ARRS 2022 Abstracts

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E1006. Diseases of the Synovium
Authors
  1. Chad Downing; Mather Hospital; Stony Brook University
  2. Aakash Babaria; Mather Hospital; Stony Brook University
  3. Lisa Park; Mather Hospital; Stony Brook University
  4. Eric Feldmann; Stony Brook University
Background
Diarthrodial joints, tendon sheaths, and some bursae are lined by a thin layer of connective tissue known as the synovium. Major functions of the synovium include maintenance of chemical balance, joint lubrication, and delivery of nutrition for chondrocytes. Pathologic processes affecting the synovial lining can be broadly categorized as degenerative, inflammatory, infectious, crystalline, neoplastic, hemorrhagic, and traumatic. Synovitis and joint effusion are common non-specific manifestations of synovial disease. Clinical history is valuable when synovial disease is identified, as many causes of synovitis have similar imaging features in the early/acute setting. Radiography remains the chief modality for diagnosing and following the course of many synovial diseases, such as rheumatoid arthritis; however, significant data now exist to substantiate the use of MRI as a surrogate marker for histologically active synovitis. The early identification of many synovial diseases allows clinicians to intervene promptly and potentially alter the course of the disease process.

Educational Goals / Teaching Points
The goals of this exhibit are as follows. Review normal histology, anatomy, and function of the synovium. Discuss etiologies of synovial disease, including inflammatory, infectious, degenerative, neoplastic, crystalline, and traumatic processes. Detail specific cases for each etiology, including rheumatoid arthritis, systemic lupus erythematosus, gout, acute pyogenic infection, synovial sarcoma, synovial chondromatosis, giant cell tumor of the tendon sheath/pigmented villonodular synovitis, lipoma arborescens and osteoarthritis. Describe the pathophysiology, clinical presentation, and MRI findings for each scenario.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will review normal anatomy and MRI appearance of diarthrodial joints; describe basic imaging protocols for characterizing synovial diseases; discuss the general imaging features of synovitis, including synovial thickening, T1-weighted and T2-weighted image features, and post-contrast enhancement; and describe specific imaging features for each subtype of synovial disease.

Conclusion
Synovial diseases are extremely common, with frequent etiologies including degenerative, inflammatory, infectious, crystalline, neoplastic, traumatic, and hemophilic processes. Damage to the synovium may progress to articular cartilage injury, potentially resulting in irreversible joint injury, deformity, and loss of function. Imaging, specifically MRI, plays an important role in early identification of synovitis and further characterization of other synovial diseases.