ISSN: 1899-0967
Polish Journal of Radiology
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vol. 88
Musculoskeletal radiology
Review paper

Primary synovial sarcoma on MRI – a case series and review of the literature

Maya Sedaghat
Sam Sedaghat

Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
© Pol J Radiol 2023; 88: e325-e330
Online publish date: 2023/07/10
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Simple MRI features are mandatory to facilitate the diagnostics of synovial sarcomas, especially for radiologists outside multidisciplinary sarcoma centres. In this case-series and review, we investigate the main appearance of synovial sarcoma on MRI.

Material and methods:
Fifteen histologically proven primary synovial sarcomas who underwent MRI at 2 different sarcoma centres were included in this case series. Patients and their primary synovial sarcomas were examined for age, localization, mean tumour size (in mm), histological grade (G – according to the Fédération Nationale des Centres de Lutte Contre Le Cancer [FNCLCC]), configuration, T2 signal intensity, presence/absence of “triple sign”, heterogeneity/homogeneity, borders (well-defined or infiltrative), and intensity of contrast enhancement on MRI. Additionally, a comprehensive literature review to identify observational studies, reviews, and case-reports assessing MRI features of primary synovial sarcoma was performed.

The mean age of the patients was 47.6 years (SD: 17.2). The mean size of primary synovial sarcoma was 59.3 mm (SD: 42). Primary synovial sarcomas were significantly most often multilobulated (n = 12, p < 0.01), heterogeneous (n = 10), and infiltrative (n = 9). Additionally, 3 other primary synovial sarcomas showed the following configurations: ovoid/nodular (n = 2) and fascicular (n = 1). Ovoid/nodular synovial sarcomas were solely depicted as homogeneous with well-defined borders. All tumours showed T2 hyperintense signal and presented with marked contrast enhancement.

Primary synovial sarcomas are mainly multilobulated, heterogeneous, and infiltrative tumours. In minor cases, ovoid/nodular or fascicular configurations occur. Knowing the main appearance of synovial sarcoma can help facilitate the diagnostics of primary synovial sarcomas.


soft tissue sarcoma, imaging, MRI, synovial sarcoma, review, radiology

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