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MRI for Differentiating Ganglion and Synovitis in the Chronic Painful Wrist

Suzanne E. Anderson1, Lynne S. Steinbach2, Edouard Stauffer3 and Esther Voegelin4

1 Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland.
2 Department of Radiology, University of California, San Francisco, San Francisco, CA.
3 Department of Pathology, University Hospital of Bern, Inselspital, Bern, Switzerland.
4 Department of Orthopedic, Plastic, and Reconstructive Surgery, Division of Hand Surgery, University Hospital of Bern, Intesspital, Bern, Switzerland.


Figure 1
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  		Fig. 1A —23-year-old woman with MRI showing characteristic features of ganglion of dorsal aspect of wrist. Focal, relatively large mass (arrows) is evident on T1-weighted image. Placement of vitamin capsule to demarcate patient's pain site has slightly displaced soft tissues. Clinically, however, no soft-tissue swelling was evident.

 

Figure 2
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  		Fig. 1B —23-year-old woman with MRI showing characteristic features of ganglion of dorsal aspect of wrist. Corresponding fast spin-echo T2-weighted axial image shows focal, fluid cystic mass (arrows) with internal septa (asterisk).

 

Figure 3
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  		Fig. 1C —23-year-old woman with MRI showing characteristic features of ganglion of dorsal aspect of wrist. After administration of IV contrast agent, wall enhancement is evident (arrows). Surgery confirmed ganglion as diagnosis. There was no joint involvement.

 

Figure 4
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  		Fig. 2A —19-year-old woman with MRI showing characteristic features of dorsal occult ganglion. Axial T1-weighted image shows small, mass-like region (arrow). Vitamin capsule was placed at level of pain and to side so as not to obscure small lesions.

 

Figure 5
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  		Fig. 2B —19-year-old woman with MRI showing characteristic features of dorsal occult ganglion. Corresponding axial fast spin-echo T2-weighted image shows focal high-signal-intensity mass (arrow).

 

Figure 6
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  		Fig. 2C —19-year-old woman with MRI showing characteristic features of dorsal occult ganglion. After contrast administration, T1-weighted fat-suppressed image shows wall enhancement (arrow). This was evident in 50% of dorsal occult ganglion cysts. Small dorsal occult ganglion characteristically is located at dorsal aspect of scapholunate ligament, superficially overlying midcarpal dorsal ligament.

 

Figure 7
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  		Fig. 2D —19-year-old woman with MRI showing characteristic features of dorsal occult ganglion. Histopathology image shows myxoid central portion devoid of gelatin myxoid material (asterisks) and chronic inflammatory wall of ganglion. Note absence of synovial lining. At surgery, dorsal occult ganglion was seen arising from scapholunate ligament, which was subsequently débrided. (H and E, x10)

 

Figure 8
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  		Fig. 3A —21-year-old woman with MRI showing characteristic features of dorsal occult ganglion. Axial T1-weighted image shows small focal mass (arrow) adjacent to dorsal aspect of scapholunate ligament.

 

Figure 9
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  		Fig. 3B —21-year-old woman with MRI showing characteristic features of dorsal occult ganglion. Fast spin-echo T2-weighted fat-suppressed image shows small ganglion (arrow).

 

Figure 10
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  		Fig. 3C —21-year-old woman with MRI showing characteristic features of dorsal occult ganglion. After contrast administration and fat suppression, diffuse contrast enhancement (arrow) is seen within the lesion.

 

Figure 11
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  		Fig. 3D —21-year-old woman with MRI showing characteristic features of dorsal occult ganglion. Histopathologic image shows chronically thickened myxoid wall with very small central pseudolumen (asterisk) (gelatinous material is removed during pathology processing) and with small lesion size, these features presumably account for presence of 50% of diffuse contrast enhancement of dorsal occult ganglion cysts. (H and E, x10)

 

Figure 12
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  		Fig. 4A —40-year-old-man with MRI showing characteristic features of synovitis. Axial T1-weighted image shows broad, thin region of altered signal intensity (arrows).

 

Figure 13
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  		Fig. 4B —40-year-old-man with MRI showing characteristic features of synovitis. Corresponding fast spin-echo fat-suppressed T2-weighted image shows diffuse region of altered signal intensity (arrows).

 

Figure 14
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  		Fig. 4C —40-year-old-man with MRI showing characteristic features of synovitis. After contrast administration, T1-weighted fat-suppressed image shows diffuse contrast enhancement (arrows).

 

Figure 15
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  		Fig. 4D —40-year-old-man with MRI showing characteristic features of synovitis. Histopathologic image shows marked pseudopolypoid-like thickened synovia. (H and E, x2.5)

 

Figure 16
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  		Fig. 4E —40-year-old-man with MRI showing characteristic features of synovitis. At higher power, chronic granulation tissue is also evident within synovial thickening. Note synovial epithelial lining (arrows). At surgery, synovitis was extensive, requiring major stripping. (H and E, x10)

 

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