What is the role of imaging studies in the workup of cystic lesions?

Updated: Dec 29, 2018
  • Author: David M Gonzalez, MD, FACS; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Obtain plain radiographs, and consider sonograms or any other studies as indicated. MRI is especially useful when evaluating knee cysts. [14, 18, 10, 19] However, ultrasonography is less expensive than MRI and has comparable accuracy in the evaluation of certain pathologic conditions of the knee. [20] See Baker Cyst Imaging.

MRIs may have to include intravenous contrast enhancement because high signal intensity on T2-weighted images does not necessarily mean that a structure is fluid filled.

Necrotic tissue, nerve sheath or myxoid tissue, flowing blood, and pus can all resemble cysts on T2-weighted MRIs. [21] Ultrasonography can also be used to determine if the mass is fluid filled.

Authors of a retrospective study regarding the prevalence of Baker cysts in patients with knee pain recommended that an ultrasound exam of the knee be performed in patients with painful osteoarthritis or evidence of effusion. They assessed the correlation between BC and severity of osteophytes and joint effusion and found that Baker cysts were present in 25.8% (102 of 399) of patients who had ultrasound features of osteoarthritis and joint effusion.

[22]

Computed tomography scanning, knee arthrography, tomography, and bone scanning have also been used.


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