3 3 4 1
N. Rojo Sanchis , P. Santo Panero , M. Simonet ; Girona/
2 3
ES, Hospitalet de Llobregat/ES, Sant Boi de Llobregat/ES,
4
Barcelona/ES
Keywords: Inflammation, MR, Musculoskeletal soft tissue
DOI: 10.1594/ecr2013/C-2443
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Page 1 of 18
Learning objectives
Background
After an injury, the synovial membrane responds by producing liquid. This fact sets up
the classic symptoms of synovitis, characterized by swelling, pain and redness in the
affected joint.
The most classical radiological signs are joint effusion and synovial thickening.
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Fig. 1: 5 years patient with suspicious of osteomylitis. T1 DP weitghed images and
T1 fat sat postcontrast media injection showed a massive joint effusion and synovial
enhancement, in relation with septic acute arthritis.
References: Hospital general Parc sanitari Sant Joan de Deu
However, in some patients is possible to observe other MRI findings. These other MRI
signs can suggest what might be the cause of the disease.
At the same time, the blood test results and the medical history can help us to distinguish
between different etiologies.
For example, if we realize a MRI knee study in a traumatic patient, we can consider than
the visualization of bone marrow edema can be explained for the traumatic injury. But,
if we observe an heterogenic fluid signal on the gradient-echo MR image, with different
low signal intensity areas inside the synovial space, we must think about an hemorrhagic
etiology.
Page 3 of 18
Fig. 2: Patient with joint knee effusion. The MRI scan showed non- homogeneous
joint effusion, with low intensity areas in the T2 FFE weighted images, in relation with
hemosiderin deposition. Patient was diagnosed of Haemorrhagic synovitis.
References: Hospital general Parc sanitari Sant Joan de Deu
MRI is a suitable technique to discern between the different etiologies able to damage the
synovial membrane. So, MRI can decrease the requirements of an invasive diagnostic
procedure.
In view of the location of the lesion inside the knee, its appearance in different MRI
sequences performed and any other associated findings, the radiologist should suggest
the most likely etiology for each synovial pathology.
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Fig. 3: Young patient with a right patella dislocation. T2 weighted images showed
a bone contusion pattern involving the inferomedial pole of the patella and the
anterolateral aspect of the nonarticular portion of the lateral femoral condyle. The
MPFL is ruptured.
References: Hospital general Parc sanitari Sant Joan de Deu
Page 5 of 18
Fig. 1: 5 years patient with suspicious of osteomylitis. T1 DP weitghed images and
T1 fat sat postcontrast media injection showed a massive joint effusion and synovial
enhancement, in relation with septic acute arthritis.
Page 6 of 18
Fig. 2: Patient with joint knee effusion. The MRI scan showed non- homogeneous
joint effusion, with low intensity areas in the T2 FFE weighted images, in relation with
hemosiderin deposition. Patient was diagnosed of Haemorrhagic synovitis.
Page 7 of 18
Fig. 3: Young patient with a right patella dislocation. T2 weighted images showed a
bone contusion pattern involving the inferomedial pole of the patella and the anterolateral
aspect of the nonarticular portion of the lateral femoral condyle. The MPFL is ruptured.
Page 8 of 18
Imaging findings OR Procedure details
• patient supine with the knee slightly flexed and in external rotation.
• Sequences:
Rare disorder proliferation of the synovial membrane. It is a formation of villi and nodules
characterized by deposit of intracellular haemosiderin, that determines local or diffuse
thickening of the synovial membrane, exhibiting benign behaviour from a biological point
of view.
The MRI study can suggest the diagnosis. However, such diagnosis can be confirmed
only on histology as the final diagnosis of PVNS.
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Differential diagnosis:
Fig. 4: Patient with pigmented villonodular synovitis. MRI study showed an intrarticular
mass located in the intercondilia space. It presence same intensity as the muscle in
T1WI and T2WI, but it has low intensity signal in T2 FFE. Joint effusion is noted too.
References: Hospital general Parc sanitari Sant Joan de Deu
Page 10 of 18
• Possible bone erosions associated with bone edema
• Possible soft tissue edema.
SYNOVIAL CHONDROMATOSIS
The most common site is the knee, and the second one the shoulder.
1. Primary: multiple presence of foreign bodies inside the joint, with equal
shape and size, which frequently presents cartilages calcification in its
central and peripheral part.
2. Secondary: hyaline cartilage injury related with trauma, osteochondritis
dissecans, neuropathic osteoarthropathy, osteoarthritis or infectious
arthritis / unspecific inflammatory disease. It is characterized by the
presence of intraarticular foreign bodies that have different shapes and
sizes, with the presence of various ring calcifications.
At CT we expect:
Page 11 of 18
Fig. 6: Patient with synovial chondromatosis: Although the example is in a patient with
shoulder disease, the axial MRI and CT images showed multiple nodules inside the
joint space. The nodules presented peripheral high intensity sign in the postcontrast
medium study.
References: - Girona/ES
In the MRI study:
LIPOMA ARBORESCENS
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Idiopathic and rare joint disease characterized by the deposition of fat in the synovial
membrane in the 100% of patients, with distension of the synovium space associated.
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Fig. 5: Patient with lipoma arborescens. In the knee MRI study we can observe a
nodular mass around the synovial membrane. It has equal signal intensity than the soft
fat tissues, but has an extremely contrast captation in the fat sat T1WI postcontrast
media injection.
References: Hospital general Parc sanitari Sant Joan de Deu
Page 14 of 18
Fig. 4: Patient with pigmented villonodular synovitis. MRI study showed an intrarticular
mass located in the intercondilia space. It presence same intensity as the muscle in T1WI
and T2WI, but it has low intensity signal in T2 FFE. Joint effusion is noted too.
Page 15 of 18
Fig. 6: Patient with synovial chondromatosis: Although the example is in a patient with
shoulder disease, the axial MRI and CT images showed multiple nodules inside the joint
space. The nodules presented peripheral high intensity sign in the postcontrast medium
study.
Page 16 of 18
Fig. 5: Patient with lipoma arborescens. In the knee MRI study we can observe a nodular
mass around the synovial membrane. It has equal signal intensity than the soft fat tissues,
but has an extremely contrast captation in the fat sat T1WI postcontrast media injection.
Page 17 of 18
Conclusion
References
Personal Information
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