Magnetic resonance imaging (MRI) has been widely used for evaluation of various pathologic conditions in the musculoskeletal system (MSK). The use of gadolinium contrast is not routine in MSK MRI, but there are several indications for which the use of contrast can aid in the evaluation of MSK pathologies; they are tumors, infection, and intra-articular pathologies (1). The use of gadolinium can be helpful in the determination of tumor extent or necrosis (2.) and in complicated bone and soft tissue infections. Recently, the use of dynamic contrast enhancement has been studied to be useful in targeting of soft tissue tumor biopsies (3) or determining treatment response (4), as well as differential diagnosis between benign and malignant tumors (5). Gadolinium has been shown to be useful in more accurate evaluation of intra-articular pathologies after intravenous (indirect MR arthrography) or intraarticular (direct) administration (6). The advances in MR technologies, including gradient strength, coil, and pulse sequences has led to further improvement of soft tissue contrast and SNR. The use of gadolinium has also been shown to be useful in cartilage evaluation (7). Much remains to be studied about the use of gadolinium in MSK imaging.
References
1. Cheng SG. Musculoskeletal MRI: contrast and non-contrast application. Appl Radiol. 2002; 31(6):81-6.
2. Putta T, Gibikote S, Madhuri V, Walter N. Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal tumours. Pol J Radiol. 2016; 81:540-548.
3. Noebauer-Huhmann I, Amann G, Krssak M, et al. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. European Radiology. 2015;25(7):2041-48.
4. Fayad LM, Mugera C, Soldatos T, Flammang A, delGrande F. Technical innovation in dynamic contrast-enhanced magnetic resonance imaging of musculoskeletal tumors: an MR angiographic sequence using a sparse k-space sampling strategy. Skeletal Radiology 2013; 42(7):993-1000.
5. Qi ZH, Li CF, Ma XX, et al. Value of 3T magnetic resonance dynamic contrast-enhanced and diffusion-weighted imaging in differential diagnosis of musculoskeletal tumors. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2012;34(2):138-45.
6. Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. MR arthrography. Radiographics. 2002;22(5):1223-46.
7. Shapiro L, Harish M, Hargreaves B, Staroswiecki E, Gold G. Advances in musculoskeletal MRI: technical considerations. J Magn Reson Imaging. 2012;36(4):775-87.