Changing practices in gadolinium-enhanced Direct Magnetic Resonance Arthrography: a UK based survey

Abstract Objectives Direct Magnetic Resonance Arthrography (MRA) is widely used for joint distension to assess intra-articular structures. Gadolinium based contrast agents (GdCA) have been used widely but concerns have emerged regarding their safety and cost. This study assesses current practice of UK musculoskeletal radiologists within the context of these recent changes. Methods A questionnaire was disseminated to members of the British Society of Skeletal Radiology. This assessed whether responders performed MRA and—if so—investigated the techniques used. Responses were aggregated and compared to those from a comparator study from 2019. Results Of 45 survey respondents, 43 regularly perform direct MRA with 24 (56%) doing over three a month. Of the 43, 72% use gadolinium with 11 using a licenced preparation and 19 using an off-licence preparation. Twelve respondents (28%) used saline instead of gadolinium. Many respondents had recently changed their practice, most commonly due to logistics (15 respondents - 33%) with concerns over bioaccumulation (14 respondents) a close second. Financial cost and environmental impact concerns were less common. Additional comments highlighted the impact of Magnevist discontinuation and improvements in conventional MRI. Conclusions Although MRA remains prevalent, practice has changed for various reasons with a notable reduction in GdCA use. These considerations and alternatives to GdCA-MRA are discussed with reference to the existing literature and our tertiary centre experience. Advances in knowledge This study outlines the evolving state of MRA use by radiologists across the UK and discusses options to optimise safety in its use, particularly referencing GdCA use.