Diagnostic Algorithm of Synovial Tumors and Tumor-Like Conditions

Abstract

In this chapter, a diagnostic algorithm and essential key points for the imaging workup of synovial tumors and tumor-like conditions are provided.

It should be emphasized that imaging findings should be interpreted in conjunction with relevant clinical and laboratory examination. The imaging algorithm of a joint lesion should start with a conventional radiograph to detect or exclude calcifications complemented. Doppler-ultrasound examination is useful to diagnose or rule out benign synovial lesions such as ganglion or synovial cysts or inflammatory or posttraumatic synovial lesions. Ultrasound is particularly helpful for superficially located cystic lesion. If the lesion is deeply located or has no definite benign characteristics on these imaging modalities or cannot be characterized as a pseudotumoral or inflammatory lesion, MRI is mandatory. If MRI findings are equivocal or suggestive of malignancy, (imaging-guided) biopsy and subsequent histopathological examination have to be performed in a tertiary referral center following multidisciplinary discussion.