Reactive carpal synovitis: initial experience with MR imaging

To retrospectively evaluate the accuracy of various magnetic resonance (MR) imaging findings in the diagnosis of reactive carpal synovitis.

Institutional review board approval was obtained, and the need for informed consent was waived. This study was compliant with the Health Insurance Portability and Accountability Act. Thirty-five consecutive patients (19 male and 16 female patients; age range, 13-57 years) who underwent arthroscopy and MR imaging within 4 weeks of surgery were evaluated by two reviewers for the following potential findings of synovitis: (a) distention of the pisotriquetral recess by fluid, (b) distention of the radial and/or prestyloid recess, (c) synovial enhancement (in patients who received contrast material), (d) amount of dorsal capsule distention, and (e) the location of bone marrow edema, if any. The chi2 and paired t tests were used to assess these findings in patients with and patients without arthroscopically proved synovitis. The sensitivity, specificity, positive and negative predictive values, and accuracy of these findings in the detection of synovitis were calculated.

Fluid in the pisotriquetral recess was seen in nine of the 14 patients with synovitis and five of the 21 patients without synovitis (P = .018). Distention of the radial and/or prestyloid recess was observed in six of the 14 patients with synovitis and two of the 21 patients without synovitis (P = .027). Among the 24 patients who received contrast material, synovial enhancement was seen in seven of eight patients with synovitis and three of 16 patients without synovitis (P = .002). The dorsal capsule measured 1-7 mm (mean, 3.07 mm) in the 14 patients with synovitis and 2-7 mm (mean, 3.76 mm) in the 21 patients without synovitis (P = .193). Although bone marrow edema was seen globally in similar frequencies (nine of 14 patients with synovitis, nine of 21 patients without synovitis), pisotriquetral bone marrow edema was seen only in patients with synovitis (two of nine patients).

Fluid in the pisotriquetral recess, enhancing synovium, and, less commonly, pisotriquetral bone marrow edema are MR imaging findings that may help in the diagnosis of reactive carpal synovitis.