Imaging

Synovitis

Preliminary Diagnosis: Synovitis

I. What imaging technique is first-line for this diagnosis?

Plain radiography.

II. Describe the advantages and disadvantages of this technique for diagnosing synovitis.

Advantages

  • Highly portable, quick, and relatively inexpensive imaging modality.

Disadvantages

  • Limited in sensitivity and specificity for diagnosing synovitis.

  • Limited for evaluating the surrounding soft tissues.

  • Limited for evaluating for any secondary complications.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.

IV. What alternative imaging techniques are available?

  • Ultrasound of the joint of concern.

  • MR imaging with contrast.

  • CT imaging without contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing synovitis.

Ultrasound of the joint of concern

Advantages

  • Highly portable imaging modality.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Highly operator dependent.

  • Only able to evaluate certain joints with increased specificity.

  • Limited in evaluating the surrounding soft tissues, osseous structures, and vasculature.

MR imaging with contrast

Advantages

  • Offers exquisite evaluation of the surrounding soft tissues.

  • Highly sensitive and specific in identifying and characterizing any joint fluid.

  • MR imaging with contrast is highly specific in detailing a septic joint.

  • Highly sensitive and specific to subtle changes of synovitis.

Disadvantages

  • Expensive.

  • Time consuming.

  • Limited in evaluating the surrounding osseous tissues.

  • May be subject to motion and susceptibility weighted artifact degrading image quality.

  • Contraindicated in patients with non-MR compatible hardware.

CT imaging without contrast

Advantages

  • Offers exquisite detail of the surrounding osseous structures.

  • Relatively quick imaging modality.

Disadvantages

  • Limited in sensitivity and specificity in detecting and diagnosing synovitis, joint effusion, and/or septic joint.

  • Offers limited evaluation of the soft tissues and joint fluid.

  • Exposes patients to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound of the joint of concern

No specific contraindications to sonographic imaging exist.

MR imaging with contrast

Contraindicated in patients with non-MR compatible hardware.

CT imaging without contrast

May be contraindicated in pregnant patients.

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