Intraarticular diffusion of Gd-DOTA after intravenous injection in the knee: MR imaging evaluation.

Abstract

Intraarticular concentration of gadolinium tetraazacyclododecanetetraacetic acid (DOTA) after intravenous injection and the diagnostic contribution of the subsequent arthrographic effect were assessed for meniscal lesions in the knee. Kinetics were studied in three healthy volunteers. Passage of contrast material into the synovial fluid of the joint was evaluated in 53 knees by measuring the signal intensity on T1-weighted images before, immediately after, and 1 hour after injection. Synovial fluid enhancement was 1.46-fold greater than the unenhanced value after 10 minutes, plateaued after 30 minutes, and was 1.95-fold greater after 1 hour. In articular fluid samples from four patients 1 hour after intravenous injection, the average intraarticular concentration was 141 mumol +/- 47 (1 standard deviation) at atomic absorption spectrophotometry. Knee mobilization improved the passage of contrast material into the synovial fluid by approximately 120% at 10 minutes and 25% at 1 hour. In eight of 39 tears, unenhanced standard sequences were equivocal. In seven of these uncertain cases, delayed contrast-enhanced images permitted adequate interpretation. Intraarticular concentration of Gd-DOTA produces a sufficient arthrographic effect for meniscus evaluation.

Magnetic resonance imaging‐determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis. Comparison with the macroscopic and microscopic appearance of the synovium

“…The signal intensity of the inflamed synovial membrane on T1-weighted images increases markedly within the first minute after intravenous Gd-DTPA injection (6,7, 21,22,26,27). The signal intensity of joint effusions also increases, starting in the periphery and gradually approaching the central parts, as Gd-DTPA passes into the joint space by diffusion of fluid from synovial capillaries (5, 24,25,28). However, the rate of signal increase in effusions is much slower than in the synovial membrane (5, 25,28), and a comparison of pre-and post-aspiration volumes has indicated that misinterpretation of the effusion-synovium border is not the major source of variation when the acquisition of the MR images is completed within 10-15 minutes after Gd-DTPA injection (lo), as in this study.…”

“…The signal intensity of joint effusions also increases, starting in the periphery and gradually approaching the central parts, as Gd-DTPA passes into the joint space by diffusion of fluid from synovial capillaries (5, 24,25,28). However, the rate of signal increase in effusions is much slower than in the synovial membrane (5, 25,28), and a comparison of pre-and post-aspiration volumes has indicated that misinterpretation of the effusion-synovium border is not the major source of variation when the acquisition of the MR images is completed within 10-15 minutes after Gd-DTPA injection (lo), as in this study. Thus, the joint fluid that is located most peripherally may be included in the synovial membrane volume, but, at least within the initial 10 minutes after Gd-DTPA injection, other sources of variation, probably particularly coincidental variations in the outlining and partial volume artifacts, apparently are more important (10).…”

Magnetic resonance imaging of normal and osteoarthritic cartilage

“…Intravenous injection of gadolinium can also enhance the intraarticular fluid signal. This enhancement, which can be by as much as 26096, improves the visibility of the cartilage surface (13,14). Gadolinium is also used to improve visualization of synovial inflammation (15,16).…”

Comparison study of intraarticular and intravenous gadolinium-enhanced magnetic resonance imaging of cartilage in a canine model

“…Thus, the theoretical maximum interstitial concentration after an intravenous dose of 0.3 mmol/kg, or 0.21-0.23 l/kg, would be 1.3-1.4 mmol/l (14). The intraarticular gadolinium concentration measured after intravenous administration of Gd-DTPA or Gd-DOTA 0.1 mmol/kg body weight is 0.029-0.44 mmol/l (14,(52)(53)(54). These values are lower than expected based on a uniform distribution in the extracellular space because the contrast medium is rapidly excreted by the renal system and only the synovial membrane of the joint capsule can be regarded as a diffusing tissue (14,(52)(53)(54).…”