Main Article Content
synovia, knee, MRI, ultrasound, CEUS, joint injection
The synovial membrane is a specialized mesenchymal tissue that lines the diarthrodial joints surfaces, bursae, and tendon sheaths of the body. This article aims to provide an overview of the fundamentals of synovial tissue, with particular regard to the imaging findings of the main pathologic processes that can affect the synovia and the role of image-guided interventions.
2. Frick MA, Wenger DE, Adkins M. MR imaging of synovial disorders of the knee: an update. Radiol Clin North Am 2007; 45: 1017-31, vii.
3. Chung CB, Boucher R, Resnick D. MR imaging of synovial disorders of the knee. Semin Musculoskelet Radiol 2009; 13: 303-25.
4. Reginelli A, Silvestro G, Fontanella G, et al. Validation of DWI in assessment of radiotreated bone metastases in elderly patients. Int J Surg 2016; 33 Suppl 1: S148-53.
5. Reginelli A, Zappia M, Barile A, Brunese L. Strategies of imaging after orthopedic surgery. Musculoskelet Surg 2017; 101: 1.
6. Barile A, Bruno F, Mariani S, et al. What can be seen after rotator cuff repair: a brief review of diagnostic imaging findings. Musculoskelet Surg 2017; 101: (Suppl1): 3-14
7. Cortellini A, Bozzetti F, Palumbo P, et al. Weighing the role of skeletal muscle mass and muscle density in cancer patients receiving PD-1/PD-L1 checkpoint inhibitors: a multicenter real-life study. Sci Rep 2020; 10: 1456.
8. Piccolo CL, Galluzzo M, Ianniello S, et al. Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging. Musculoskelet Surg 2017; 101: 85-102.
9. Zappia M, Capasso R, Berritto D, et al. Anterior cruciate ligament reconstruction: MR imaging findings. Musculoskelet Surg 2017; 101: 23-35.
10. Bruno F, Arrigoni F, Palumbo P, et al. The Acutely Injured Wrist. Radiol Clin North Am 2019; 57: 943-55
11. Salvati F, Rossi F, Limbucci N, et al. Mucoid metaplastic-degeneration of anterior cruciate ligament. The Journal of sports medicine and physical fitness 2008; 48: 483-487
12. Zappia M, Castagna A, Barile A, et al. Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder. Skeletal Radiology 2017; 46: 1101-1111
13. Mariani S, La Marra A, Arrigoni F, et al. Dynamic measurement of patello-femoral joint alignment using weight-bearing magnetic resonance imaging (WB-MRI). European journal of radiology 2015; 84: 2571-8
14. De Filippo M, Pesce A, Barile A, et al. Imaging of postoperative shoulder instability. Musculoskelet Surg 2017; 101: 15-22.
15. Pogliacomi F, De Filippo M, Paraskevopoulos A, Alesci M, Marenghi P, Ceccarelli F. Mini-incision direct lateral approach versus anterior mini-invasive approach in total hip replacement: results 1 year after surgery. Acta Biomed 2012; 83: 114-21.
16. Barile A, Bruno F, Mariani S, et al. Follow-up of surgical and minimally invasive treatment of Achilles tendon pathology: a brief diagnostic imaging review. Musculoskelet Surg 2017; 101: 51-61.
17. Zoccali C, Arrigoni F, Mariani S, Bruno F, Barile A, Masciocchi C. An unusual localization of chondroblastoma: The triradiate cartilage; from a case report a reconstructive technique proposal with imaging evolution. J Clin Orthop Trauma 2017; 8: S48-s52.
18. Bruno F, Barile A, Arrigoni F, et al. Weight-bearing MRI of the knee: a review of advantages and limits. Acta Biomed 2018; 89: 78-88.
19. Zappia M, Reginelli A, Russo A, et al. Long head of the biceps tendon and rotator interval. Musculoskelet Surg 2013; 97 Suppl 2: S99-108.
20. Di Pietto F, Chianca V, de Ritis R, et al. Postoperative imaging in arthroscopic hip surgery. Musculoskelet Surg 2017; 101: 43-49.
21. Bredella MA, Tirman PF, Wischer TK, Belzer J, Taylor A, Genant HK. Reactive synovitis of the knee joint: MR imaging appearance with arthroscopic correlation. Skeletal Radiol 2000; 29: 577-82.
