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Periarticular bone findings in rheumatoid arthritis: T2-weighted versus contrast-enhanced T1-weighted MRI
Lawrence Yao1, Michael Magalnick, Mildred Wilson
1Diagnostic Radiology Department, National Institutes of Health, 10 Center Drive, Room 1C640, Bethesda, MD 20892-1182, USA.
Objective:
The purpose of this study was to establish the relative predictive value of T2-weighted and contrast-enhanced T1-weighted MRI techniques for bone erosions that are evident on CT. Because it is known that MRI depicts abnormalities in the periarticular bone of patients with rheumatoid arthritis, we wanted to compare the outcomes of T2-weighted versus contrast-enhanced T1-weighted MRI techniques.
Materials And Methods:
Eleven patients with rheumatoid arthritis underwent CT imaging of their most affected wrist. Fast spin-echo T2-weighted MR images were then acquired with spectral fat saturation. Enhanced T1-weighted spin-echo images acquired before and after IV administration of gadopentetate dimeglumine were used to determine the percent enhancement. Imaging examinations were scored for 15 anatomic zones. The CT score was based on cortical bone erosion. The MR score was based on periarticular bone marrow signal alteration.
Results:
Both T2-weighted MR images with spectral fat saturation and enhanced T1-weighted images were concordant for the presence or absence of bone abnormalities in 122 of 165 zones (74%). Of the 43 zones that were discordant for an abnormality by the two MR techniques, the T2-weighted images were positive in five zones, and enhanced T1-weighted images were positive in 38 zones (p < 0.001). Of the 43 zones that were discordant by the two MR techniques, enhanced T1-weighted images were concordant with CT in 20 zones, whereas the T2-weighted images were concordant with CT in 23 zones (p = 0.76). A greater proportion of lesions detected by the T2-weighted images were "edema-like" signal patterns.
Conclusion:
In rheumatoid arthritis, contrast-enhanced T1-weighted MRI depicts more periarticular bone abnormalities than fat-suppressed T2-weighted MRI. These MR techniques are equally predictive of frank, erosive disease that is evident on CT.
Insights
Contrast-enhanced T1-weighted MRI shows more bone abnormalities in rheumatoid arthritis patients than T2-weighted MRI. Both MRI techniques accurately predict CT-evident erosive disease.
Area of Science:
- Radiology
- Orthopedics
- Rheumatology
Background:
- Rheumatoid arthritis (RA) commonly affects the wrist, leading to bone erosions.
- Magnetic Resonance Imaging (MRI) is valuable for detecting periarticular bone abnormalities in RA.
- Comparing different MRI sequences is crucial for optimizing diagnostic accuracy.
Purpose of the Study:
- To compare the predictive value of T2-weighted and contrast-enhanced T1-weighted MRI for CT-evident bone erosions in RA.
- To evaluate the sensitivity of each MRI technique in detecting periarticular bone marrow signal alterations.
Main Methods:
- Eleven RA patients underwent CT and MRI of the wrist.
- T2-weighted MRI with spectral fat saturation and contrast-enhanced T1-weighted MRI (gadolinium-based contrast) were performed.
- Imaging data were analyzed for 15 anatomic zones, scoring bone erosion on CT and bone marrow signal alteration on MRI.
Main Results:
- Both MRI techniques showed good concordance with CT for bone abnormalities (74%).
- Contrast-enhanced T1-weighted MRI identified significantly more abnormalities (38 zones) than T2-weighted MRI (5 zones) in discordant cases (p < 0.001).
- T2-weighted images often showed edema-like patterns, while contrast-enhanced T1-weighted MRI was more sensitive to subtle bone marrow changes.
Conclusions:
- Contrast-enhanced T1-weighted MRI is more sensitive than fat-suppressed T2-weighted MRI for detecting periarticular bone abnormalities in RA.
- Both MRI techniques demonstrate equal predictive value for established, CT-visible erosive disease.
