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Reactive Carpal Synovitis: Initial Experience with MR Imaging¹

¹ From the Department of Radiology, New York University Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003 (M.S.B., M.E.S., M.B.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (W.B.M.); and Department of Orthopedic Surgery, Philadelphia Hand Center, King of Prussia, Pa (R.W.C.). Received March 3, 2004; revision requested May 13; revision received September 21; accepted September 28. Address correspondence to M.E.S. (e-mail: mark.schweitzer{at}nyumc.org).

View larger version (123K): [in a new window]   Figure 1a. MR images obtained in an 18-year-old man with synovitis related to a triangular fibrocartilage complex tear. (a) Transverse unenhanced three-dimensional gradient-echo image (45/15, 10° flip angle) demonstrates no substantial abnormality in the pisotriquetral recess (arrows). (b) Transverse three-dimensional gradient-echo image (45/15, 10° flip angle) obtained immediately after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates enhancement of the pisotriquetral recess (arrows). (c) Coronal T2-weighted image (2500/50) shows bone marrow edema within the triquetrum (arrowheads) and increased signal intensity in the triangular fibrocartilage complex (arrows). (d) Coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates marrow enhancement in the triquetrum (arrowheads) and a peripheral cleft in the triangular fibrocartilage complex (arrows).

View larger version (118K): [in a new window]   Figure 1b. MR images obtained in an 18-year-old man with synovitis related to a triangular fibrocartilage complex tear. (a) Transverse unenhanced three-dimensional gradient-echo image (45/15, 10° flip angle) demonstrates no substantial abnormality in the pisotriquetral recess (arrows). (b) Transverse three-dimensional gradient-echo image (45/15, 10° flip angle) obtained immediately after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates enhancement of the pisotriquetral recess (arrows). (c) Coronal T2-weighted image (2500/50) shows bone marrow edema within the triquetrum (arrowheads) and increased signal intensity in the triangular fibrocartilage complex (arrows). (d) Coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates marrow enhancement in the triquetrum (arrowheads) and a peripheral cleft in the triangular fibrocartilage complex (arrows).

View larger version (166K): [in a new window]   Figure 1c. MR images obtained in an 18-year-old man with synovitis related to a triangular fibrocartilage complex tear. (a) Transverse unenhanced three-dimensional gradient-echo image (45/15, 10° flip angle) demonstrates no substantial abnormality in the pisotriquetral recess (arrows). (b) Transverse three-dimensional gradient-echo image (45/15, 10° flip angle) obtained immediately after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates enhancement of the pisotriquetral recess (arrows). (c) Coronal T2-weighted image (2500/50) shows bone marrow edema within the triquetrum (arrowheads) and increased signal intensity in the triangular fibrocartilage complex (arrows). (d) Coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates marrow enhancement in the triquetrum (arrowheads) and a peripheral cleft in the triangular fibrocartilage complex (arrows).

View larger version (164K): [in a new window]   Figure 1d. MR images obtained in an 18-year-old man with synovitis related to a triangular fibrocartilage complex tear. (a) Transverse unenhanced three-dimensional gradient-echo image (45/15, 10° flip angle) demonstrates no substantial abnormality in the pisotriquetral recess (arrows). (b) Transverse three-dimensional gradient-echo image (45/15, 10° flip angle) obtained immediately after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates enhancement of the pisotriquetral recess (arrows). (c) Coronal T2-weighted image (2500/50) shows bone marrow edema within the triquetrum (arrowheads) and increased signal intensity in the triangular fibrocartilage complex (arrows). (d) Coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of paramagnetic gadopentetate dimeglumine demonstrates marrow enhancement in the triquetrum (arrowheads) and a peripheral cleft in the triangular fibrocartilage complex (arrows).

View larger version (171K): [in a new window]   Figure 2a. MR images in a 54-year-old woman with synovitis. (a) Anterior coronal T2-weighted image obtained with fat saturation (2500/50) shows distention of the pisotriquetral recess (arrow). P = pisiform. (b) Transverse T2-weighted image obtained with fat saturation (2500/50) shows focal subchondral cysts with surrounding edema in the pisiform (arrowhead) and triquetrum (arrow) bones.

View larger version (119K): [in a new window]   Figure 2b. MR images in a 54-year-old woman with synovitis. (a) Anterior coronal T2-weighted image obtained with fat saturation (2500/50) shows distention of the pisotriquetral recess (arrow). P = pisiform. (b) Transverse T2-weighted image obtained with fat saturation (2500/50) shows focal subchondral cysts with surrounding edema in the pisiform (arrowhead) and triquetrum (arrow) bones.

View larger version (133K): [in a new window]   Figure 3a. MR images obtained in a 52-year-old man with synovitis. Coronal T1-weighted (a) and T2- weighted (b) images (400/10 and 2500/50, respectively) demonstrate distention of the radial-sided recess (black arrowheads), extrinsic erosion with adjacent subchondral marrow edema in the distal scaphoid (arrows), and the radial styloid (white arrowhead). (c) Transverse coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of gadopentetate dimeglumine demonstrates focal enhancement of the synovium along the dorsal aspect of the wrist (arrows).

View larger version (161K): [in a new window]   Figure 3b. MR images obtained in a 52-year-old man with synovitis. Coronal T1-weighted (a) and T2- weighted (b) images (400/10 and 2500/50, respectively) demonstrate distention of the radial-sided recess (black arrowheads), extrinsic erosion with adjacent subchondral marrow edema in the distal scaphoid (arrows), and the radial styloid (white arrowhead). (c) Transverse coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of gadopentetate dimeglumine demonstrates focal enhancement of the synovium along the dorsal aspect of the wrist (arrows).

View larger version (152K): [in a new window]   Figure 3c. MR images obtained in a 52-year-old man with synovitis. Coronal T1-weighted (a) and T2- weighted (b) images (400/10 and 2500/50, respectively) demonstrate distention of the radial-sided recess (black arrowheads), extrinsic erosion with adjacent subchondral marrow edema in the distal scaphoid (arrows), and the radial styloid (white arrowhead). (c) Transverse coronal three-dimensional gradient-echo image (45/15, 10° flip angle) obtained after the intravenous administration of gadopentetate dimeglumine demonstrates focal enhancement of the synovium along the dorsal aspect of the wrist (arrows).