22. Perry TA, Gait A, O’Neill TW, et al. Measurement of synovial tissue volume in knee osteoarthritis using a semiautomated MRI-based quantitative approach. Magn Reson Med 2019; 81: 3056-64.
23. Wang Y, Teichtahl AJ, Pelletier JP, et al. Knee effusion volume assessed by magnetic resonance imaging and progression of knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2019; 58: 246-53.
24. Liu H, Huang C, Chen S, et al. Value of contrast-enhanced ultrasound for detection of synovial vascularity in experimental rheumatoid arthritis: an exploratory study. J Int Med Res 2019; 47: 5740-51.
25. Fiocco U, Stramare R, Coran A, et al. Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis. Clin Rheumatol 2015; 34: 1903-12.
26. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate in rheumatoid arthritis: optimizing therapy among different formulations. Current and emerging paradigms. Clin Ther 2014; 36: 427-35.
27. Giacomelli R, Gorla R, Trotta F, et al. Quality of life and unmet needs in patients with inflammatory arthropathies: results from the multicentre, observational RAPSODIA study. Rheumatology (Oxford) 2015; 54: 792-7.
28. Ruscitti P, Ursini F, Cipriani P, et al. Poor clinical response in rheumatoid arthritis is the main risk factor for diabetes development in the short-term: A 1-year, single-centre, longitudinal study. PLoS One 2017; 12: e0181203.
29. Ruscitti P, Cipriani P, Masedu F, et al. Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study. PLoS One 2017; 12: e0170108.
30. Ruscitti P, Cipriani P, Liakouli V, et al. Subclinical and clinical atherosclerosis in rheumatoid arthritis: results from the 3-year, multicentre, prospective, observational GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Arthritis Res Ther 2019; 21: 204.
31. Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still’s disease. J Autoimmun 2018; 93: 24-36.
32. Ruscitti P, Iacono D, Ciccia F, et al. Macrophage Activation Syndrome in Patients Affected by Adult-onset Still Disease: Analysis of Survival Rates and Predictive Factors in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale Cohort. J Rheumatol 2018; 45: 864-72.
33. Ruscitti P, Cipriani P, Ciccia F, et al. Prognostic factors of macrophage activation syndrome, at the time of diagnosis, in adult patients affected by autoimmune disease: Analysis of 41 cases collected in 2 rheumatologic centers. Autoimmun Rev 2017; 16: 16-21.
34. Cipriani P, Di Benedetto P, Ruscitti P, et al. Perivascular Cells in Diffuse Cutaneous Systemic Sclerosis Overexpress Activated ADAM12 and Are Involved in Myofibroblast Transdifferentiation and Development of Fibrosis. J Rheumatol 2016; 43: 1340-9.
35. Giacomelli R, Liakouli V, Berardicurti O, et al. Interstitial lung disease in systemic sclerosis: current and future treatment. Rheumatol Int 2017; 37: 853-63.
36. Di Cesare E, Battisti S, Di Sibio A, et al. Early assessment of sub-clinical cardiac involvement in systemic sclerosis (SSc) using delayed enhancement cardiac magnetic resonance (CEMRI). Eur J Radiol 2013; 82: e268-73.
37. Salaffi F, Carotti M, Di Carlo M, Farah S, Gutierrez M. Adherence to Anti-Tumor Necrosis Factor Therapy Administered Subcutaneously and Associated Factors in Patients With Rheumatoid Arthritis. J Clin Rheumatol 2015; 21: 419-25.
38. Di Geso L, Zardi EM, Afeltra A, et al. Comparison between conventional and automated software-guided ultrasound assessment of bilateral common carotids intima-media thickness in patients with rheumatic diseases. Clin Rheumatol 2012; 31: 881-4.
39. Salaffi F, Carotti M, Bosello S, et al. Computer-aided quantification of interstitial lung disease from high resolution computed tomography images in systemic sclerosis: correlation with visual reader-based score and physiologic tests. Biomed Res Int 2015; 2015: 834262.
40. Vitali C, Carotti M, Salaffi F. Is it the time to adopt salivary gland ultrasonography as an alternative diagnostic tool for the classification of patients with Sjogren’s syndrome? Comment on the article by Cornec et al. Arthritis Rheum 2013; 65: 1950.
