Proton-density fat-saturated non-contrast MR imaging is comparable to post-contrast MR imaging for revealing wrist synovitis
Abstract
Objectives: Standard MR imaging (MRI) for rheumatoid arthritis (RA) patients comprises a post-contrast T1-fat-saturated (T1FS + C) sequence to detect wrist synovitis and tenosynovitis. This study investigates whether non-contrast sequences can provide similar information to post-contrast imaging.
Materials and methods: Seventy-seven RA patients (F/M: 64/13; age: 61 ± 12 years) underwent MRI examination of the most symptomatic wrist on a 3.0-T system. Axial T1FS + C as well as proton-density imaging with fat-saturation (PDFS) and T2-weighted imaging with fat-saturation (T2FS) sequences were performed. Two radiologists independently scored synovitis and tenosynovitis severity on all sequences, using the rheumatoid arthritis magnetic resonance imaging scoring system (RAMRIS). Intra- and interclass correlation coefficients (ICCs) were assessed.
Results: For synovitis severity scoring, PDFS was practically identical to T1FS + C, while T2FS overestimated synovitis severity by up to 19%. For synovitis severity, PDFS imaging correlated better with T1FS + C than T2FS imaging (ICC: Reader 1: 0.931 vs 0.897; Reader 2: 0.969 vs 0.948). For tenosynovitis severity, PDFS and T2FS both yielded higher tenosynovitis scores than T1FS + C ( p < 0.001). Compared to T1FS + C imaging, PDFS overestimated tenosynovitis severity by up to 39%, while T2FS overestimated tenosynovitis severity by up to 54%. For tenosynovitis severity, PDFS imaging correlated better with T1FS + C than T2FS imaging (ICC: Reader 1: 0.856 vs 0.731; Reader 2: 0.808 vs 0.800).
Conclusion: PDFS imaging had good (for tenosynovitis) to excellent (for synovitis) intra- and inter-reader reliability and provides comparable scoring to T1FS + C imaging when evaluating synovitis severity, though it tends to overestimate tenosynovitis severity. PDFS imaging can reasonably replace contrast-enhanced imaging for assessing wrist synovitis in RA patients.
Key Points: Question Post-contrast imaging is recommended for evaluating synovitis and tenosynovitis in rheumatoid arthritis (RA) patients, though it involves higher cost, scan time, and discomfort.
Findings Proton-density imaging with fat-saturation (PDFS) imaging had good to excellent intra- and inter-reader reliability for evaluating synovitis and tenosynovitis in RA wrists. Compared to post-contrast T1-fat-saturated (T1FS + C) imaging, PDFS imaging provides comparable semi-quantitative synovitis severity grading but tends to overestimate tenosynovitis severity.
Critical relevance statement Post-contrast imaging for synovitis and tenosynovitis in RA patients involves discomfort, a longer time, and cost. PDFS imaging has good reliability and compares well with post-contrast imaging. In RA wrists, compared to T1FS+C imaging, PDFS imaging provides comparative semi-quantitative synovitis severity grading but tends to overestimate tenosynovitis severity.
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BibTeX
@article{wu2026protondensity,
title = {{Proton-density fat-saturated non-contrast MR imaging is comparable to post-contrast MR imaging for revealing wrist synovitis}},
author = {Su Wu and James Francis Griffith and João Dourado and Lai Shan Tam},
journal = {Insights into imaging},
year = {2026},
month = oct,
doi = {10.1186/s13244-026-02406-1},
url = {https://europepmc.org/article/PMC/PMC13653001},
note = {CC BY},
}
RIS
TY - JOUR
TI - Proton-density fat-saturated non-contrast MR imaging is comparable to post-contrast MR imaging for revealing wrist synovitis
AU - Su Wu
AU - James Francis Griffith
AU - João Dourado
AU - Lai Shan Tam
PY - 2026
DA - 2026/10/09
JO - Insights into imaging
DO - 10.1186/s13244-026-02406-1
UR - https://europepmc.org/article/PMC/PMC13653001
AB - Objectives: Standard MR imaging (MRI) for rheumatoid arthritis (RA) patients comprises a post-contrast T1-fat-saturated (T1FS + C) sequence to detect wrist synovitis and tenosynovitis. This study investigates whether non-contrast sequences can provide similar information to post-contrast imaging. Materials and methods: Seventy-seven RA patients (F/M: 64/13; age: 61 ± 12 years) underwent MRI examination of the most symptomatic wrist on a 3.0-T system. Axial T1FS + C as well as proton-density imaging with fat-saturation (PDFS) and T2-weighted imaging with fat-saturation (T2FS) sequences were performed. Two radiologists independently scored synovitis and tenosynovitis severity on all sequences, using the rheumatoid arthritis magnetic resonance imaging scoring system (RAMRIS). Intra- and interclass correlation coefficients (ICCs) were assessed. Results: For synovitis severity scoring, PDFS was practically identical to T1FS + C, while T2FS overestimated synovitis severity by up to 19%. For synovitis severity, PDFS imaging correlated better with T1FS + C than T2FS imaging (ICC: Reader 1: 0.931 vs 0.897; Reader 2: 0.969 vs 0.948). For tenosynovitis severity, PDFS and T2FS both yielded higher tenosynovitis scores than T1FS + C ( p < 0.001). Compared to T1FS + C imaging, PDFS overestimated tenosynovitis severity by up to 39%, while T2FS overestimated tenosynovitis severity by up to 54%. For tenosynovitis severity, PDFS imaging correlated better with T1FS + C than T2FS imaging (ICC: Reader 1: 0.856 vs 0.731; Reader 2: 0.808 vs 0.800). Conclusion: PDFS imaging had good (for tenosynovitis) to excellent (for synovitis) intra- and inter-reader reliability and provides comparable scoring to T1FS + C imaging when evaluating synovitis severity, though it tends to overestimate tenosynovitis severity. PDFS imaging can reasonably replace contrast-enhanced imaging for assessing wrist synovitis in RA patients. Key Points: Question Post-contrast imaging is recommended for evaluating synovitis and tenosynovitis in rheumatoid arthritis (RA) patients, though it involves higher cost, scan time, and discomfort. Findings Proton-density imaging with fat-saturation (PDFS) imaging had good to excellent intra- and inter-reader reliability for evaluating synovitis and tenosynovitis in RA wrists. Compared to post-contrast T1-fat-saturated (T1FS + C) imaging, PDFS imaging provides comparable semi-quantitative synovitis severity grading but tends to overestimate tenosynovitis severity. Critical relevance statement Post-contrast imaging for synovitis and tenosynovitis in RA patients involves discomfort, a longer time, and cost. PDFS imaging has good reliability and compares well with post-contrast imaging. In RA wrists, compared to T1FS+C imaging, PDFS imaging provides comparative semi-quantitative synovitis severity grading but tends to overestimate tenosynovitis severity.
SN - 1869-4101
ER -