Journal of the Louisiana State Medical Society
dromatosis. Computed tomography (CT) scanning also can only be used for identification of calcified loose bodies; it cannot provide visualization of unmineralized fragments. 5,6 The best modality for visualizing synovial osteochon- dromatosis ismagnetic resonance imaging (MRI). MRI imag- ing may be diagnostic, even when calcification is minimal or absent, because uncalcified bodies of cartilage appear characteristically lobulated. They also appear isointense or slightly stronger in intensity than muscle tissue on T1- and T2-weighted images. Signal intensity correlates with the quantity of calcium present in the nodule. The degree of composing cellular component compared to acellular hyaline matrix and the quantity of calcium present in the nodules correlates with the signal intensity. Gadolinium enhancement can also be added to increase the sensitivity of the scan and assist in identifying lesions. MRI may also reveal areas of high signal intensity consistent with synovial thickening and joint effusion. Plain radiographs are useful adjuncts to MRI when the presence of calcification is am- biguous. Still, further evaluation can be achieved via nuclear imaging; lesions induce increased radionuclide uptake on technetium-99m bone scans in affected areas. 7-9 REFERENCES 1. Mussey RD, Henderson MS. Osteochondromatosis. J Bone Joint Surg Am 1949;31:619-627. 2. Bearcroft PPW. Joint Disease. In: Adam A, Dixon AK, Grainger RG, Allison DJ, eds. Grainger & Allison’s Diagnostic Radiology . Churchill Livingstone 2007. 3. Milgram JW. Synovial osteochondromatosis: a histopathological study of thirty cases. J Bone Joint Surg Am 1977;59:792-801. 4. Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of Synovial Chondromatosis with Radiologic-Pathologic Correlation. RadioGraphics 2007;27:1465-1488. 5. Sheldon PJ, Forrester DM, Learch TJ. Imaging of Intra-articular Masses. RadioGraphics 2005;25:105-119. 6. Ryan RS, Harris AC, O’Connell JX, Munk PL. Synovial osteochondromatosis: the spectrum of imaging findings. Australasian Radiology 2005;49:95-100. 7. Winalski CS, Foldes K, Gravallese EM, et al. Synovial membrane disorders. Magn Reson Imaging 1999;2:1079-1096. 8. Cohen EK, Kressel HY, Frank TS, FallonM, Burk DL, DalinkaMK, Schiebler ML. Hyaline Cartilage-Origin Bone and Soft-Tissue Neoplasms: MRAppearance andHistologic Correlation. Radiology 1988;167:477-481. 9. Frick MA, Wenger DE, Adkins M. MR Imaging of Synovial Disorders of the Knee: An Update. Radiol Clin NAm 2007;45:1017- 1031.
Ms. Nagalingam is a Medical Student at Tulane School of Medicine in New Orleans. Dr. Weidenhaft is a second-year Radiology resident at Tulane University Health Sciences Center in New Orleans
128 J La State Med Soc VOL 166 May/June 2014
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