41. Giacomelli R, Afeltra A, Alunno A, et al. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev 2019; 18: 93-106.
42. Cipriani P, Berardicurti O, Masedu F, et al. Biologic therapies and infections in the daily practice of three Italian rheumatologic units: a prospective, observational study. Clin Rheumatol 2017; 36: 251-60.
43. Dakkak YJ, Boer AC, Boeters DM, Niemantsverdriet E, Reijnierse M, van der Helm-van Mil AHM. The relation between physical joint examination and MRI-depicted inflammation of metatarsophalangeal joints in early arthritis. Arthritis Res Ther 2020; 22: 67.
44. Barendregt AM, Bray TJP, Hall-Craggs MA, Maas M. Emerging quantitative MR imaging biomarkers in inflammatory arthritides. Eur J Radiol 2019; 121: 108707.
45. Cimmino MA, Parodi M, Barbieri F, et al. Dynamic Contrast- Enhanced MRI Confirms Rapid And Sustained Improvement Of Rheumatoid Arthritis Induced By Tocilizumab Treatment: An Italian Multicentre Study. Biologics 2020; 14: 13-21.
46. Cimmino MA, Innocenti S, Livrone F, Magnaguagno F, Silvestri E, Garlaschi G. Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease. Arthritis Rheum 2003; 48: 1207-13.
47. Yi J, Lee YH, Song HT, Suh JS. Double-inversion recovery with synthetic magnetic resonance: a pilot study for assessing synovitis of the knee joint compared to contrast-enhanced magnetic resonance imaging. Eur Radiol 2019; 29: 2573-80.
48. Perrotta FM, Astorri D, Zappia M, Reginelli A, Brunese L, Lubrano E. An ultrasonographic study of enthesis in early psoriatic arthritis patients naive to traditional and biologic DMARDs treatment. Rheumatol Int 2016; 36: 1579-83.
49. Ostergaard M, Court-Payen M, Gideon P, et al. Ultrasonography in arthritis of the knee. A comparison with MR imaging. Acta Radiol 1995; 36: 19-26.
50. El-Miedany YM, Housny IH, Mansour HM, Mourad HG, Mehanna AM, Megeed MA. Ultrasound versus MRI in the evaluation of juvenile idiopathic arthritis of the knee. Joint Bone Spine 2001; 68: 222-30.
51. Bruno F, Arrigoni F, Palumbo P, et al. New advances in MRI diagnosis of degenerative osteoarthropathy of the peripheral joints. Radiol Med 2019; 124: 1121-27.
52. Carotti M, Salaffi F, Di Carlo M, Giovagnoni A. Relationship between magnetic resonance imaging findings, radiological grading, psychological distress and pain in patients with symptomatic knee osteoarthritis. Radiol Med 2017; 122: 934-43.
53. de Vries BA, van der Heijden RA, Poot DHJ, et al. Quantitative DCE-MRI demonstrates increased blood perfusion in Hoffa’s fat pad signal abnormalities in knee osteoarthritis, but not in patellofemoral pain. Eur Radiol 2020; 30: 3401-08.
54. Oo WM, Linklater JM, Bennell KL, et al. Are OMERACT knee osteoarthritis ultrasound scores associated with pain severity, other symptoms, radiographic and MRI findings? J Rheumatol 2020;
55. Shakoor D, Demehri S, Roemer FW, Loeuille D, Felson DT, Guermazi A. Are contrast-enhanced and non-contrast MRI findings reflecting synovial inflammation in knee osteoarthritis: a meta-analysis of observational studies. Osteoarthritis Cartilage 2020; 28: 126-36.
56. Barile A, Arrigoni F, Bruno F, et al. Present role and future perspectives of interventional radiology in the treatment of painful bone lesions. Future Oncol 2018; 14: 2945-55.
57. Masciocchi C, Arrigoni F, Ferrari F, et al. Uterine fibroid therapy using interventional radiology mini-invasive treatments: current perspective. Med Oncol 2017; 34: 52 69.
58. Ierardi AM, Piacentino F, Fontana F, et al. The role of endovascular treatment of pelvic fracture bleeding in emergency settings. Eur Radiol 2015; 25: 1854-64.
