Diffuse-Type Tenosynovial Giant Cell Tumor: What Are the Important Findings on the Initial and Follow-Up MRI?

Simple Summary: Tenosynovial giant cell tumor is a benign yet aggressive neoplasm of the synovium that predominantly affects young patients. The tumor comprises two subtypes: the localized type and diffuse type, with the diffuse type exhibiting significantly higher aggressiveness. MRI stands out as the most valuable imaging modality for both its diagnosis and planning its treatment. When interpreting the initial MRI for suspected tenosynovial giant cell tumor, it is imperative to consider: (i) the characteristic findings of tenosynovial giant cell tumor, (ii) the potential findings of the diffuse type, and (iii) the tumor's resectability. In interpreting follow-up MRIs of the diffuse type after treatment, it is crucial to consider both local recurrence and the development of early osteoarthritis after surgery as well as the treatment response after systemic treatment. Recognizing the distinctive MRI findings of diffuse type tenosynovial giant cell tumor before and after treatment enhances radiologic evaluation, contributing to optimal patient management. Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young patients (usually in the fourth decade of life). The tumor comprises two subtypes: the localized type (L-TSGCT) and the diffuse type (D-TSGCT). Although these subtypes share histological and genetic similarities, they present a different prognosis. D-TSGCT tends to exhibit local aggressiveness and a higher recurrence rate compared to L-TSGCT. Magnetic resonance imaging (MRI) is the preferred diagnostic tool for both the initial diagnosis and for treatment planning. When interpreting the initial MRI of a suspected TSGCT, it is essential to consider: (i) the characteristic findings of TSGCT—evident as low to intermediate signal intensity on both T1- and T2-weighted images, with a blooming artifact on gradient-echo sequences due to hemosiderin deposition; (ii) the possibility of D-TSGCT—extensive involvement of the synovial membrane with infiltrative margin; and (iii) the resectability and extent—if resectable, synovectomy is performed; if not, a novel systemic therapy involving colony-stimulating factor 1 receptor inhibitors is administered. In the interpretation of follow-up MRIs of D-TSGCTs after treatment, it is crucial to consider both tumor recurrence and potential complications such as osteoarthritis after surgery as well as the treatment response after systemic treatment. Given its prevalence in young adult patents and significant impact on patients' quality of life, clinical trials exploring new agents targeting D-TSGCT are currently underway. Consequently, understanding the characteristic MRI findings of D-TSGCT before and after treatment is imperative. [ABSTRACT FROM AUTHOR]