle Scholar
  51. 51.
    Bidwell JK, Young JW, Khalluff E. Giant cell tumor of the spine: computed tomography appearance and review of the literature. J Comput Tomogr 1987; 11:307–311.CrossRefPubMedGoogle Scholar
  52. 52.
    Staub-Schmidt T, Chaouat A, Rey D, Bloch JG, Christmann D. Spinal involvement in gout. Arthritis Rheum 1995; 38:139–141.PubMedGoogle Scholar
  53. 53.
    Resnick D, editor. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders, 2002.Google Scholar
  54. 54.
    Fenton P, Young S, Prutis K. Gout of the spine. Two case reports and a review of the literature. J Bone Joint Surg Am 1995; 77:767–771.PubMedGoogle Scholar
  55. 55.
    Kinoshita T, Maruoka S, Yamazaki T, Sakamoto K. Tophaceous pseudogout of the cervical spine: MR imaging and bone scintigraphy findings. Eur J Radiol 1998; 27:271–273.CrossRefPubMedGoogle Scholar
  56. 56.
    Crotty JM, Monu JU, Pope TL, Jr. Synovial osteochondromatosis. Radiol Clin North Am 1996; 34:327–342, xi.PubMedGoogle Scholar
  57. 57.
    Burrafato V, Campanacci DA, Franchi A, Capanna R. Synovial chondromatosis in a lumbar apophyseal joint. Skeletal Radiol 1998; 27:385–387.Google Scholar
  58. 58.
    Kaplan P, Resnick D, Murphey M, et al. Destructive noninfectious spondyloarthropathy in hemodialysis patients: a report of four cases. Radiology 1987; 162:241–244.PubMedGoogle Scholar
  59. 59.
    Ito M, Hayashi K, Noguchi M, Kitamori H. Evaluation of spinal bone changes in patients with chronic renal failure by CT and MR imaging with pathologic correlation. Acta Radiol 1994; 35:291–295.Google Scholar

Copyright information

© ISS 2005

Authors and Affiliations

  • Kambiz Motamedi
    • 1
    • 7
  • Mark D. Murphey
    • 1
    • 4
    • 5
  • John F. Fetsch
    • 2
  • Mary A. Furlong
    • 2
  • Tinhoa N. Vinh
    • 3
  • William B. Laskin
    • 6
  • Donald E. Sweet
    • 3
  1. 1.Department of Radiologic PathologyArmed Forces Institute of PathologyWashingtonUSA
  2. 2.Department of Soft Tissue PathologyArmed Forces Institute of PathologyWashingtonUSA
  3. 3.Department of Orthopedic Pathology Armed Forces Institute of PathologyWashingtonUSA
  4. 4.Department of Radiology and Nuclear MedicineUniformed Services University of Health SciencesBethesdaUSA
  5. 5.Department of RadiologyUniversity of Maryland School of MedicineBaltimoreUSA
  6. 6.Department of Surgical PathologyNorthwestern Memorial HospitalChicagoUSA
  7. 7.Department of Radiology (Section of Musculoskeletal Radiology)David Geffen School of Medicine at UCLALos AngelesUSA

Personalised recommendations