Basic radiological assessment of synovial diseases: a pictorial essay

Abstract

IntroductionThe synovium is a thin specialized membrane lining the diarthrodial joint surfaces, bursae, and tendon sheaths. Synovium coats the inner surface of the fibrous joint capsule, fat pads, and intraarticular ligaments. Other intraarticular structures such as the articular cartilage, menisci, labra, and small bone bare area are not covered by the synovium (1, 2). The synovium provides nutrition and lubrication to the joint cartilage by fluid secretion (3).Synovial diseases are classified as inflammatory, infectious, degenerative, traumatic, hemorrhagic, and neoplastic. There are also tumor-like conditions such as pigmented villonodular synovitis, nodular synovitis, giant cell tumor of tendon sheath, synovial chondromatosis/osteochondromatosis, and lipoma arborescens (1, 3).Damage in other intraarticular structures, particularly cartilages, generally occurs as a consequence of pathologic processes involving the synovium, leading to irreversible joint destruction (4). Imaging plays a crucial role in the early detection of synovial diseases prior to the occurrence of irreversible joint damage. Plain radiography, ultrasonography (US), and magnetic resonance imaging (MRI) are utilized in the diagnosis and follow-up of synovial diseases. Gadolinium-enhanced MRI is the best tool to diagnose synovial disorders (1, 3).MRI findings of synovial diseases include thickening of the synovium, hyperintensity on T2-weighted images (T2WI) due to water accumulation, and prominent contrast enhancement on postcontrast T1-weighted images (T1WI). Because of the high soft-tissue contrast resolution of MRI, besides synovitis diagnosis, joint effusion, articular cartilage, subchondral bone, ligaments, muscles, and juxtaarticular soft tissues can be evaluated (5). Herein, each of these synovial diseases were explained in detail. Rheumatoid arthritisRheumatoid arthritis (RA) is a joint-based chronic, progressively destructive inflammatory systemic disease. Synovial hypertrophy occurs initially, and locally invasive behavior causes cartilage destruction and bone erosions. RA proceeds progressively, ultimately causing multiple deformities. All synovial joints can be affected; however, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints are the most frequently involved ones. Bilateral and symmetric involvement is a rule and atlantoaxial joint particularly involved in the spine (6, 7). RA also has extraarticular musculoskeletal manifestations such as rheumatoid nodules, enthesopathy, bursitis, tenosynovitis, and tendon rupture.Radiographs show typical findings such as soft-tissue swelling, marginal erosions, periarticular osteopenia, joint space narrowing, and joint subluxation. Besides bone alterations, this imaging modality is unable to display synovitis at an early stage. Identification of early changes facilitate the prevention of joint damage The synovium is a specialized tissue lining the synovial joints, bursae, and tendon sheaths of the body. It is affected by various localized or systemic disorders. Syn...

Feasibility of MRI in diagnosis and characterization of intra-articular synovial masses and mass-like lesions

“…In the current series, all cases of PVNS were diffuse and MRI showed lobulated margin mass-like proliferative synovium with low signal foci at all pulse sequences due to deposition of hemosiderin in agreement with Patricket al [2]., A. Rodríguez Pan et al [3], and Aynur-Turan et al [4], who reported that the diffuse form PVNS is the commonest form and reported similar imaging appearance.…”

“…Particularly, hemosiderin appears as blooming artifacts on gradient echo (GRE) images because of its magnetic susceptibility, which is almost pathognomonic in all forms of PVNS. Lesions may show evident contrast enhancement after administration of IV gadolinium denoting the synovial proliferation high vascularity [3,4,16,17].…”

“…Early imaging is highly important in the early detection of synovial disorders to avoid the incidence of irreversible joint injury. Conventional radiography, joint high-frequency ultrasonography (US), and musculoskeletal magnetic resonance imaging (MRI) are used in the diagnosis of synovial lesions and in follow-up [4].…”

Sonographic presentation of rice bodies in subacromial-subdeltoid chronic bursitis

“…If the rice bodies are mineralized, they can easily be visualized on plain radiographs. Otherwise, MR T-2-weighted scans are very helpful for its diagnosis [14]. An article published in 1996 by Griffith et al presented 2 cases of the subacromial-subdeltoid bursitis with rice bodies in the size of the rice bodies ranging from 3 to 10 mm, while in our study, the size was ranging from 4.6 to 7.1 mm [15].…”

Impact of Clinical Presentation on Imaging Evaluation to Direct Effective Treatment Strategies

“…The synovium lines the joint capsule, fat pads, and intraarticular ligaments and serves to provide critical nutrition and lubrication to the joint. 67 After initial evaluation with radiographs looking for erosions and bone remodeling, MRI is commonly used for most synovial disorders. Several synovial pathologies have characteristic findings on MRI, for example, hemosiderin deposition associated with hemophilic arthropathy (►Fig.…”