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MR Arthrography of the Shoulder, Hip, and Wrist: Evaluation of Contrast Dynamics and Image Quality with Increasing Injection-to-Imaging Time

¹ Institute for Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
² Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.
³ Guerbet AG, Zurich, Switzerland.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Decrease of contrast-to-noise ratio (CNR) over time. Clustered box plots show temporal behavior in hip (light gray), shoulder (dark gray), and wrist (white) with regard to T1-weighted spin-echo imaging without (A) and with (B) fat suppression.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Decrease of contrast-to-noise ratio (CNR) over time. Clustered box plots show temporal behavior in hip (light gray), shoulder (dark gray), and wrist (white) with regard to T1-weighted spin-echo imaging without (A) and with (B) fat suppression.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Overall image quality for direct MR arthrography using T1-weighted spin-echo MRI with (black) and without (gray) fat suppression. Bars represent mean overall image quality using 5-point scale. Figures show similar trends in decreasing image quality over time for imaging shoulder (A), hip (B), and wrist (C).

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Overall image quality for direct MR arthrography using T1-weighted spin-echo MRI with (black) and without (gray) fat suppression. Bars represent mean overall image quality using 5-point scale. Figures show similar trends in decreasing image quality over time for imaging shoulder (A), hip (B), and wrist (C).

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Overall image quality for direct MR arthrography using T1-weighted spin-echo MRI with (black) and without (gray) fat suppression. Bars represent mean overall image quality using 5-point scale. Figures show similar trends in decreasing image quality over time for imaging shoulder (A), hip (B), and wrist (C).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —36-year-old man with chronic left-sided wrist pain. Coronal T1-weighted spin-echo sequences (TR/TE, 420/15) with (A) and without (B) fat suppression acquired 19 minutes after intraarticular injection of Gd-DOTA (tetraazacyclododecanetetraacetic acid) (time point 1). In distal radioulnar joint (arrow), joint distension, sharpness of anatomic structures, and contrast between joint fluid and adjacent anatomic structures was rated higher on fat-suppressed MR images (good) than on non-fat-suppressed images (fair).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —36-year-old man with chronic left-sided wrist pain. Coronal T1-weighted spin-echo sequences (TR/TE, 420/15) with (A) and without (B) fat suppression acquired 19 minutes after intraarticular injection of Gd-DOTA (tetraazacyclododecanetetraacetic acid) (time point 1). In distal radioulnar joint (arrow), joint distension, sharpness of anatomic structures, and contrast between joint fluid and adjacent anatomic structures was rated higher on fat-suppressed MR images (good) than on non-fat-suppressed images (fair).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —28-year-old man with chronic right-sided hip pain. A Coronal fat-suppressed T1-weighted spin-echo sequences (TR/TE, 500/13) were acquired at 17 minutes (time point [TP] 1) (A), 50 minutes (TP 2) (B), 115 minutes (TP 3) (C), 175 minutes (TP 4) (D), and 217 minutes (TP 5) (E) after intraarticular administration of Gd-DOTA (tetraazacyclododecanetetraacetic acid). MR image acquired at TP 1 (A) shows maximal distension of hip recess (arrow) and maximal sharpness of labrum, as well as maximal contrast between joint fluid versus labrum and cartilage. MR image at TP 2 (B) still shows good distension, sharpness, and contrast (arrow). At TP 3 (C), MR image shows notable loss of joint distension, sharpness, and contrast between intraarticular structures (arrow). At TPs 4 (D) and 5 (E), image quality was rated insufficient for diagnostic purposes because of lack of joint distension and contrast (arrows).

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —28-year-old man with chronic right-sided hip pain. Coronal fat-suppressed T1-weighted spin-echo sequences (TR/TE, 500/13) were acquired at 17 minutes (time point [TP] 1) (A), 50 minutes (TP 2) (B), 115 minutes (TP 3) (C), 175 minutes (TP 4) (D), and 217 minutes (TP 5) (E) after intraarticular administration of Gd-DOTA (tetraazacyclododecanetetraacetic acid). MR image acquired at TP 1 (A) shows maximal distension of hip recess (arrow) and maximal sharpness of labrum, as well as maximal contrast between joint fluid versus labrum and cartilage. MR image at TP 2 (B) still shows good distension, sharpness, and contrast (arrow). At TP 3 (C), MR image shows notable loss of joint distension, sharpness, and contrast between intraarticular structures (arrow). At TPs 4 (D) and 5 (E), image quality was rated insufficient for diagnostic purposes because of lack of joint distension and contrast (arrows).

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —28-year-old man with chronic right-sided hip pain. Coronal fat-suppressed T1-weighted spin-echo sequences (TR/TE, 500/13) were acquired at 17 minutes (time point [TP] 1) (A), 50 minutes (TP 2) (B), 115 minutes (TP 3) (C), 175 minutes (TP 4) (D), and 217 minutes (TP 5) (E) after intraarticular administration of Gd-DOTA (tetraazacyclododecanetetraacetic acid). MR image acquired at TP 1 (A) shows maximal distension of hip recess (arrow) and maximal sharpness of labrum, as well as maximal contrast between joint fluid versus labrum and cartilage. MR image at TP 2 (B) still shows good distension, sharpness, and contrast (arrow). At TP 3 (C), MR image shows notable loss of joint distension, sharpness, and contrast between intraarticular structures (arrow). At TPs 4 (D) and 5 (E), image quality was rated insufficient for diagnostic purposes because of lack of joint distension and contrast (arrows).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —28-year-old man with chronic right-sided hip pain. Coronal fat-suppressed T1-weighted spin-echo sequences (TR/TE, 500/13) were acquired at 17 minutes (time point [TP] 1) (A), 50 minutes (TP 2) (B), 115 minutes (TP 3) (C), 175 minutes (TP 4) (D), and 217 minutes (TP 5) (E) after intraarticular administration of Gd-DOTA (tetraazacyclododecanetetraacetic acid). MR image acquired at TP 1 (A) shows maximal distension of hip recess (arrow) and maximal sharpness of labrum, as well as maximal contrast between joint fluid versus labrum and cartilage. MR image at TP 2 (B) still shows good distension, sharpness, and contrast (arrow). At TP 3 (C), MR image shows notable loss of joint distension, sharpness, and contrast between intraarticular structures (arrow). At TPs 4 (D) and 5 (E), image quality was rated insufficient for diagnostic purposes because of lack of joint distension and contrast (arrows).

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —28-year-old man with chronic right-sided hip pain. Coronal fat-suppressed T1-weighted spin-echo sequences (TR/TE, 500/13) were acquired at 17 minutes (time point [TP] 1) (A), 50 minutes (TP 2) (B), 115 minutes (TP 3) (C), 175 minutes (TP 4) (D), and 217 minutes (TP 5) (E) after intraarticular administration of Gd-DOTA (tetraazacyclododecanetetraacetic acid). MR image acquired at TP 1 (A) shows maximal distension of hip recess (arrow) and maximal sharpness of labrum, as well as maximal contrast between joint fluid versus labrum and cartilage. MR image at TP 2 (B) still shows good distension, sharpness, and contrast (arrow). At TP 3 (C), MR image shows notable loss of joint distension, sharpness, and contrast between intraarticular structures (arrow). At TPs 4 (D) and 5 (E), image quality was rated insufficient for diagnostic purposes because of lack of joint distension and contrast (arrows).

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