title: 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.
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
  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.
authors.affiliation: Department of Medical Imaging, Western University, London, Ontario, Canada.
authors.forename: Benjamin Y M
authors.initials: BYM
authors.lastname: Kwan
authors.affiliation: Department of Medical Imaging, Western University, London, Ontario, Canada.
authors.forename: Fateme
authors.identifier: http://orcid.org/0000-0002-5866-5377
authors.initials: F
authors.lastname: Salehi
authors.affiliation: Department of Medical Imaging, Western University, London, Ontario, Canada.
authors.forename: Sang
authors.initials: S
authors.lastname: Jia
authors.affiliation: Department of Clinical Neurological Sciences, Western University, London Ontario, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: McGregor
authors.affiliation: Department of Clinical Neurological Sciences, Western University, London Ontario, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Duggal
authors.affiliation: Department of Medical Imaging, Western University, London, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Pelz
authors.affiliation: Department of Medical Imaging, Western University, London, Ontario, Canada.
authors.forename: Manas
authors.initials: M
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery; D010146:Pain / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D012421:Rupture / Q000000981:diagnostic imaging* / Q000601:surgery*; D013581:Synovial Cyst / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: CT; Lumbosacral; MRI; Spine