Do I need contrast for an ankle MRI?

From the Guidelines

Contrast is not typically needed for a standard ankle MRI. Most ankle conditions, including ligament tears, tendon injuries, bone fractures, and cartilage damage, can be adequately evaluated with a non-contrast MRI, as stated in the American College of Radiology guidelines 1. The standard protocol uses different imaging sequences that provide excellent visualization of soft tissues and bone structures without requiring any injection.

Key Points to Consider

• MRI without IV contrast is considered the study of choice for assessment of cartilage abnormalities and bone contusions related to acquired osteochondral lesion, particularly in patients with symptoms of persistent pain, stiffness, locking, clicking, and ankle swelling 1.
• MRI of the ankle without IV contrast is most sensitive for evaluation of occult fractures with associated bone marrow edema patterns, particularly in inversion injuries and persistent lateral ankle pain, as well as presence and extent of soft-tissue injuries 1.
• However, in specific situations, your doctor might order an MRI with contrast (usually gadolinium-based) if they suspect certain conditions like infection, inflammatory arthritis, tumors, or complex synovial disorders that benefit from enhanced imaging.

Important Considerations

• Contrast works by highlighting areas with increased blood flow or breakdown of tissue barriers.
• If contrast is needed, it will be administered through an IV during your appointment.
• You should inform your healthcare provider about any kidney problems or previous allergic reactions to contrast agents before the procedure, as these factors may influence the decision to use contrast.

From the Research

Need for Contrast in Ankle MRI

• The decision to use contrast in an ankle MRI depends on several factors, including the patient's clinical information and the properties of the contrast agent 2.
• Gadolinium-based contrast agents (GBCAs) are commonly used in MRI to improve the visibility of organ structures and to enhance the signal by increasing its intensity and shortening the relaxation time of the proton 3.
• However, the use of GBCAs has been associated with potential risks, including nephrogenic systemic fibrosis and gadolinium deposition disease, particularly in patients with renal failure 4, 5.
• Research is ongoing to develop new contrast agents and technologies that can reduce the risks associated with GBCAs, such as high-stability and high-relaxivity GBCAs, and optimization of MRI acquisitions 5.
• The long-term and cumulative effects of retained gadolinium in the brain and elsewhere are not yet fully understood, and patients who have undergone MRI with GBCAs have reported symptoms such as bone and joint complaints, and skin changes, which have been termed "gadolinium deposition disease" 6.

Considerations for Ankle MRI

• The choice of contrast agent and the decision to use contrast in an ankle MRI should be made on a case-by-case basis, taking into account the patient's individual needs and medical history 2, 4.
• The radiologist should consider factors such as the safety and clinical impact of the contrast agent, its biodistribution and diagnostic application, and the potential risks and benefits of using contrast in the specific clinical context 2.
• The use of contrast in an ankle MRI may be necessary to provide accurate diagnoses and to guide treatment, but it should be used judiciously and with caution, particularly in patients with renal failure or other underlying medical conditions 4, 5.