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Imaging Findings

• Large effusion
  
• Normal bone density
  
• Cartilage preserved until late in process
  
• Erosion; occurs in 50%
  
• Large, well-marginated subchondral cyst
  
• Secondary degenerative changes late in process
  
  • Cartilage narrowing, osteophyte formation
    
• Very rarely & late, may show dystrophic calcification
  
• Synovial-based masses
  
  • May be solitary nodular mass
    
  • May thicken synovium throughout most of joint, with nodularity
    
  • May extend through capsular defects along juxta-articular ligaments
    
  • T1 MR: Low signal, homogeneous
    
  • T2 & other fluid sensitive sequences: Variably low signal & inhomogeneous
    
  • Gradient echo sequence: Blooming relating to presence of hemosiderin
    
  • Post-contrast imaging: Moderate to intense enhancement, with inhomogeneity
    

• Resection with synovectomy
  
• Incomplete resection has high recurrence rate
  
  • Overall recurrence of intraarticular PVNS: 20-50% (the higher rate related to incomplete synovectomy)
    
• Arthroscopic synovectomy unlikely to have complete access to some lesions & open procedure required
  
• Radiation synovectomy occasionally is used following recurrence
  
• Refractory cases with severe osteoarthritis require arthroplasty or arthrodesis
  

Our patient with total hip arthroplasty

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