59. Masciocchi C, Arrigoni F, La Marra A, et al. Treatment of focal benign lesions of the bone: MRgFUS and RFA. The British journal of radiology 2016; 89: 20150356-56 71.
60. Carrafiello G, Ierardi AM, Duka E, et al. Usefulness of Cone- Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization. Cardiovasc Intervent Radiol 2016; 39: 530-7.
61. Perri M, Grattacaso G, di Tunno V, et al. T2 shine-through phenomena in diffusion-weighted MR imaging of lumbar discs after oxygen-ozone discolysis: a randomized, double-blind trial with steroid and O2-O3 discolysis versus steroid only. Radiol Med 2015; 120: 941-50.
62. Cazzato RL, Arrigoni F, Boatta E, et al. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2019; 124: 34-49.
63. Arrigoni F, Barile A, Zugaro L, et al. Intra-articular benign bone lesions treated with Magnetic Resonance-guided Focused Ultrasound (MRgFUS): imaging follow-up and clinical results. Med Oncol 2017; 34: 55.
64. Zoccali C, Rossi B, Zoccali G, et al. A new technique for biopsy of soft tissue neoplasms: a preliminary experience using MRI to evaluate bleeding. Minerva Med 2015; 106: 117-120
65. Barile A, La Marra A, Arrigoni F, et al. Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures. Br J Radiol 2016; 89: 20150355.
66. De Lucia O, Murgo A, Pregnolato F, et al. Hyaluronic Acid Injections in the Treatment of Osteoarthritis Secondary to Primary Inflammatory Rheumatic Diseases: A Systematic Review and Qualitative Synthesis. Adv Ther 2020; 37: 1347-59.
67. Henrotin Y, Lambert C, Richette P. Importance of synovitis in osteoarthritis: evidence for the use of glycosaminoglycans against synovial inflammation. Semin Arthritis Rheum 2014; 43: 579-87.
68. Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014; 5: 351-61.
69. Deseyne N, Conrozier T, Lellouche H, et al. Hip Inflammation MRI Scoring System (HIMRISS) to predict response to hyaluronic acid injection in hip osteoarthritis. Joint Bone Spine 2018; 85: 475-80.
70. Paterson KL, Hunter DJ, Metcalf BR, et al. Efficacy of intraarticular injections of platelet-rich plasma as a symptom- and disease-modifying treatment for knee osteoarthritis - the RESTORE trial protocol. BMC Musculoskelet Disord 2018; 19: 272.
71. Raeissadat SA, Ghorbani E, Sanei Taheri M, et al. MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial). J Pain Res 2020; 13: 65-73.
72. Telischak NA, Wu JS, Eisenberg RL. Cysts and cystic-appearing lesions of the knee: A pictorial essay. Indian J Radiol Imaging 2014; 24: 182-91.
73. Bermejo A, De Bustamante TD, Martinez A, Carrera R, Zabia E, Manjon P. MR imaging in the evaluation of cystic-appearing soft-tissue masses of the extremities. Radiographics 2013; 33: 833-55.
74. Beaman FD, Peterson JJ. MR imaging of cysts, ganglia, and bursae about the knee. Magn Reson Imaging Clin N Am 2007; 15: 39-52.
75. Falek A, Niemunis-Sawicka J, Wrona K, et al. Pigmented villonodular synovitis. Folia Med Cracov 2018; 58: 93-104.
76. Willimon SC, Busch MT, Perkins CA. Pigmented Villonodular Synovitis of the Knee: An Underappreciated Source of Pain in Children and Adolescents. J Pediatr Orthop 2018; 38: e482- e85.
77. Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res 2017; 103: S91-S97.
78. Nambiar M, Onggo JR, Jacobson A. Lipoma arborescens: a rare cause of clicking in the knee. BMJ Case Rep 2019; 12:
79. Minami S, Miyake Y, Kinoshita H. Lipoma arborescens arising in the extra-articular bursa of the knee joint. SICOT J 2016; 2: 28.
80. Padhan P, Ahmed S. Synovial Chondromatosis. N Engl J Med 2019; 381: 1364.
81. Derek Stensby J, Fox MG, Kwon MS, Caycedo FJ, Rahimi A. Primary synovial chondromatosis of the subtalar joint: case report and review of the literature. Skeletal Radiol 2018; 47: 391-96.