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Gadolinium Enhancement RA MRI — SCE Rheumatology MCQ

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ModerateMusculoskeletal ImagingGadolinium Enhancement RA MRISCE Rheumatology

A 45-year-old woman with rheumatoid arthritis undergoes MRI of the dominant hand and wrist. The protocol includes pre-contrast and early post-gadolinium fat-suppressed T1-weighted images together with a fluid-sensitive fat-suppressed sequence. What is the principal added value of gadolinium in assessing inflammatory disease activity?

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Correct answer: C — Show vascularised synovium enhancing separately from relatively non-enhancing joint fluid

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

Gadolinium highlights perfused, vascularised inflammatory synovium and tenosynovium on early post-contrast fat-suppressed T1-weighted images. This improves separation of active synovial tissue from relatively non-enhancing joint or tendon-sheath fluid; dynamic enhancement also correlates with histological inflammation. Cortical erosions are primarily structural defects assessed on non-fluid-sensitive T1-weighted images, rather than being identified because they enhance (A). Bone marrow oedema requires a fluid-sensitive sequence such as STIR or T2 fat suppression (B), so gadolinium does not replace these sequences (C). Enhancement is not specific to RA: infective and other inflammatory synovitides may also enhance, so it cannot reliably exclude septic arthritis (E).

Reference: Østergaard M et al. Importance of timing of post-contrast MRI in rheumatoid arthritis: what happens during the first 60 minutes after IV gadolinium-DTPA? Ann Rheum Dis. 2001. https://pubmed.ncbi.nlm.nih.gov/11602477/