MSK imaging: pigmented villonodular synovitis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · MSK imaging: pigmented villonodular synovitis

Sample item

A 30-year-old has a swollen knee with recurrent blood-stained aspirates. MRI shows synovial thickening with low signal on all sequences that blooms on gradient-echo images. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Pigmented villonodular synovitis

Haemosiderin deposition in proliferative synovium gives low signal on T1 and T2 and blooming on gradient-echo sequences. Haemorrhagic effusions and pressure erosions on both sides of the joint can occur. Treatment is synovectomy.

Option by option

  • A. Synovial osteochondromatosis

    Synovial osteochondromatosis shows multiple calcified loose bodies.

  • B. Rheumatoid arthritis

    Rheumatoid synovium does not show haemosiderin blooming.

  • C. Pigmented villonodular synovitis (correct)

    Correct. Blooming haemosiderin in thick synovium indicates PVNS.

  • D. Septic arthritis

    Septic arthritis presents acutely with fever and pus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Pigmented villonodular synovitis. Haemosiderin deposition in proliferative synovium gives low signal on T1 and T2 and blooming on gradient-echo sequences.

Why is "Synovial osteochondromatosis" not the answer?

Synovial osteochondromatosis shows multiple calcified loose bodies.

Why is "Rheumatoid arthritis" not the answer?

Rheumatoid synovium does not show haemosiderin blooming.

Why is "Septic arthritis" not the answer?

Septic arthritis presents acutely with fever and pus.

What concept does this question test?

It tests MSK imaging: pigmented villonodular synovitis in Radiology. Haemorrhagic effusions and pressure erosions on both sides of the joint can occur. Treatment is synovectomy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study MSK imaging: pigmented villonodular synovitis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.