Does diffusion-weighted Imaging (DWI) offer added value over Conventional Magnetic Resonance Imaging (MRI) in evaluating synovial Pathologies of the Knee? - A Prospective Observational Study of 63 patients

Does diffusion-weighted Imaging (DWI) offer added value over Conventional Magnetic Resonance Imaging (MRI) in evaluating synovial Pathologies of the Knee? - A Prospective Observational Study of 63 patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Does diffusion-weighted Imaging (DWI) offer added value over Conventional Magnetic Resonance Imaging (MRI) in evaluating synovial Pathologies of the Knee? - A Prospective Observational Study of 63 patients Dr Ritansh Khera Ritansh, Dr Harmeet Kaur Harmeet, Mr. Sandeep Singh Sandeep, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8309902/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Synovial pathologies of the knee include a broad spectrum of inflammatory, infective, proliferative, and neoplastic disorders. Conventional Magnetic Resonance Imaging (MRI) is widely used for evaluation; however, it has limitations in differentiating lesions with overlapping morphological features. Diffusion-Weighted Imaging (DWI), a functional MRI technique, offers additional tissue characterization without the need for contrast administration. This study aimed to assess the added diagnostic value of DWI over conventional MRI in evaluating knee synovial pathologies. Methods This hospital-based, prospective, cross-sectional study was conducted from October 2022 to May 2024 and included 63 patients aged 18–70 years with clinically suspected knee synovial pathology. All patients underwent conventional MRI and DWI. Apparent diffusion coefficient (ADC) values were calculated by placing multiple regions of interest in areas of maximum synovial thickening. MRI findings were compared with histopathological diagnosis as the reference standard. Statistical analysis was performed using SPSS software, with kappa statistics used to assess diagnostic agreement and the Kruskal-Wallis test applied for intergroup ADC comparison. Results Inflammatory synovitis (61.9%) was the most common diagnosis, followed by tubercular synovitis (9.5%), pigmented villonodular synovitis (7.9%), synovial chondromatosis (7.9%), ganglion cysts (6.3%), hemangiomas (3.2%), and synovial sarcoma (3.2%). Diffusion restriction was observed in 81% of cases. Benign lesions such as ganglion cysts and hemangiomas showed high ADC values, while malignant lesions and pigmented villonodular synovitis demonstrated low ADC values. A statistically significant difference in ADC values among various synovial pathologies was observed (p < 0.05). The agreement between MRI and histopathology was excellent (κ = 0.836, p < 0.001). Conclusion The addition of DWI to conventional MRI significantly improves diagnostic confidence in the evaluation of knee synovial pathologies, especially in differentiating benign from malignant lesions and inflammatory from infective conditions. DWI serves as a valuable, non-contrast functional imaging tool that enhances diagnostic accuracy and supports better clinical decision-making. Trial Registration: Not applicable. Diffusion-weighted imaging (DWI) Apparent Diffusion Coefficient (ADC) Magnetic Resonance Imaging (MRI) Synovial pathologies Knee Joint Musculoskeletal imaging Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarytables.docx GraphicalABStractt.png Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8309902","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582476796,"identity":"71bc38e6-02b7-4161-a4a3-1e37f936cbc4","order_by":0,"name":"Dr Ritansh Khera Ritansh","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Ritansh","middleName":"Khera","lastName":"Ritansh","suffix":""},{"id":582476797,"identity":"1dc8722b-cd7c-47b0-849e-da3df9cfdbc8","order_by":1,"name":"Dr Harmeet Kaur Harmeet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBACCSBmZqiwkWNg4CFJy5k0YxK1MLYdTmwgWotk+xmzzwVsaekbjp89+OADg52cbgMBLdI8OcazZ/DY5G44k5dsOIMh2djsAAEtcgw5xsw8Emm5Gw7kmEnzMBxI3EZQC/8boBaDw+kG598QqUVaAmRLwuEEgxvE2iI541kxM8+BNMOZN94YG84wIMIvEueTNzPz/rOR5zufY/jgQ4WdHEEtcKAAVmlArHIQkG8gRfUoGAWjYBSMKAAAApU9c268M3QAAAAASUVORK5CYII=","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":true,"prefix":"Dr","firstName":"Harmeet","middleName":"Kaur","lastName":"Harmeet","suffix":""},{"id":582476798,"identity":"6ee22000-bfd4-47c5-9114-388ebc163d61","order_by":2,"name":"Mr. Sandeep Singh Sandeep","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Mr.","firstName":"Sandeep","middleName":"Singh","lastName":"Sandeep","suffix":""},{"id":582476799,"identity":"0951c6ac-aac5-4c76-99e2-1eaf97a92ff5","order_by":3,"name":"Dr Paramdeep Singh Paramdeep","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Paramdeep","middleName":"Singh","lastName":"Paramdeep","suffix":""},{"id":582476800,"identity":"c293fc40-4a7f-49cb-b9bf-5448786f26e9","order_by":4,"name":"Dr Tarun Goyal Tarun","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Tarun","middleName":"Goyal","lastName":"Tarun","suffix":""},{"id":582476801,"identity":"1fe5589c-3add-4acf-9ff0-ff976ce5c50f","order_by":5,"name":"Dr Manjeet Kaur Rana Manjeet","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"Dr","firstName":"Manjeet","middleName":"Kaur