title: Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors: Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands, w.stomp@lumc.nl.
authors: Wouter
authors: W
authors: Stomp
authors: Annemarie
authors: A
authors: Krabben
authors: Désirée
authors: D
authors: van der Heijde
authors: Tom W J
authors: TW
authors: Huizinga
authors: Johan L
authors: JL
authors: Bloem
authors: Mikkel
authors: M
authors: Østergaard
authors: Annette H M
authors: AH
authors: van der Helm-van Mil
authors: Monique
authors: M
authors: Reijnierse
mesh_terms: D001168:Arthritis / Q000175:diagnosis*; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013585:Synovitis / Q000175:diagnosis; D013717:Tenosynovitis / Q000175:diagnosis; D014955:Wrist Joint / Q000473:pathology
chemical_list: D003287:Contrast Media; D005682:Gadolinium
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