Suzanne Anderson MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Significance of MRI for differentiating between ganglion and synovitis in the chronic painful wrist Methods and Materials: Seventy-one patients underwent MRI for chronic wrist pain between 1998 and 2002. Inclusion criteria included patients without swelling; absence of symptoms related to triangular fibrocartilage tear, trauma or previous surgery. All patients had normal radiographs. MRI standard sequences with vitamin capsule demarcating pain and post contrast imaging was performed. Lesion location, size, shape, margins, presence of internal septa, signal characteristics and contrast enhancement were noted. Diagnoses included ganglia, synovitis or tendon pathology. Efficacy of MR imaging with regards to patient treatment was analyzed. Surgery and MR findings were correlated with histopathology. Results: Ninety nine abnormalities were seen on MRI. There were 34 operated patients with 38 findings (age range of 18- 41 years, average 29.5 years) with 29 ganglions, 8 synovitis, and 1 tendinosis. MR diagnosis was confirmed by surgery in 69% of these cases. Intraoperatively 8 MR diagnosed ganglia were not found and 3 surgical ganglia were not visible on MRI. Forty-six patients and 61 MR findings were conservatively treated (age range 24-47 years, average 35.7 years). Of these there were 40 ganglia, 18 synovitis, and 3 tendon pathologies. In 37 patients, pain did not correlate with ganglia on MRI imaging. MRI diagnosed synovitis correlated with clinical course in 11 of 18 (61%). In seven, MRI diagnosis did not correlate with clinical course. Four main criteria were useful in helping with differentiating ganglion from synovitis: margin, shape, internal structure and post contrast enhancement. With respective sensitivities for ganglion being: 88%, 96%, 59%, 76% and specificities of 42%, 25%, 98%, and 86%. Sensitivities for synovitis were respectively 74%, 96%, 96%, 58% and specificities of 97%, 96%, 44%, 93%. Shape and internal structure were most helpful. Conclusion: MR imaging with vitamin capsule demarcating the patients pain correlated with intraoperative findings and clinical course in two-thirds of patients. If the ganglion does not correspond to focal persistent pain at a precise location, it is probably incidental in nature.       Questions about this event email: suzanne.anderson@bluewin.ch

Anderson MD, S, Significance of MRI for differentiating between ganglion and synovitis in the chronic painful wrist.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3104958.html