title: Lumbar facet joint synovial cysts: does T2 signal intensity predict outcomes after percutaneous rupture?
abstract: OBJECTIVE
  Lumbar facet synovial cysts are a cause of back pain and radiculopathy with facet joint degeneration, the most common cause for cyst formation. Typically, LFSCs are T2 hyperintense on MR imaging, but the signal intensity is variable. Treatment options include percutaneous rupture and surgical resection. This study evaluates the relationship between LFSC signal intensity on MR imaging and outcomes as it relates to percutaneous rupture success and need for subsequent surgery.
  
  
  METHODS
  A retrospective review of 110 patients who underwent CT fluoroscopic-guided rupture of symptomatic LFSCs was performed. The LFSCs were characterized by their T2 signal intensity on MR imaging and divided into 3 groups: high, intermediate, and low T2 signal intensity. The rates of successful cyst rupture and need for subsequent surgery were recorded.
  
  
  RESULTS
  Percutaneous LFSC rupture was technically successful in 87% of all cases. Cyst rupture was successful in 89% and 90% of high and intermediate signal intensity cysts, respectively, and in 65% of low signal intensity cysts (P = .017, .030). High signal intensity cysts had lower postprocedural surgical rates (29%) when compared with intermediate and low signal cyst as a group (P = .045).
  
  
  CONCLUSIONS
  T2 hyperintense and intermediate signal intensity LFSCs are easier to rupture, perhaps because the cysts contain a higher proportion of fluid and are less gelatinous or calcified than T2 hypointense cysts. Patients with T2 hyperintense LFSCs are less likely to need surgery.
authors: Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA. swordrads@gmail.com
authors: S C
authors: SC
authors: Cambron
authors: J J
authors: JJ
authors: McIntyre
authors: S J
authors: SJ
authors: Guerin
authors: Z
authors: Z
authors: Li
authors: D A
authors: DA
authors: Pastel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D013581:Synovial Cyst / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000473:pathology* / Q000601:surgery*