What is the role of MRI in the diagnosis of giant cell tumor of the tendon sheath?

Updated: Aug 06, 2019
  • Author: James R Verheyden, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

On magnetic resonance imaging (MRI), giant cell tumors of the tendon sheath frequently have a unique appearance for an extra-articular soft-tissue mass. [34, 35] On both T1- and T2-weighted MRI, at least some portions of the tumor have decreased signal intensity (see the images below) similar to that seen with pigmented villonodular synovitis (PVNS). However, this appearance is not entirely specific to giant cell tumors of the tendon sheath.

Typical T2-weighted MRI appearance of a giant cell Typical T2-weighted MRI appearance of a giant cell tumor of the tendon sheath. Most of the tumor has intermediate signal intensity, and portions of the tumor have low signal intensity; the latter finding likely reflects signal attenuation due to hemosiderin deposition.
Typical T1-weighted MRI appearance of a giant cell Typical T1-weighted MRI appearance of a giant cell tumor of the tendon sheath. Portions of the tumor have decreased signal intensity.
Typical T1-weighted MRI findings in a giant cell t Typical T1-weighted MRI findings in a giant cell tumor of the tendon sheath overlying the metacarpophalangeal joint. Note the low-signal-intensity areas.
Corresponding T2-weighted MRI findings in the tumo Corresponding T2-weighted MRI findings in the tumor shown in the image above. Note the areas of low signal intensity.

The degree to which these low-signal-intensity areas are present depends on the amount of hemosiderin, which varies. PVNS often has more low-signal-intensity areas on T2-weighted images, secondary to its higher hemosiderin content resulting from characteristic intralesional bleeding.


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