Article Text

PDF
Original research
Retrospective review of percutaneous synovial cyst ruptures: increased thickness of the T2 hypointense rim on post-rupture MRI may be associated with need for subsequent surgery
  1. Benjamin Y M Kwan1,
  2. Fateme Salehi1,
  3. Sang Jia1,
  4. Stuart McGregor2,
  5. Neil Duggal2,
  6. David Pelz1,
  7. Manas Sharma1
  1. 1Department of Medical Imaging, Western University, London, Ontario, Canada
  2. 2Department of Clinical Neurological Sciences, Western University, London Ontario, Canada
  1. Correspondence to Dr Manas Sharma, LHSC—University Hospital, 339 Windermere Rd, London, ON, Canada N6G 2V4; Manas.Sharma{at}lhsc.on.ca

Abstract

Objective To analyze MRI characteristics of lumbar facet synovial cysts and distinguish those requiring subsequent surgical management for recurrence, after percutaneous synovial cyst rupture.

Methods and materials Retrospective chart review conducted in patients undergoing percutaneous synovial cyst rupture between February 2012 and April 2015. Pre- and post-percutaneous rupture procedure MRI spine studies were serially reviewed. Synovial cyst sizes, T1 and T2 signal characteristics and changes therein, T2 hypointense (or ‘dark rim’) thickness and change, and changes in the complexity of cyst signals were compared. Operative notes for patients who underwent subsequent surgical removal of recurrent synovial cysts were reviewed.

Results 24 patients received 41 percutaneous synovial cyst rupture procedures, with a technical success rate of 82.9%. There was a significant difference in the mean increased thickness of the T2 hypointense rim on the first post-rupture MRI scan (p=0.0411) between patients requiring subsequent surgery and those who did not. There was a significant difference in the average sizes of synovial cysts before the procedure (p=0.0483) in those requiring subsequent surgery and those who did not. Five complications were noted (12.2%), mostly involving leg pain or weakness. Of the nine patients who underwent subsequent surgery post-synovial cyst rupture, six of the surgeries had recorded difficulty pertaining to scarring and/or adherence of the cyst to dura.

Conclusions A larger increase in thickness of the T2 hypointense rim on the first post-rupture MRI scan and a larger synovial cyst size were associated with the need for subsequent surgical resection.

  • Spine
  • CT
  • Lumbosacral
  • MRI

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.