Abstract
Aim: To identify imaging findings that could aid in differential diagnosis by assessing the relationship between magnetic resonance imaging (MRI) characteristics and lesion location of extremity synovial sarcomas.
Materials and Methods: MRI findings of patients diagnosed with synovial sarcoma histopathologically between 2004–2022 and referred to our department for preoperative imaging were retrospectively evaluated by a radiologist with more than ten years of experience in musculoskeletal radiology.
Results: The study included 29 lesions (16 proximal, 13 distal appendicular). In 20 (69.0%) lesions, hyperintense signals were observed in T1-weighted (T1W) series. In T2W images, fluid signal was detected in 24 (82.8%) lesions. The ‘triple sign’ was present in 23 (79.3%) lesions. In T1W images, inhomogeneity was observed in 25 (86.2%) lesions, while in T2W series and contrast-enhanced images, it was detected in 28 (96.6%) lesions. 18 (62.1%) lesions were classified as predominantly solid. Perilesional edema was observed in 27 (93.1%) cases, while fascial edema was observed in 25 (86.2%) cases. In 9 (31.0%) lesions, edema favoring osteitis or infiltration was identified in the adjacent bone. Calcification was detected in 15 (51.7%) lesions. No significant difference was observed in the MRI findings of lesions with proximal and distal appendicular localization (p>0.05).
Conclusion: High signal on T1W images, presence of the ‘triple sign’, a predominantly solid lesion with heterogeneous enhancement, presence of calcification, perilesional and fascial edema are the MRI findings commonly detected in synovial sarcoma in this study. The imaging findings of extremity synovial sarcomas do not vary per their location.
References
- Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. From the archives of the AFIP: Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics. 2006;26(5):1543–65.
- Ferrari A, Sultan I, Huang TT, Rodriguez-Galindo C, Shehadeh A, Meazza C, et al. Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatr Blood Cancer. 2011 Dec 1;57(6):943–9.
- Kransdorf MJ, Murphey MD. Imaging of Soft Tissue Tumors. Lippincott Williams & Wilkins; 2006. 607 p.
- Gazendam AM, Popovic S, Munir S, Parasu N, Wilson D, Ghert M. Synovial Sarcoma: A Clinical Review. Curr Oncol. 2021 May 19;28(3):1909–20.
- Deshmukh R, Mankin HJ, Singer S. Synovial sarcoma: the importance of size and location for survival. Clin Orthop Relat Res. 2004 Feb;(419):155–61.
- Ferrari A, Gronchi A, Casanova M, Meazza C, Gandola L, Collini P, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004 Aug 1;101(3):627–34.
- Sultan I, Rodriguez-Galindo C, Saab R, Yasir S, Casanova M, Ferrari A. Comparing children and adults with synovial sarcoma in the Surveillance, Epidemiology, and End Results program, 1983 to 2005: an analysis of 1268 patients. Cancer. 2009 Aug 1;115(15):3537–47.
- Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors. Mosby; 2001. 1662 p.
- Jones BC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging findings in 34 patients. AJR Am J Roentgenol. 1993 Oct;161(4):827–30.
- O’Sullivan PJ, Harris AC, Munk PL. Radiological features of synovial cell sarcoma. Br J Radiol. 2008 Apr;81(964):346–56.
- Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel). 2023 Oct 5;15(19):4860.
- Bixby SD, Hettmer S, Taylor GA, Voss SD. Synovial sarcoma in children: imaging features and common benign mimics. AJR Am J Roentgenol. 2010 Oct;195(4):1026–32.
- Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol. 1990 Dec;155(6):1251–5.
- Stacy GS, Nair L. Magnetic resonance imaging features of extremity sarcomas of uncertain differentiation. Clin Radiol. 2007 Oct;62(10):950–8.
- Farkas AB, Baghdadi S, Arkader A, Nguyen MK, Venkatesh TP, Srinivasan AS, et al. Magnetic resonance imaging findings of synovial sarcoma in children: location-dependent differences. Pediatr Radiol. 2021 Dec;51(13):2539–48.
- Liang C, Mao H, Tan J, Ji Y, Sun F, Dou W, et al. Synovial sarcoma: Magnetic resonance and computed tomography imaging features and differential diagnostic considerations. Oncol Lett. 2015 Feb;9(2):661–6.
- Baheti AD, Tirumani SH, Sewatkar R, Shinagare AB, Hornick JL, Ramaiya NH, et al. Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients. Br J Radiol. 2015 Feb;88(1046):20140608.
- Tateishi U, Hasegawa T, Beppu Y, Satake M, Moriyama N. Synovial sarcoma of the soft tissues: prognostic significance of imaging features. J Comput Assist Tomogr. 2004;28(1):140–8.
- Wilkerson BW, Crim JR, Hung M, Layfield LJ. Characterization of synovial sarcoma calcification. AJR Am J Roentgenol. 2012 Dec;199(6):W730-734.
Abstract
Amaç: Bu çalışma ekstremite sinoviyal sarkomlarının manyetik rezonans görüntüleme (MRG) bulgularının lezyon yerleşim yeri ile ilişkisini inceleyerek ayırıcı tanıda faydalı olabilecek görüntüleme bulgularını saptamayı amaçlamaktadır.
