Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?

Eur Radiol. 2014 Oct;24(10):2614-22. doi: 10.1007/s00330-014-3272-0. Epub 2014 Jun 28.


Purpose: To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA).

Material and methods: In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference.

Results: Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80-0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %).

Conclusion: T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA.

Key points: • Bone marrow oedema scores are equal on T2 and T1-Gd-chelate enhanced sequences. • Agreement between scores based on T2 and T1-Gd-chelate images was excellent. • Sensitivity and specificity for presence of bone marrow oedema were high. • A short protocol without T2 images suffices in rheumatoid arthritis patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / diagnosis*
  • Bone Marrow / pathology*
  • Contrast Media*
  • Diagnosis, Differential
  • Edema / diagnosis*
  • Edema / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Metacarpophalangeal Joint / pathology*
  • Middle Aged
  • ROC Curve
  • Reproducibility of Results


  • Contrast Media