From the Guidelines
Yes, contrast is typically needed when assessing for tenosynovitis or abscess on MRI. According to the most recent and highest quality study, 1, the addition of postcontrast imaging to wrist MRI aids in distinguishing synovitis from joint effusion and ganglion cysts, and also aids in the detection of tenosynovitis. This is further supported by another study, 1, which states that the inclusion of postcontrast images to MRI of the wrist improves detection of tenosynovitis.
The use of intravenous gadolinium-based contrast agents significantly improves diagnostic accuracy by highlighting areas of inflammation and infection. For tenosynovitis, contrast enhancement helps differentiate between fluid within the tendon sheath and actual synovial inflammation, as the inflamed synovium will enhance while simple fluid will not. When evaluating for an abscess, contrast is essential as it creates a characteristic rim enhancement pattern around the abscess cavity while the central portion remains non-enhancing, allowing clear distinction from surrounding edema or phlegmon.
Some key points to consider when using contrast in MRI for tenosynovitis or abscess include:
- The standard dose is typically 0.1 mmol/kg of gadolinium-based contrast agent administered intravenously prior to the relevant MRI sequences.
- T1-weighted fat-suppressed sequences obtained after contrast administration are particularly valuable for assessment.
- In cases where patients cannot receive contrast due to severe renal impairment or allergies, alternative sequences like STIR (Short Tau Inversion Recovery) or diffusion-weighted imaging may provide some information but with reduced sensitivity and specificity compared to contrast-enhanced studies.
It's worth noting that while some studies suggest that contrast may not be necessary in certain cases, the most recent and highest quality evidence supports the use of contrast in assessing for tenosynovitis or abscess on MRI, as seen in studies 1 and 1.
From the Research
Assessment of Tenosynovitis or Abscess on MRI
- The use of contrast in MRI assessments for tenosynovitis or abscess is supported by various studies 2, 3, 4.
- A study published in the Annals of the rheumatic diseases in 2021 found that contrast-enhanced MRI had a high sensitivity for detecting tenosynovitis in patients with rheumatoid arthritis 2.
- Another study published in Arthritis research & therapy in 2019 compared the sensitivity of ultrasound and MRI in detecting synovitis and tenosynovitis, and found that MRI had a higher sensitivity, particularly when using contrast-enhanced imaging 3.
- A review of imaging and laboratory workup for hand infections published in Hand clinics in 2020 recommended the use of MRI with contrast to evaluate deep space or bony infections and preoperative surgical planning 4.
Specific Conditions
- Tenosynovitis of the hand and wrist can be diagnosed and treated with various methods, including corticosteroid injections and surgical releases 5.
- However, the use of contrast in MRI assessments for these conditions is not explicitly mentioned in the study 5.
- The diagnosis of abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis can be supported by laboratory values and imaging studies, including MRI with contrast 4.