Use of DCE-MRI in arthritis in the appendicular skeleton: a narrative review

Arthritis of the appendicular skeleton encompasses various inflammatory and degenerative joint diseases, where active inflammation in the soft tissues and bones significantly affects patients' quality of life and prognosis. Therefore, effective arthritis management depends on early diagnosis and treatment initiation, which rely on sensitive methods for detecting and monitoring inflammatory activity. Conventional MRI techniques, such as fluid-sensitive MRI using static 2D or 3D fat-saturated T2-weighted, proton density-weighted, STIR, and particularly T1-weighted images after intravenous Gadolinium contrast injection, have been widely used as reference standards for detecting inflammation and monitoring the response to treatment in clinical trials and clinical practice. However, several studies have indicated that these static imaging sequences may have problems capturing the degree of inflammation, detecting early treatment responses and associating the imaging scores with clinical findings. As a result, T1-weighted dynamic contrast-enhanced MRI (DCE-MRI), which captures and maps vascularity and tissue perfusion, has been increasingly used as a more sensitive surrogate measure for detecting and monitoring the inflammatory treatment response in arthritis. This review outlines the rationale for utilising DCE-MRI in arthritis imaging. It will discuss the advantages and limitations of current acquisition and analysis methods and highlight which DCE-MRI-derived parameters correlate with clinical findings, histological results and responses to inflammatory treatments in common forms of appendicular arthritis.