 Good morning, my name is Dr. Ravel, I am from Krishna Institute of Medical Sciences, Karahat. So today my topic of discussion is MRA Imaging of the Sinovial Dissolve the Knee. So in this first introduction, as you all know that knee is one of the largest and most complicated joints in the body and this is Sinovium line joint. So Sinovial Dissolve does often affect knee joint and they are the common cause of mobility. So early imaging is highly important and it is very helpful in the early detection to avoid the incidence of irreversible joint injury. So what are the available investigations are like conventional radiography, ultrasound and MRA which will be helpful in the diagnosis and even in the follow-up also. So main aim and objective of my presentation is to determine and differentiate the uncommon Sinovial Dissolve associated with the knee joint. So materials and methods in this retrospective cross-sectional study was performed of the Sinovial Dissolve in our department and MRA knee was performed on Siemens 1.5 Tesla. Nineteen cases of knee pain and swelling were taken into our study in which some impact to Sinovitis, rheumatoid arthritis, pigmented rheumatoid arthritis, Sinovil contomatoces, Lycoma absence and so on. Sinovil hemangiomas were identified. First coming to rheumatoid arthritis. This is a common chronic and a progressive inflammatory disorder primarily affecting the Sinovia. So the main early feature will be the Sinovitis and it is a strong predictor for the future erosive changes. So on the radiography you will be seeing bony changes when it is in the chronic surgery it stills. So in MRA it will be mainly helpful to see the earlier or other changes of RA. So what are the features of RA on MRA? So this is Sinovil hyperamia, penis formation, degree thickness of platelet and subcondar cysts and erosions. And juxta-articulate bone marrow edema and joint affluence can also be seen in the rheumatoid arthritis. So in the, in our case now, coming to our case, in the T1 serratal, PD serratal and PDFS serratal, you could see that there is a diffuse Sinovil screen along the Sinovil, which is more a better evident on the PDFS. And in the PDFS coronal, you could see that there is a cartilage loss in the subcondar marrow edema. This patient afterwards went for Sinovil biopsy and it turned out to be rheumatoid arthritis. So in the, in the, of the same patient you have, we have also this radiograph in which if you are showing this bone erosive tables and the marginal osteophytes also can be seen. So next common close differential for the rheumatoid arthritis, that is rheumatoid arthritis or inflammatory arthritis is infected to Sinovitis. In this patient, we have another patient in which it was a child who came with the patient in complaint of knee pain and so on. And in this, you can see T1 serratal, PDFS serratal and PDFS serratal, you could see that this joint effusion was seen as associated with diffuse Sinovil's thickening, diffuse Sinovil's thickening was seen holding. And on post contrast images, you could see that there is diffuse Sinovil enhancement, every post contrast enhancement, which was more evident on the axial scans. This patient turned out to be infected to Sinovitis. So pigmented willow root of Sinovil. This, this benign process characterized by hyperplastic Sinovil proliferation either within the joint or along the tendonsics and within the bursa also can be seen. So wherever the bursa and tendonsics that is lined by Sinovil, will be affected with this, with this pigmented willow root of Sinovil. So this is of two types, localized form and decreased form. Localized form is most common disease and usually extraordinary. So MRA typically shows mass-like Sinovil proliferation with low belated margins. So signal characteristics, what are the signal characteristics are? P1 it will be low to intermediate signal and on post contrast, which will be showing variable enhancement. On T2, low to intermediate signal with some areas of high signal will also be seen and on GRA sequences it will show blooming. That is main characteristic feature of pigmented willow root of Sinovitis. So in our case, how coming to this our case, PV sagittal, T1 sagittal. PV sagittal you can see at the high point as mass in the robust fat pad. And on T1 sagittal you could see some other low signal mass in the robust fat pad, same mass. And on PDF it is also low signal and on very sequence it is showing blooming. And in post contrast images you can see that hetero Jesus post contrast enhancement is seen. So these are the features of suggestive of localized pigmented willow root of Sinovitis. This is MRI need to perform which was showing ill-defined nodular masses all around the knee joint in the interim. Even it was extending into the intramuscular plane also which was not shown here. You could see that the PV sagittal, T1 sagittal, PDF sagittal you could see there is heterogeneously hyper intense mass in hyper intense areas also we can and for showing which blooming also here, which will be blooming also. And on post contrast it is heterogeneous post contrast enhancement is seen. So after its patient went for arthroscopy and it turned out to be the Sinovitis. The joint at the end can also be seen which is showing the supra-patternization. This is Sinovial contromotor system. Sinovial contromotor system is here in benign condition which the Sinovium lining