Professional Documents
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Poster No.:
C-2443
Congress:
ECR 2013
Type:
Educational Exhibit
Authors:
4 1
Barcelona/ES
Keywords:
DOI:
10.1594/ecr2013/C-2443
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Page 1 of 18
Learning objectives
1. Define the synovial membrane.
2. Describe a proper MRI technical study protocol.
3. Illustrate synovial pathology of the knee withMRIstudies. Emphases in the differential
diagnosis for this disease.
Background
According to Medical Disability Guidelines, synovitis is described as irritation and
inflammation of the joint lining, anatomically called synovium.
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.
This condition can be caused by infection, , hemorrhage, inflammation (rheumatoid
arthritis, gout) or be related to characteristics entities as pigmented villonodular synovitis
(PVNS), synovial chondromatosis or lipoma arborescens.
On a MRI study, the knee's synovial pathology is frequently observed.
The most classical radiological signs are joint effusion and synovial thickening.
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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.
Page 4 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.
References: Hospital general Parc sanitari Sant Joan de Deu
Images for this section:
Page 5 of 18
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.
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7.
Page 9 of 18
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
The MRI findings are:
SYNOVIAL CHONDROMATOSIS
Benign tumor characterized by nodules of hyaline cartilage tissue located in subsynovial,
tendons or bursa. This process determines a distension of the synovial space.
It is observed in adult men.
The most common site is the knee, and the second one the shoulder.
There are two types of synovial chondromatosis:
1.
2.
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.
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.
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:
Page 12 of 18
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.
The deposit of fat is a diffusely villous proliferation secondary to chronic irritation.
Patients with lipoma arborescens can develope inflammatory arthritis.
Most frequent presentation disease: Unilateral involvement of the knee.
In 87% of cases is also observed meniscus cartilage degenerative changes. It can
involutes completely in 72% of the patients.
There are two known categories of lipoma arborescens:
1.
2.
Page 13 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.
References: Hospital general Parc sanitari Sant Joan de Deu
The signs observed on MRI are:
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
The knee synovial pathology is a relatively common entity. It is becoming imperative
for the radiologist know its possible causes and guide to a correct diagnosis based on
characteristic MRI findings.
References
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Personal Information
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