What is the role of gadolinium-based contrast agents in synovial sarcoma imaging?

Updated: Mar 02, 2019
  • Author: Michael J Duh, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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The use of gadolinium-based contrast agents has a limited value in the evaluation of synovial sarcomas. On dynamic imaging, malignant soft-tissue masses have been shown to enhance earlier, faster, and more predominantly peripherally than benign lesions. [25] These findings are believed to be secondary to the effects of tumor angiogenesis. Synovial sarcomas usually demonstrate heterogeneous contrast enhancement, with early enhancement of tumor within 7 seconds of arterial enhancement. [25]

Gadolinium-based agents may be helpful in posttreatment MRIs, in which mild, diffuse, nonfocal contrast enhancement is a typical finding. With recurrent disease, focal nodules with homogeneous enhancement and high signal intensity without cystic components are typically seen on T2-weighted images.

Gadolinium-based contrast agents have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Systemic Fibrosis. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see Medscape.

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