Gereç ve Yöntem: Ocak 2004- Aralık 2022 tarihleri arasında histopatolojik olarak sinoviyal sarkom tanısı almış ve bölümümüze cerrahi öncesi görüntüleme için yönlendirilen olguların MRG bulguları kas-iskelet sistemi radyolojisinde on yıldan fazla deneyimi olan radyoloji hekimi tarafından retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya 29 lezyon (16 proksimal, 13 distal apendiküler) dahil edildi. Lezyonların 20 (%69) tanesinde T1 ağırlıklı (T1A) serilerde hiperintens sinyal izlendi. T2 ağırlıklı (T2A) görüntülerde sıvı sinyali lezyonların 24 (%82,8)’ünde saptandı. ‘Triple sign’ lezyonların 23 (%79,3) tanesinde mevcuttu. T1A sekansta lezyonların 25 (%86,2)’inde, T2A serilerde ve kontrastlı imajlarda ise 28 (%96,6)’inde inhomojenite izlendi. Lezyonların 18 (%62,1)’i solid ağırlıklı olarak sınıflandı. Perilezyonel ödem olguların 27 (%93,1)’sinde, fasyal ödem ise 25 (%86,2)’inde izlendi. Lezyonların 9 (%31)’unda komşu kemikte osteit lehine ödem veya infiltrasyon saptandı. Kalsifikasyon ise lezyonların 15 (%51,7) tanesinde tespit edildi. Proksimal ve distal apendiküler yerleşim gösteren lezyonların MRG bulguları arasında anlamlı farklılık izlenmedi (p>0,05).
Sonuç: T1A görüntülerde yüksek sinyal, ‘triple sign’ varlığı, heterojen kontrastlanan solid ağırlıklı lezyon, kalsifkasyon varlığı, perilezyonel ve fasyal ödem sinoviyal sarkomun çalışmamızda yaygın olarak tespit edilen MRG bulgularıdır. Ekstremite sinoviyal sarkomlarının görüntüleme bulguları apendiküler iskeletteki yerleşimine göre değişkenlik göstermemektedir.
References
- Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. From the archives of the AFIP: Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics. 2006;26(5):1543–65.
- Ferrari A, Sultan I, Huang TT, Rodriguez-Galindo C, Shehadeh A, Meazza C, et al. Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatr Blood Cancer. 2011 Dec 1;57(6):943–9.
- Kransdorf MJ, Murphey MD. Imaging of Soft Tissue Tumors. Lippincott Williams & Wilkins; 2006. 607 p.
- Gazendam AM, Popovic S, Munir S, Parasu N, Wilson D, Ghert M. Synovial Sarcoma: A Clinical Review. Curr Oncol. 2021 May 19;28(3):1909–20.
- Deshmukh R, Mankin HJ, Singer S. Synovial sarcoma: the importance of size and location for survival. Clin Orthop Relat Res. 2004 Feb;(419):155–61.
- Ferrari A, Gronchi A, Casanova M, Meazza C, Gandola L, Collini P, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004 Aug 1;101(3):627–34.
- Sultan I, Rodriguez-Galindo C, Saab R, Yasir S, Casanova M, Ferrari A. Comparing children and adults with synovial sarcoma in the Surveillance, Epidemiology, and End Results program, 1983 to 2005: an analysis of 1268 patients. Cancer. 2009 Aug 1;115(15):3537–47.
- Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors. Mosby; 2001. 1662 p.
- Jones BC, Sundaram M, Kransdorf MJ. Synovial sarcoma: MR imaging findings in 34 patients. AJR Am J Roentgenol. 1993 Oct;161(4):827–30.
- O’Sullivan PJ, Harris AC, Munk PL. Radiological features of synovial cell sarcoma. Br J Radiol. 2008 Apr;81(964):346–56.
- Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel). 2023 Oct 5;15(19):4860.
- Bixby SD, Hettmer S, Taylor GA, Voss SD. Synovial sarcoma in children: imaging features and common benign mimics. AJR Am J Roentgenol. 2010 Oct;195(4):1026–32.
- Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol. 1990 Dec;155(6):1251–5.
- Stacy GS, Nair L. Magnetic resonance imaging features of extremity sarcomas of uncertain differentiation. Clin Radiol. 2007 Oct;62(10):950–8.
- Farkas AB, Baghdadi S, Arkader A, Nguyen MK, Venkatesh TP, Srinivasan AS, et al. Magnetic resonance imaging findings of synovial sarcoma in children: location-dependent differences. Pediatr Radiol. 2021 Dec;51(13):2539–48.
- Liang C, Mao H, Tan J, Ji Y, Sun F, Dou W, et al. Synovial sarcoma: Magnetic resonance and computed tomography imaging features and differential diagnostic considerations. Oncol Lett. 2015 Feb;9(2):661–6.
- Baheti AD, Tirumani SH, Sewatkar R, Shinagare AB, Hornick JL, Ramaiya NH, et al. Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients. Br J Radiol. 2015 Feb;88(1046):20140608.
- Tateishi U, Hasegawa T, Beppu Y, Satake M, Moriyama N. Synovial sarcoma of the soft tissues: prognostic significance of imaging features. J Comput Assist Tomogr. 2004;28(1):140–8.
- Wilkerson BW, Crim JR, Hung M, Layfield LJ. Characterization of synovial sarcoma calcification. AJR Am J Roentgenol. 2012 Dec;199(6):W730-734.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Radiology and Organ Imaging |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 10, 2025 |
| Submission Date | December 30, 2024 |
| Acceptance Date | February 23, 2025 |
| Published in Issue | Year 2025Volume: 64 Issue: 2 |
