From the Research
MRI for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) typically does require contrast enhancement with gadolinium for optimal diagnostic value. This is based on the most recent and highest quality study available, which highlights the importance of contrast-enhanced MRI in visualizing nerve root enhancement, a hallmark finding in CIDP 1. The standard protocol includes T1-weighted images before and after gadolinium administration, along with T2-weighted and STIR sequences.
The use of contrast agent helps to highlight areas of inflammation and breakdown of the blood-nerve barrier, making abnormal nerve roots more visible. This is particularly important for detecting thickened or enhanced nerve roots in the brachial or lumbosacral plexus regions. While non-contrast MRI can show some structural changes like nerve enlargement, the addition of contrast significantly improves sensitivity for detecting inflammatory changes.
Some key points to consider when using MRI for CIDP diagnosis include:
- Informing the radiologist that CIDP is suspected to ensure appropriate sequences and views are obtained
- Using T1-weighted images before and after gadolinium administration, along with T2-weighted and STIR sequences
- Avoiding contrast in patients with severe kidney dysfunction (GFR < 30 mL/min) due to the risk of nephrogenic systemic fibrosis
- Considering alternative imaging approaches in patients who cannot receive contrast
It's worth noting that other studies have focused on treatment approaches for CIDP, such as the use of corticosteroids 2, 3, but these do not directly address the question of whether MRI for CIDP requires contrast. The most relevant study for this question is the one from 2016, which discusses the use of plexus MRI in the diagnosis of atypical CIDP cases 1.