Non-contrast MRI of synovitis in the knee using quantitative DESS

Objectives To determine whether synovitis graded by radiologists using hybrid quantitative double-echo in steady-state (qDESS) images can be utilized as a non-contrast approach to assess synovitis in the knee, compared against the reference standard of contrast-enhanced MRI (CE-MRI). Methods Twenty-two knees (11 subjects) with moderate to severe osteoarthritis (OA) were scanned using CE-MRI, qDESS with a high diffusion weighting (qDESS(High)), and qDESS with a low diffusion weighting (qDESS(Low)). Four radiologists graded the overall impression of synovitis, their diagnostic confidence, and regional grading of synovitis severity at four sites (suprapatellar pouch, intercondylar notch, and medial and lateral peripatellar recesses) in the knee using a 4-point scale. Agreement between CE-MRI and qDESS, inter-rater agreement, and intra-rater agreement were assessed using a linearly weighted Gwet's AC2. Results Good agreement was seen between CE-MRI and both qDESS(Low) (AC2 = 0.74) and qDESS(High) (AC2 = 0.66) for the overall impression of synovitis, but both qDESS sequences tended to underestimate the severity of synovitis compared to CE-MRI. Good inter-rater agreement was seen for both qDESS sequences (AC2 = 0.74 for qDESS(Low), AC2 = 0.64 for qDESS(High)), and good intra-rater agreement was seen for both sequences as well (qDESS(Low) AC2 = 0.78, qDESS(High) AC2 = 0.80). Diagnostic confidence was moderate to high for qDESS(Low) (mean = 2.36) and slightly less than moderate for qDESS(High) (mean = 1.86), compared to mostly high confidence for CE-MRI (mean = 2.73). Conclusions qDESS shows potential as an alternative MRI technique for assessing the severity of synovitis without the use of a gadolinium-based contrast agent.

Automated summary

The study demonstrates that qDESS has the potential to be an alternative MRI technique for assessing the severity of synovitis in the knee, with good consistency and diagnostic confidence.