Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients

Br J Radiol. 2015 Feb;88(1046):20140608. doi: 10.1259/bjr.20140608. Epub 2014 Nov 28.


Objective: To study the appearance of primary and metastatic extremity synovial sarcoma (SS) on cross-sectional imaging.

Methods: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, the imaging features of 78 patients (42 males and 36 females; mean age, 40 years) with primary and metastatic extremity SS on MRI and multidetector CT were reviewed, with baseline MRI of the primary available in 31 patients.

Results: Primary SSs were predominantly well-circumscribed (27/31) and heterogeneously enhancing solid (18/31) or solid-cystic (13/31) tumours. Imaging features visualized included the presence of perilesional oedema (14/31), interfascial (15/31) and intercompartmental extension (7/31), triple sign (11/31), intratumoral haemorrhage (10/31), calcification (6/31), bowl of grapes appearance (5/31) and bone involvement (3/31). Smaller T1 stage tumours (8/31) appeared as heterogeneously enhancing lesions, with some lesions demonstrating interfascial and intercompartmental extension and perilesional oedema. Recurrent/metastatic disease developed in 49/78 (63%) patients. Of these, 20/78 (26%) had metastasis at presentation, while the remaining developed metastatic disease at a median interval of 27 months (range, 3-161 months). Pleuropulmonary metastases (46/78) were the most common sites, with most of the metastases being pleural based. On univariate analysis, larger tumour size, the presence of perilesional oedema, intercompartmental extension, the presence of intralesional haemorrhage and bowl of grapes appearance on MRI were associated with a significantly higher incidence of metastatic disease.

Conclusion: Certain imaging features of primary SS predict the risk of development of metastatic disease. Imaging features of T1 stage tumours included heterogeneous enhancement, interfascial extension and perilesional oedema. Pleural-based metastases are commonly seen in SSs.

Advances in knowledge: Imaging features of primary SS correlate with metastatic disease. Pleural-based metastases are often present in SSs.

MeSH terms

  • Adult
  • Aged
  • Diagnosis, Differential
  • Extremities
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / secondary*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Pleural Neoplasms / diagnosis
  • Pleural Neoplasms / secondary*
  • Retrospective Studies
  • Sarcoma, Synovial / diagnosis*
  • Sarcoma, Synovial / secondary