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Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of
Wouter Stomp1, Annemarie Krabben, Désirée van der Heijde
1Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands, w.stomp@lumc.nl.
Purpose:
To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA).
Material And Methods:
In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference.
Results:
Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80-0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %).
Conclusion:
T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA.
Key Points:
• Bone marrow oedema scores are equal on T2 and T1-Gd-chelate enhanced sequences. • Agreement between scores based on T2 and T1-Gd-chelate images was excellent. • Sensitivity and specificity for presence of bone marrow oedema were high. • A short protocol without T2 images suffices in rheumatoid arthritis patients.
Insights
T1 post-gadolinium chelate images are as effective as T2-weighted images for assessing bone marrow edema in rheumatoid arthritis, enabling shorter MRI protocols.
Area of Science:
- Rheumatology
- Radiology
- Medical Imaging
Background:
- Rheumatoid arthritis (RA) diagnosis and monitoring often involve magnetic resonance imaging (MRI) to assess bone marrow edema (BME).
- Standard MRI protocols include T2-weighted (T2) and T1 post-gadolinium chelate (T1Gd) images.
- Reducing MRI scan time is desirable for patient comfort and workflow efficiency.
Purpose of the Study:
- To evaluate if T1Gd images can substitute T2 images for BME assessment in RA.
- To determine if a shortened MRI protocol is feasible for RA patients.
Main Methods:
- 179 early arthritis and 43 advanced RA patients underwent extremity MRI at 1.5-T.
- Standard protocol included coronal T1, T2 fat-saturated, and coronal/axial T1 fat-saturated after Gd.
- Bone marrow edema was scored using OMERACT RAMRIS by two observers, with and without T2 images.
Main Results:
- Excellent agreement (ICC 0.80-0.99) was found between BME scores derived from T2 and T1Gd images.
- T1Gd demonstrated high sensitivity and specificity (≥80%) for BME detection compared to T2 images across both patient groups and readers.
- Scores for bone marrow edema were equivalent on both T2 and T1Gd sequences.
Conclusions:
- T1Gd and T2 images are equally suitable for evaluating BME in RA.
- A concise MRI protocol utilizing T1 and T1Gd sequences is sufficient for RA assessment.
- Eliminating T2 imaging can streamline MRI protocols for rheumatoid arthritis patients without compromising diagnostic accuracy for BME.
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