Severity of synovium and bone marrow abnormalities of the temporomandibular joint in early rheumatoid arthritis: role of gadolinium-enhanced fat-suppressed T1-weighted spin echo MRI

Our goal was to evaluate the efficacy of dynamic contrast-enhanced fat-suppressed MRI of the temporomandibular joint (TMJ) in detecting early joint involvement in patients with rheumatoid arthritis (RA). Conventional T1- and T2-weighted, gadolinium-enhanced T1-weighted, and dynamic gadolinium-enhanced fat-suppressed SE imaging sequences were performed in 22 patients with RA. The dynamic gadolinium-enhanced fat-suppressed T1-weighted SE sequence was more sensitive than the other techniques in detecting early changes in inflamed synovium of periarticular tissue and in detecting condylar bone marrow involvement. In patients with RA, 17 joints with joint pain showed synovial proliferation in 10 (59%) cases and joint effusion in 4 (24%). Of 14 joints with joint sound, 4 (29%) showed synovial proliferation and 7 (50%) showed joint effusion. A lower positional change of the disk was observed in joints with RA than in those with TMJ disorders (82 patients). Gadolinium-enhanced fat-suppressed MRI was extremely effective in diagnosing early changes of the inflamed TMJ.