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MRI of large intraosseous lesions in patients with inflammatory arthritis
Jamshid Tehranzadeh1, Oganes Ashikyan, Jane Dascalos
1Department of Radiological Sciences, University of California, Irvine, 101 The City Drive S, Route 140, Orange, CA 92868, USA.
Objective:
The purpose of our study was to evaluate on MRI the occurrence of large cystlike intraosseous lesions in patients with inflammatory arthritis.
Subjects And Methods:
We prospectively reviewed contrast-enhanced MR images of 128 hands and wrists in 44 patients with clinical presentation of inflammatory arthritis. Large lesions (> or = 1 cm) found on MR images were further evaluated for the presence of a cortical break and intraarticular extension. These data were correlated with clinical and laboratory findings and the duration of arthritis.
Results:
We found 26 patients with rheumatoid arthritis, seven with psoriatic arthritis, two with systemic lupus erythematosus, one with HIV-associated arthritis, one with mixed connective tissue disorder, one with paraneoplastic-associated arthritis, one with inflammatory bowel disease arthritis, and five patients with early unclassified inflammatory arthritis. Twelve patients had 16 large intraosseous lesions, none of which were detected on available radiographs (availability of radiographs for large erosions was 75%). A cortical break with intraarticular extension of the large lesions was seen in 12 cases. Four lesions were not intraarticular.
Conclusion:
Even large intraosseous lesions may be occult on radiography. MRI is a superior technique for detecting these lesions in the small joints of the hand and wrist in inflammatory arthritis. Although large intraosseous erosions often communicate with joints, we observed four large purely intraosseous enhancing lesions without intraarticular connection. Patients with large erosions have a longer duration of inflammatory arthritis.
Insights
Magnetic resonance imaging (MRI) is superior for detecting large intraosseous lesions in inflammatory arthritis of the hand and wrist, as these are often missed by radiography. Longer disease duration correlates with larger erosions.
Area of Science:
- Rheumatology
- Radiology
- Orthopedics
Background:
- Inflammatory arthritis commonly affects small joints of the hand and wrist.
- Intraosseous lesions can be a manifestation of inflammatory arthritis.
- Radiography is the standard imaging modality, but may have limitations in detecting subtle bone changes.
Purpose of the Study:
- To evaluate the occurrence of large cystlike intraosseous lesions using MRI in patients with inflammatory arthritis.
- To compare MRI findings with radiography for detecting these lesions.
- To correlate lesion characteristics with clinical and laboratory findings.
Main Methods:
- Prospective review of contrast-enhanced MRI scans of 128 hands and wrists in 44 patients with inflammatory arthritis.
- Evaluation of large intraosseous lesions (>= 1 cm) for cortical break and intraarticular extension.
- Correlation of imaging findings with clinical data, laboratory results, and arthritis duration.
Main Results:
- Sixteen large intraosseous lesions were identified in 12 patients; none were detected on available radiographs (75% availability).
- Cortical break with intraarticular extension was observed in 12 lesions; four were purely intraosseous.
- Patients with large erosions had a longer duration of inflammatory arthritis.
Conclusions:
- MRI is a superior imaging technique for detecting large intraosseous lesions in inflammatory arthritis of the hand and wrist.
- Large intraosseous lesions can be occult on radiography.
- While many large erosions communicate with joints, purely intraosseous lesions also occur.
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