European Radiology

, Volume 29, Issue 5, pp 2573–2580 | Cite as

Double-inversion recovery with synthetic magnetic resonance: a pilot study for assessing synovitis of the knee joint compared to contrast-enhanced magnetic resonance imaging

  • Jisook Yi
  • Young Han LeeEmail author
  • Ho-Taek Song
  • Jin-Suck Suh



To investigate the agreement between double-inversion recovery (DIR) with synthetic magnetic resonance imaging (MRI) and T1-weighted contrast-enhanced (CE)-MRI for the assessment of knee synovitis.


T1-weighted CE-MRI and synthetic MRI of 30 patients were compared. Synthetic DIR image reconstruction was performed with two inversion times (280–330 ms and 2800–2900 ms). Subjective image quality, visibility of synovium, detection of synovitis, and total synovitis score in the knee joint were evaluated on both MR images. The relative signal intensity (SI) and relative contrast of synovium, joint effusion, and bone marrow for two imaging were assessed. Differences in data between two imaging were assessed by using Wilcoxon’s signed-rank test and chi-square test/Fisher’s exact test. Interobserver agreement was expressed as weighted kappa value. Accuracy of synthetic DIR image was calculated by using CE-MRI as reference standard.


T1-weighted CE-MRI yielded better image quality than synthetic DIR imaging (p < 0.001). Interobserver agreements for detecting synovitis diagnosis/sum of the synovitis score were moderate to almost perfect (κ = 0.58/0.44, synthetic DIR; κ = 0.83/0.65, T1-weighted CE-MRI). There were no statistical differences in visibility of synovium (p = 0.058–0.190), detection of synovitis (p < 0.001), and relative SI of structures between two imaging (p = 0.086–0.360). Synovium-to-effusion contrast was higher in synthetic DIR (p = 0.003) and synovium-to-bone marrow contrast was higher in CE-MRI (p < 0.001).


Synthetic DIR imaging showed a moderate degree of interobserver agreement and good accuracy for detecting synovitis. Though it has limitations, it may play a role in imaging of degenerative joint disease or larger cohort scientific studies where gadolinium application is not feasible.

Key Points

• Synthetic double-inversion recovery (DIR) imaging avoids the use of contrast agent.

• There was no significant difference between T1-weighted CE-MRI and synthetic DIR imaging in evaluating presence of synovitis in knee joint.

• Synthetic DIR imaging showed moderate degree of interobserver agreement and good accuracy for detecting synovitis compared to CE-MRI, and it may facilitate evaluation of some regions of peripatellar synovitis.


Knee Synovitis Magnetic resonance imaging Contrast media 



Double-inversion recovery




Multiple-dynamic multiple echo



This work was supported by a National Research Foundation (NRF) grant funded by the Korea government, Ministry of Science and ICT (MSIP, 2018R1A2B6008076).

Compliance with ethical standards


The scientific guarantor of this publication is Young Han Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Jisook Yi
    • 1
    • 2
  • Young Han Lee
    • 1
    Email author
  • Ho-Taek Song
    • 1
  • Jin-Suck Suh
    • 1
  1. 1.Department of Radiology, Research Institute of Radiological Science, YUHS-KRIBB Medical Convergence Research Institute, and Severance Biomedical Science InstituteYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Haeundae Paik HospitalInje University College of MedicineBusanRepublic of Korea

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