Gadolinium-DTPA enhanced magnetic resonance imaging of bone cysts in patients with rheumatoid arthritis.

Abstract

Objectives-To examine the contents of intraosseous cysts in patients with rheumatoid arthritis (RA) through the signal intensity characteristics on gadolinium-DTPA (Gd-DTPA) enhanced magnetic resonance imaging. Methods-The hand or foot joints of nine patients with the cystic form of RA (where the initial radiological abnormality consisted of intraosseous cysts without erosions) were imaged before and after intravenous administration of Gd-DTPA. A 06 unit, Ti weighted spin echo and T2* weighted gradient echo were used to obtain images in at least two perpendicular planes. Results-Most cysts showed a low signal intensity on the non-enhanced Ti weighted (spin echo) images and a high signal intensity on the T2* weighted (gradient echo) images, consistent with a fluid content. No cyst showed an enhancement of signal intensity on the Ti weighted images after intravenous administration of Gd-DTPA, whereas synovium hyperplasia at the site ofbony erosions did show an increased signal intensity after Gd-DTPA. Magnetic resonance imaging detected more cysts (as smali as 2 mm) than plain films, and the cysts were located truly intraosseously. In six patients no other joint abnormalities were identified by magnetic resonance imaging; the three other patients also showed, after Gd-DTPA administration, an enhanced synovium at the site ofbony erosions. Conclusions-It is suggested that intraosseous bone cysts in patients with RA do not contain hyperaemic synovial proliferation. The bone cysts in patients with the cystic form of RA may be the only joint abnormality.

Advanced imaging of early rheumatoid arthritis

“…Bone cysts show a low-signal intensity on nonenhanced T1-weighted images and a high-signal intensity on T2-weighted images, reflecting their water content. It is believed that bone cysts may be partially responsible for the decreased specificity of MR imaging in assessing erosions; however, when postgadolinium T1-weighted sequences are used, the specificity in distinguishing cysts from erosions increases because cysts do not enhance with contrast shortly after IV injection [68]. A study of the hands or feet of nine patients who had cystic RA showed that after IV infusion of Gd-DTPA, no enhancement of signal intensity was seen in any of the cysts [68].…”

“…Intraosseous cysts are demonstrated more reliably on MR images than on radiographs [67][68][69]. Bone cysts show a low-signal intensity on nonenhanced T1-weighted images and a high-signal intensity on T2-weighted images, reflecting their water content.…”

Magnetic Resonance Imaging in Early Detection of Rheumatoid Arthritis

“…It is thought that bone cysts may be partially responsible for decreased specificity of MRI in assessing erosions; however, when post-gadolinium T1-weighted sequences are used, the specificity in distinguishing cysts from erosions increases as cysts do not enhance with contrast. 68 A study of the hands or feet in nine patients with cystic RA showed that, after intravenous infusion of Gd-DPTA, no enhancement of signal intensity was seen in any of the cysts. 68 It was therefore concluded that the cysts did not contain hyperemic synovial tissue and were not associated with erosions.…”

“…68 A study of the hands or feet in nine patients with cystic RA showed that, after intravenous infusion of Gd-DPTA, no enhancement of signal intensity was seen in any of the cysts. 68 It was therefore concluded that the cysts did not contain hyperemic synovial tissue and were not associated with erosions. A different study described a cystic form of RA in 9% (n = 70) of study patients.…”

“…67 Intraosseous cysts are demonstrated more reliably on MRI than on radiographs. [67][68][69] Bone cysts show a low signal intensity on nonenhanced T1-weighted imaging and a high signal intensity on T2-weighted imaging, reflecting their water content. It is thought that bone cysts may be partially responsible for decreased specificity of MRI in assessing erosions; however, when post-gadolinium T1-weighted sequences are used, the specificity in distinguishing cysts from erosions increases as cysts do not enhance with contrast.…”