Abstract The object of this work was to evaluate the usefulness of fat-suppressed gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) for the diagnosis of early-stage rheumatoid arthritis. Forty wrists of patients who had suffered from stiff or swollen hands for 1-12 months were examined prospectively by MRI. Rheumatoid arthritis (RA) was proven in 21 patients, and the other 19 patients were not classified as having RA. Hypertrophy of the synovial membrane and tendon sheaths were evaluated by fat-suppressed Gd-enhanced MRI, and bone erosions were also evaluated by T1-enhanced MRI. These results were compared between two groups. Seventeen of 19 patients (89.5%) in the non-RA group showed little or no synovial hypertrophy, while 17 of 21 patients (81%) in the RA group showed moderate to severe hypertrophy of the synovial membrane. Little or no tenosynovitis was found in 14 of 19 patients (73.7%) in the non-RA group, while 14 of 21 patients (66.7%) in the RA group had moderate to severe tenosynovitis. No bone erosion was found in the non-RA group, while a few bone erosions were found in 10 of 21 patients (47.6%) of the RA group. Fat-suppressed, Gd-enhanced MRI was useful in differentiating early-stage RA from non-RA when all patients had some symptoms in their hands.