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Wrist and finger joint MR imaging in rheumatoid arthritis
M Klarlund1, M Ostergaard, P Gideon
1The Danish Research Centre of Magnetic Resonance and the Department of Rheumatology, Hvidovre Hospital, University of Copenhagen.
Purpose:
To elaborate the best MR imaging protocol for studies in rheumatoid arthritis (RA) and to evaluate the sensitivity and interobserver agreement with respect to detection of bone erosions (MR and radiography) and grading of synovial membrane hypertrophy (MR imaging only).
Material And Methods:
MR imaging and conventional radiography of wrist and metacarpophalangeal (MCP) joints were performed in 41 RA patients and 3 healthy controls. The following pulse sequences were applied: T1-weighted spin-echo (T1-SE) with and without contrast enhancement, T2-SE, T2-turbo-SE, T1-2D-FLASH, T1-3D-FLASH, fat-saturated-T1-SE, STIR and 3D-DESS.
Results:
Bone erosions were found by MR compared to radiography in 261 versus 85 bones of the wrist (ratio 3.1) and 59 versus 21 MCP joint quadrants (ratio 2.81). MR and radiography interobserver agreements were both approximately 90%. Likewise, MR scored synovial membrane hypertrophy in wrist and MCP joints with a high interobserver agreement. The most informative MR sequence appeared to be contrast-enhanced T1-SE MR, preferably with fat saturation. A STIR sequence or T2-weighted fat saturation sequence was useful in screening for joint disease.
Conclusion:
The sensitivity of MR is superior to conventional radiography with respect to detection of bone erosions in wrist and MCP joints. The interobserver agreement for MR and radiography was similar. Thus, MR of wrist and finger joints may become a useful supplement to conventional radiography in the evaluation of RA patients in clinical trials and clinical practice.
Insights
Magnetic resonance imaging (MRI) significantly improves detection of rheumatoid arthritis (RA) bone erosions compared to radiography. MRI offers comparable interobserver agreement for assessing RA joint inflammation and erosions.
Area of Science:
- Rheumatology
- Medical Imaging
- Orthopedics
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting joints.
- Accurate assessment of bone erosions and synovial hypertrophy is crucial for RA management.
- Conventional radiography has limitations in detecting early joint changes in RA.
Purpose of the Study:
- To establish an optimal MR imaging protocol for rheumatoid arthritis (RA) studies.
- To evaluate the sensitivity of MR imaging versus radiography for detecting bone erosions.
- To assess interobserver agreement for MR imaging and radiography in RA patients.
Main Methods:
- MR imaging and conventional radiography of wrist and metacarpophalangeal (MCP) joints were performed in 41 RA patients.
- Various MR pulse sequences were applied, including T1-weighted spin-echo (T1-SE), T2-SE, STIR, and fat-saturated sequences.
- Sensitivity for bone erosion detection and interobserver agreement for erosion and synovial hypertrophy grading were evaluated.
Main Results:
- MR imaging detected 3.1 times more bone erosions in the wrist and 2.8 times more in MCP joints compared to radiography.
- Interobserver agreement for both MR imaging and radiography was approximately 90% for bone erosion detection.
- Contrast-enhanced T1-SE MR with fat saturation was the most informative sequence; STIR and T2-weighted fat saturation sequences were useful for screening.
Conclusions:
- MR imaging demonstrates superior sensitivity to conventional radiography for detecting bone erosions in RA wrist and MCP joints.
- MR imaging provides a useful supplement to conventional radiography for evaluating RA patients.
- The findings support the integration of MR imaging into clinical trials and practice for RA assessment.