Rana","lastName":"Manjeet","suffix":""}],"badges":[],"createdAt":"2025-12-08 16:53:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8309902/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8309902/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104967832,"identity":"1b5ca5a6-120b-4387-9445-822cf77f51ff","added_by":"auto","created_at":"2026-03-19 10:12:07","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":904783,"visible":true,"origin":"","legend":"","description":"","filename":"finalmanuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8309902/v1_covered_e253653d-9b44-4f5f-a807-d96549cc3a67.pdf"},{"id":101523148,"identity":"13200666-3337-4e31-8d30-1643c3f13038","added_by":"auto","created_at":"2026-01-30 17:40:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16745,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8309902/v1/bbda89c6cbf26c1bef6a8ceb.docx"},{"id":101523152,"identity":"b2fdeac6-9884-41ad-8d05-7ae4fe464325","added_by":"auto","created_at":"2026-01-30 17:40:43","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":13492144,"visible":true,"origin":"","legend":"","description":"","filename":"GraphicalABStractt.png","url":"https://assets-eu.researchsquare.com/files/rs-8309902/v1/98f44ab0c935389393e67102.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does diffusion-weighted Imaging (DWI) offer added value over Conventional Magnetic Resonance Imaging (MRI) in evaluating synovial Pathologies of the Knee? - A Prospective Observational Study of 63 patients","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diffusion-weighted imaging (DWI), Apparent Diffusion Coefficient (ADC), Magnetic Resonance Imaging (MRI), Synovial pathologies, Knee Joint, Musculoskeletal imaging","lastPublishedDoi":"10.21203/rs.3.rs-8309902/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8309902/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSynovial pathologies of the knee include a broad spectrum of inflammatory, infective, proliferative, and neoplastic disorders. Conventional Magnetic Resonance Imaging (MRI) is widely used for evaluation; however, it has limitations in differentiating lesions with overlapping morphological features. Diffusion-Weighted Imaging (DWI), a functional MRI technique, offers additional tissue characterization without the need for contrast administration. This study aimed to assess the added diagnostic value of DWI over conventional MRI in evaluating knee synovial pathologies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis hospital-based, prospective, cross-sectional study was conducted from October 2022 to May 2024 and included 63 patients aged 18\u0026ndash;70 years with clinically suspected knee synovial pathology. All patients underwent conventional MRI and DWI. Apparent diffusion coefficient (ADC) values were calculated by placing multiple regions of interest in areas of maximum synovial thickening. MRI findings were compared with histopathological diagnosis as the reference standard. Statistical analysis was performed using SPSS software, with kappa statistics used to assess diagnostic agreement and the Kruskal-Wallis test applied for intergroup ADC comparison.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eInflammatory synovitis (61.9%) was the most common diagnosis, followed by tubercular synovitis (9.5%), pigmented villonodular synovitis (7.9%), synovial chondromatosis (7.9%), ganglion cysts (6.3%), hemangiomas (3.2%), and synovial sarcoma (3.2%). Diffusion restriction was observed in 81% of cases. Benign lesions such as ganglion cysts and hemangiomas showed high ADC values, while malignant lesions and pigmented villonodular synovitis demonstrated low ADC values. A statistically significant difference in ADC values among various synovial pathologies was observed (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The agreement between MRI and histopathology was excellent (κ\u0026thinsp;=\u0026thinsp;0.836, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe addition of DWI to conventional MRI significantly improves diagnostic confidence in the evaluation of knee synovial pathologies, especially in differentiating benign from malignant lesions and inflammatory from infective conditions. DWI serves as a valuable, non-contrast functional imaging tool that enhances diagnostic accuracy and supports better clinical decision-making.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial Registration:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Does diffusion-weighted Imaging (DWI) offer added value over Conventional Magnetic Resonance Imaging (MRI) in evaluating synovial Pathologies of the Knee? - A Prospective Observational Study of 63 patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 17:40:20","doi":"10.21203/rs.3.rs-8309902/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ede46595-4ef4-4ba7-82bd-60c74eaa0f4e","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T10:11:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 17:40:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8309902","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8309902","identity":"rs-8309902","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}