Dynamic gadolinium-enhanced magnetic resonance imaging allows accurate assessment of the synovial inflammatory activity in rheumatoid arthritis knee joints: a comparison with synovial histology

Scand J Rheumatol. 2012 Mar;41(2):89-94. doi: 10.3109/03009742.2011.608375. Epub 2012 Jan 30.


Objective: To determine whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluated using semi-automatic image processing software can accurately assess synovial inflammation in rheumatoid arthritis (RA) knee joints.

Methods: In 17 RA patients undergoing knee surgery, the average grade of histological synovial inflammation was determined from four biopsies obtained during surgery. A preoperative series of T(1)-weighted dynamic fast low-angle shot (FLASH) MR images was obtained. Parameters characterizing contrast uptake dynamics, including the initial rate of enhancement (IRE), were generated by the software in three different areas: (I) the entire slice (Whole slice); (II) a manually outlined region of interest (ROI) drawn quickly around the joint, omitting large artefacts such as blood vessels (Quick ROI); and (III) a manually outlined ROI following the synovial capsule of the knee joint (Precise ROI). Intra- and inter-reader agreement was assessed using the intra-class correlation coefficient (ICC).

Results: The IRE from the Quick ROI and the Precise ROI revealed high correlations to the grade of histological inflammation (Spearman's correlation coefficient (rho) = 0.70, p = 0.001 and rho = 0.74, p = 0.001, respectively). Intra- and inter-reader ICCs were very high (0.93-1.00). No Whole slice parameters were correlated to histology.

Conclusion: DCE-MRI provides fast and accurate assessment of synovial inflammation in RA patients. Manual outlining of the joint to omit large artefacts is necessary.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / diagnosis*
  • Arthritis, Rheumatoid / diagnostic imaging
  • Arthroplasty, Replacement, Knee
  • Contrast Media
  • Female
  • Gadolinium
  • Humans
  • Image Interpretation, Computer-Assisted
  • Knee Joint / metabolism
  • Knee Joint / pathology
  • Knee Joint / surgery
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Observer Variation
  • Radionuclide Imaging
  • Reproducibility of Results
  • Synovitis / diagnosis*
  • Synovitis / diagnostic imaging
  • Synovitis / etiology
  • Young Adult


  • Contrast Media
  • Gadolinium