OBJECTIVES: The aim of the present study was to propose a methodologically innovative sonographic approach for optimal evaluation of synovial tissues (starting from histopathology). METHODS: Using high-frequency ultrasound probes and high-level ultrasound machines, we matched the histological microarchitecture of synovial tissues with multiple sonographic patterns in physiological and pathological conditions. Likewise, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS: Modern equipment allows for a macroscopic classification of synovial pathologies recognizing different morphological patterns; however, intimal and subintimal layers of the synovium cannot be distinguished from each other on ultrasound. High-sensitive Doppler imaging clearly defines the microvascular pattern, especially in patients with hypertrophic synovial pathologies. CONCLUSIONS: In clinical practice, using adequate technological equipment i.e. high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of synovial tissues can be performed - defining the main sono-histological patterns.

Department of Pediatrics Vittore Buzzi Children's Hospital University of Milan Milan Italy

Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center National Taiwan University Hospital Bei Hu Branch Taiwan

Department of Rehabilitation Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Hacettepe University Medical School Department of Physical and Rehabilitation Medicine Ankara Turkey

Institute of Anatomy 1st Faculty of Medicine Charles University Prague Czech Republic

Pathology Unit Maggiore Hospital Bologna Italy; Department of Experimental Diagnostic and Specialty Medicine University of Bologna Bologna Italy

Physical and Rehabilitation Medicine Unit Luigi Sacco University Hospital ASST Fatebenefratelli Sacco Milan Italy

UZR Ultraschallzentrum und Institut für Rheumatologie Basel Switzerland; Rheumatology Clinic University Hospital of Basel Basel Switzerland

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