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Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?

  • Musculoskeletal
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To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness.

Materials and Methods

Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed.


At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses.


Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment.

Key Points

Eliminating gadolinium contrast administration results in low specificity for synovitis

For tenosynovitis, sensitivity is low without gadolinium contrast administration

Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis

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The scientific guarantor of this publication is Monique Reijnierse. Wouter Stomp has received speaker fees from GE Healthcare. Mikkel Østergaard has received consultancy/speaker fees and/or research support form Abbott/Abbvie, BMS, Boehringer-Ingelheim, Eli-Lilly, Centocor, GSK, Janssen, Merck, Mundipharma, Novo, Pfizer, Schering-Plough, Roche UCB, and Wyeth. This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (, and the Dutch Arthritis Foundation, project TRACER (grant 04I-202). The research has also been funded by The European Community Seventh Framework Program FP7 Health-F2-2008-223404 (Masterswitch) as well as by a European grant from the Innovative medicine Initiative: BTCURE. This work of A. van der Helm-van Mil is supported by a Vidi-grant of the Netherlands Organisation for Scientific Research. The work of A. Krabben is supported by a grant of the Dutch Arthritis Foundation. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects in this study. Patients are participating in the Leiden Early Arthritis clinic, and multiple articles have been published about this cohort with ongoing inclusion, including two other studies on MRI results (Krabben A, Stomp W, Huizinga TWJ, et al. (2013) Concordance between inflammation at physical examination and on MRI in patients with early arthritis. Ann Rheum Dis. doi: 10.1136/annrheumdis-2013-204005 and Stomp W, Krabben A, van der Heijde D, et al. (2014) Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema? Eur Radiol 24:2614–2622. doi: 10.1007/s00330-014-3272-0). Methodology: prospective cross sectional study performed at one institution.

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Stomp, W., Krabben, A., van der Heijde, D. et al. Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?. Eur Radiol 25, 1520–1527 (2015).

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