GADOLINIUM-ENHANCED MR-IMAGING OF THE WRIST IN RHEUMATOID-ARTHRITIS -VALUE OF FAT-SUPPRESSION PULSE SEQUENCES

Objective. To determine the usefulness of fat-suppressed gadolinium (G d)-enhanced MR imaging of the wrist in patients with rheumatoid arthri tis (RA). Design and patients. Fat-suppressed Gd-enhanced T1-weighted spin-echo (SE) images were obtained and compared with other standard t echniques in 38 wrists of 27 patients (22-77 years) with RA. Scoring b ased on the degree of synovial enhancement of each joint was developed and the total scores (J-score) were correlated with radiographic stag e, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and symptomatic change in the follow-up study. Results. Synovial prolifer ations showed marked enhancement in all the wrists. In addition, contr ast enhancement in the bone marrow and tenosynovium was seen in 36 and eight wrists respectively. Fat-suppressed Gd-enhanced T1-weighted ima ges demonstrated these abnormalities better than other techniques, The J-scores correlated well with values of CRP (P=0.0034), but not with radiographic stages and ESR. Conclusion. Fat-suppressed Gd-enhanced T1 -weighted SE images can clearly demonstrate most of the essential lesi ons in RA including the proliferative synovium, bone erosion, bone mar row inflammatory change, and tenosynovitis. Scoring based on the exten t of Gd-enhancement of synovium can be useful in the assessment of the inflammatory status.