European Radiology

, Volume 29, Issue 7, pp 3441–3449 | Cite as

Magnetic resonance imaging features of fibromas and giant cell tumors of the tendon sheath: differential diagnosis

  • Yuxi Ge
  • Gang Guo
  • Yaqian You
  • Yunzhi Li
  • Yinghua Xuan
  • Zhe-Wu JinEmail author
  • Gen YanEmail author



The clinical and imaging characteristics of fibromas of the tendon sheath (FTS) closely resemble those of giant cell tumors of the tendon sheath (GCTTS). We aimed to study MRI features of FTS and GCTTS to distinguish the two entities and improve their differential diagnosis.

Materials and methods

We retrospectively analyzed data from 18 patients (9 men, 9 women; age, 17–62 years) and 24 patients (13 men, 11 women; age, 15–67 years) treated between May 2011 and May 2016, with histologically confirmed FTS and GCTTS, respectively. Specific MRI features of the two groups were compared using the independent sample t tests and chi-square tests.


FTS exhibited round or oval shapes. Proton-weighted images (PDWI) showed heterogeneous hypointensity that appeared striped or disordered and was located in the lesion center. Enhanced scans demonstrated asymmetrical signal in the foci. GCTTS mostly exhibited a lobulated or casting mold pattern, with a hypointense ring on PDWI. The hypointense components appeared granular/flaky or separated, sometimes behaving as a uniform signal on PDWI. Significant differences in the following features were observed between the two groups: lesion morphology (p < 0.001); imaging features on PDWI, including whether the signal is homogeneous (p < 0.001); the presence of a hypointense ring (p = 0.006); the location and morphology of hypointensity (p < 0.001); bone absorption (p = 0.008); enhancing pattern (p = 0.008); and whether the tumor crossed the joint (p = 0.026).


FTS and GCTTS demonstrate distinctive MRI features, which can be used for differential diagnosis with sensitivities, specificities, and diagnostic accuracies of 83–100%, 29–79%, and 60–89%, respectively.

Key Points

• Fibromas and giant cell tumors of the tendon sheath have distinct features on MRI, including differences in lesion morphology and intensity patterns, which can be used for differential diagnosis.

• Among other signs, GCTTS are more uniform than FTS, and FTS have a striped or disordered pattern.

• Tumors were classified with 90% accuracy into either FTS or GCTTS based on a combination of two features: homogenous signal and hypointensity shape on PDWI.


Fibroma Giant cell tumors Magnetic resonance imaging 



Fibromas of the tendon sheath


Giant cell tumors of the tendon sheath


Proton density-weighted imaging


T1-weighted spin-echo imaging


T2-weighted spin-echo or fast spin-echo imaging



This study has received funding by the Natural Science Foundation of Jiangsu Province (No. BK20151106), Wuxi Key Medical Talents (ZDRC032), and Public Health Research Center at Jiangnan University (No. JUPH201501).

Compliance with ethical standards


The scientific guarantor of this publication is Gen Yan, M.D., Ph.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yinghua Xuan kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Case-control study

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Affiliated HospitalJiangnan UniversityWuxiPeople’s Republic of China
  2. 2.Department of Radiology, The Second Affiliated HospitalXiamen Medical CollegeXiamenPeople’s Republic of China
  3. 3.Department of Basic Medicine, Wuxi School of MedicineJiangnan UniversityWuxiPeople’s Republic of China
  4. 4.Department of Basic MedicineBeijing University of Chinese MedicineBeijingPeople’s Republic of China

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