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Non-contrast MRI of synovitis in the knee using quantitative DESS

  • Musculoskeletal
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Abstract

Objectives

To determine whether synovitis graded by radiologists using hybrid quantitative double-echo in steady-state (qDESS) images can be utilized as a non-contrast approach to assess synovitis in the knee, compared against the reference standard of contrast-enhanced MRI (CE-MRI).

Methods

Twenty-two knees (11 subjects) with moderate to severe osteoarthritis (OA) were scanned using CE-MRI, qDESS with a high diffusion weighting (qDESSHigh), and qDESS with a low diffusion weighting (qDESSLow). Four radiologists graded the overall impression of synovitis, their diagnostic confidence, and regional grading of synovitis severity at four sites (suprapatellar pouch, intercondylar notch, and medial and lateral peripatellar recesses) in the knee using a 4-point scale. Agreement between CE-MRI and qDESS, inter-rater agreement, and intra-rater agreement were assessed using a linearly weighted Gwet’s AC2.

Results

Good agreement was seen between CE-MRI and both qDESSLow (AC2 = 0.74) and qDESSHigh (AC2 = 0.66) for the overall impression of synovitis, but both qDESS sequences tended to underestimate the severity of synovitis compared to CE-MRI. Good inter-rater agreement was seen for both qDESS sequences (AC2 = 0.74 for qDESSLow, AC2 = 0.64 for qDESSHigh), and good intra-rater agreement was seen for both sequences as well (qDESSLow AC2 = 0.78, qDESSHigh AC2 = 0.80). Diagnostic confidence was moderate to high for qDESSLow (mean = 2.36) and slightly less than moderate for qDESSHigh (mean = 1.86), compared to mostly high confidence for CE-MRI (mean = 2.73).

Conclusions

qDESS shows potential as an alternative MRI technique for assessing the severity of synovitis without the use of a gadolinium-based contrast agent.

Key Points

  • The use of the quantitative double-echo in steady-state (qDESS) sequence for synovitis assessment does not require the use of a gadolinium-based contrast agent.

  • Preliminary results found that low diffusion-weighted qDESS (qDESS Low ) shows good agreement to contrast-enhanced MRI for characterization of the severity of synovitis, with a relative bias towards underestimation of severity.

  • Preliminary results also found that qDESS Low shows good inter- and intra-rater agreement for the depiction of synovitis, particularly for readers experienced with the sequence.

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Abbreviations

CE-MRI:

Contrast-enhanced MRI

GBCA:

Gadolinium-based contrast agent

OA:

Osteoarthritis

qDESS:

Quantitative double-echo in steady-state

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Funding

This study has received grant support from GE Healthcare and NIH grants R01EB002524, R01AR077604, K24AR062068, R00EB022634, and an OARSI Collaborative Research Grant.

Author information

Author notes

  1. Dr. MacKay and Dr. Kogan contributed equally to shaping this work from a clinical (JW) and technical (FK) perspective.

Authors and Affiliations

  1. Department of Radiology, Stanford University, Stanford, CA, USA

    Jacob Thoenen, Kathryn J. Stevens, Akshay Chaudhari, Lauren E. Watkins, Brian A. Hargreaves, Garry E. Gold & Feliks Kogan

  2. Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK

    Tom D. Turmezei

  3. Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, SK, Canada

    Emily J. McWalter

  4. Department of Radiology, University of Cambridge, Cambridge, UK

    James W. MacKay

  5. Norwich Medical School, University of East Anglia, Norwich, UK

    James W. MacKay

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  1. Jacob Thoenen
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  2. Kathryn J. Stevens
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  4. Akshay Chaudhari
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Correspondence to Jacob Thoenen.

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Guarantor

The scientific guarantor of this publication is Dr. Feliks Kogan.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Drs. Gold, MacKay, Hargreaves, Kogan, Chaudhari, and Stevens receive research funding from GE Healthcare, Drs. Gold, Hargreaves, Kogan, and Chaudhari receive research funding from Phillips Healthcare, and Dr. MacKay receives research funding from GlaxoSmithKline. Dr. MacKay is now an employee of AstraZeneca.

Statistics and biometry

Dr. Jarrett Rosenberg kindly provided statistical advice for this manuscript.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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Thoenen, J., Stevens, K.J., Turmezei, T.D. et al. Non-contrast MRI of synovitis in the knee using quantitative DESS. Eur Radiol 31, 9369–9379 (2021). https://doi.org/10.1007/s00330-021-08025-2

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