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MRI of the knee in rheumatoid arthritis: Gd-DTPA perfusion dynamics
M Yamato1, K Tamai, T Yamaguchi
1Department of Radiology, Dokkyo University School of Medicine, Tochigi-ken, Japan.
Objective:
Seventeen knees in 13 patients with rheumatoid arthritis (RA) were studied with MRI to clarify the dynamics of Gd-DTPA administered intravenously and to determine an optimal imaging time.
Materials And Methods:
Dynamic gradient recalled echo imaging with bolus intravenous injection of Gd-DTPA was performed following unenhanced T1- and T2-weighted SE imaging. Late-phase SE or serial gradient recalled echo images were obtained following dynamic study.
Results:
There was rapid enhancement of synovium with maximal enhancement ratio of 96-499% (mean 214 +/- 111%) with Tmax ranging from 120 to 660 s (mean 253 s). The synovial enhancement persisted over 80% of the peak enhancement for 6-27 min (average 12 min) with eventual enhancement of joint effusion from the periphery to the center beginning at 6 min to 8 min, 20 s after contrast medium injection. Complete enhancement of joint effusion was noted in four joints at 24-86 min.
Conclusion:
We conclude that enhancement of synovium in patients with RA is a time-dependent phenomenon, and an optimal imaging time would be within 5 min following contrast medium administration.
Insights
Dynamic MRI with Gd-DTPA in rheumatoid arthritis (RA) shows synovial enhancement is time-dependent. Optimal imaging is within 5 minutes after contrast administration for accurate RA assessment.
Area of Science:
- Rheumatology
- Radiology
- Medical Imaging
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting joints.
- Accurate assessment of synovial inflammation is crucial for RA management.
Purpose of the Study:
- To investigate the dynamic enhancement patterns of synovium using Gd-DTPA in RA patients.
- To determine the optimal imaging time for assessing synovial enhancement with MRI.
Main Methods:
- Dynamic gradient recalled echo MRI with intravenous Gd-DTPA injection.
- Comparison with unenhanced T1- and T2-weighted SE imaging.
- Serial imaging to capture enhancement dynamics.
Main Results:
- Synovial enhancement peaked between 120-660 seconds (mean 253s), with a mean enhancement ratio of 214%.
- Synovial enhancement remained above 80% of peak for an average of 12 minutes.
- Joint effusion enhancement began peripherally at 6-8 minutes and completed between 24-86 minutes.
Conclusions:
- Synovial enhancement in RA is a time-dependent process.
- Optimal MRI imaging time for assessing synovial enhancement in RA is within 5 minutes post-contrast administration.