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Villonodular synovitis (PVNS) of the spine

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Abstract

Objective

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).

Results

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.

Conclusions

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.

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Acknowledgements

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.

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Author notes

  1. Kambiz Motamedi

    Present address: Department of Radiology (Section of Musculoskeletal Radiology), David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 165–59, Los Angeles, CA , 90095-6952, USA

Authors and Affiliations

  1. Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC, 20306-6000, USA

    Kambiz Motamedi & Mark D. Murphey

  2. Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, DC, 20306, USA

    John F. Fetsch & Mary A. Furlong

  3. Department of Orthopedic Pathology , Armed Forces Institute of Pathology, Washington, DC, 20306, USA

    Tinhoa N. Vinh & Donald E. Sweet

  4. Department of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA

    Mark D. Murphey

  5. Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA

    Mark D. Murphey

  6. Department of Surgical Pathology, Northwestern Memorial Hospital, Chicago, IL, USA

    William B. Laskin

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  1. Kambiz Motamedi
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Correspondence to Mark D. Murphey.

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The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Air Force, Army, Navy or Defense.

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Motamedi, K., Murphey, M.D., Fetsch, J.F. et al. Villonodular synovitis (PVNS) of the spine. Skeletal Radiol 34, 185–195 (2005). https://doi.org/10.1007/s00256-004-0880-9

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