develops Chondral or Osteopontal nodules. So if it is Osteopontal nodule it can be easily diagnosed on a radiograph as it is bony. But if it is a Chondral condition that is cartilage it can be easily treated for us to diagnose on a X-ray. So as if an MRE can be helpful in this diagnosis although it may be a non-specific features will be there like T1 hyper hyper T2 hyper will be there and it will be associated with joint definition. Advanced cases generally will be associated with Osteopontal nodule around the knee joint. And the symptomatology is often similar to that of a patient sampling with osteoarthritis. Next this one case T1 sagittal, T1 exter, T1 coronal you are seeing a hyper intense mass. The hyper intense mass all around the knee joint here also you could see. And as I have mentioned as a star mark here this one is that with the one which was seen predominantly in the posterior aspect. And on PDFS you are seeing that this is the hyper intense hyperintelsization which this is suggestive of Sinovial contromotor system. And this is of another patient. Out of this patient you are showing multiple loose bodies in the knee. So this is suggestive of Osteopontomatosis to Osteopontomatosis. Next Lypoma herbicides. Lypoma herbicides is a real condition affecting the Sinovial linings with a front like deposition of fatty tissue due to non specific react to Sinovial proliferation. This knee joint is the most common set of environment. Other joints will be like shoulder, elbow, ankle, wrist. And MR is the modality of choice for this diagnosis. In this there will be a front like Sinovial mass which will be characteristic appearance always associated with joint. In T1 it will be a high signal as we know that appears T1, T2 high signal which will add certain types of red sequences. On the gradient they go sequences we can see sometimes these fads immediately resist. So in our case of coming to our case patient came with knee pain patient came with knee pain. In this there is a front like mass in the Suprapatellar region which was appearing hyper on T1, PD and the hyper on PDFS and on the post contrast you are showing the post contrast. This is suggestive of ligoma or presence. So next is Sinovial hematoma. This is rare pain in vascular malformations that occur most commonly in relation to the joint. So most commonly this will be seen out of this knee joint and sometimes associated with the femoris also. In that MR8 can be typically lopulated interarticular mass will be seen. Sometimes that lopidation can be seen or sometimes diffuse we can also be seen. So signal characteristics include T1 it will be used in the joint which include T1 it will be usually of intermediate signal or iso also sometimes and T2 it will be markedly hyper intense background because of the cold blade within the vascular spaces and sometimes if it is a high flow vascular malformations you could see the flow voids also and on T1 post contrast you could see marked enhancement. So even suggestive here you could see a iso intense mass which is in the superior to the opus fat fat and in the PD it is also iso on T1 hyper on PD hyper on PD address and in the pre contrast image you could see there is T1 net as hyper and on post contrast you can see slight enhancement and on post contrast deliered T-blast you will see rich enhancement which is suggestive of low flow venous malformation as it is being better well seen on the deliered images. So this is a piece of information. So based on this based on our MRA teachers and Sinoval biopsy teachers and arthritic followers have divided the patients into based on the Sinoval pathology. So most common pathology we found is the impact to Sinovalitis as we got the 6 patients and atleast last work like Lycoma Abysses and Sinoval Hemp, which were like one one case of each. So next conclusion 19 cases were followed and segregated according to the MRA findings. Among them 6 were of impact to Sinovalitis, 4 were of arthritic, 4 were of Invented Velo nodular Sinovalitis, 3 were of Sinoval gonobitis and each case of Lycoma Abysses and Sinoval Hemp. So based on the my MRA teachers we are suspecting some Sinoval pathologies what are the sequences we will be taking of T1, T2 or PD player sequences and even the gradient sequences and post contrast delieres also can be needed as well. So in this MRA imaging is really helpful for modality for the differential diagnosis preoperative assessment follow up of Sinoval disease. So MRA along the Sinoval biopsy is the best possible diagnosis. So based on this we have prepared a diagnostic algorithm with thickened and irregular synomium mass present in mass also when masses are offset periarticular erosions, subcontrances marrow edema, joint effusions these are all there then we have to suspect inflammatory or infective pathologies and if masses are present solitary mass forming or multiple mass forming this solitary mass forming it will be like Lycoma Abysses and localize the congenital Sinovalitis in plopoma Abysses there won't be any loose bodies but bone erosions are blooming but in localize the congenital Sinovalitis bone erosions blooming and loose bodies can be seen multiple mass forming you will be seeing diffused congenital Sinovalitis blooming. In Sinovalic congenital Sinovalitis you won't be seeing any blooming. So this will be associated with intervetorotial infections these are my references. Thank you.