Discrimination between fluid, synovium, and cartilage in patients with rheumatoid arthritis: Contrast enhanced spin echo versus non-contrast-enhanced fat-suppressed gradient echo MR imaging

Abstract

PURPOSE: The aim of this study was to compare fat-suppressed T1-weighted 3D-Gradient Echo (GE)-images and conventional T1-weighted contrast-enhanced SE images in the assessment of patients with rheumatoid arthritis in an attempt to improve discrimination of inflamed synovium, joint fluid, and cartilage. PATIENTS AND METHODS: 28 knee joints in 20 patients with rheumatoid arthritis were examined with a 3 D-GE-T1 weighted sequence with frequency-selective fat suppression (Flash 3D fat sat) and T1-weighted SE-sequences after intravenous gadolinium-containing contrast agent administration using a 1.5T system. Differentiation of cartilage, synovium, and joint effusion was assessed on both sequences qualitatively by two observers and quantitatively by signal intensity measurements. RESULTS: Qualititative analysis revealed higher grading rates for cartilage/fluid differentiation with fat-suppressed T1-weighted GE images than contrast enhanced T1-SE images. Quantitative analysis by measurements of contrast-to-noise ratios revealed significantly higher rates for the Flash 3D fat sat with regard to cartilage/fluid discrimination, significantly higher rates for T1-SE post-contrast for cartilage/synovium discrimination, and significantly higher rates for T1-SE post-contrast for synovium/fluid discrimination. CONCLUSION: 3D-GE-imaging with fat-suppressed T1 weighted sequences allows sufficient differentiation of cartilage and joint fluid in patients with rheumatoid arthritis without application of contrast agents and may assist in monitoring disease progression and response to therapy. The higher contrast to noise ratios of cartilage/synovium and synovium/fluid on T1-SE images following administration of gadolinium-containing contrast agents may improve detection of disease activity.