A simplified fluid-sensitive MRI protocol for the hands to detect inflammation without contrast administration: a
Anna M P Boeren1,2, Dennis A Ton3, Elise van Mulligen4,3
1Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands. a.boeren@erasmusmc.nl.
Objective:
MRI of the hands is valuable for risk-stratification in patients with arthralgia at-risk for developing rheumatoid arthritis (RA). Contrast-enhanced MRI is considered standard for assessment of RA, but has practical disadvantages. It also shows inflammation-like features in the general population, especially at older age, which should be considered in image interpretation. The modified-Dixon (mDixon) technique is reliable compared to contrast-enhanced sequences. Moreover, this short protocol without contrast-enhancement is patient-friendly. Whether it also shows inflammation-like features in the general population is unknown. We studied this to support accurate use in the clinic.
Methods:
Two hundred twenty symptom-free volunteers from different age-categories were recruited from the general population and underwent mDixon MRI of both hands. Two readers independently scored MRIs for synovitis, tenosynovitis, and bone marrow edema (BME) in the metacarpophalangeal-joints (MCP) and wrists according to the RAMRIS. Features were considered present if scored by both readers; frequencies > 5% were considered relevant in terms of specificity and determined per age-category (< 40/40- < 60/ ≥ 60-years).
Results:
Higher age correlated with higher BME-scores (p-value < 0.005), but not with synovitis and tenosynovitis-scores. BME (grade 1) occurred in some bones in people aged ≥ 60, 14% had BME in the lunate, 7% in metacarpal-1, and 6% in the trapezium. Synovitis and tenosynovitis did not occur in > 5%, except for grade-1 synovitis in the right distal radio-ulnar-joint in people aged ≥ 60 (11%).
Conclusion:
On mDixon MRI, inflammatory features in the hands of the general population are rare. This facilitates image interpretation. To prevent overinterpretation, only several locations should be considered when evaluating people aged ≥ 60-years.
Insights
The modified-Dixon (mDixon) MRI technique rarely shows inflammatory features in the general population
Area of Science:
- Radiology
- Rheumatology
- Medical Imaging
Background:
- Hand MRI is crucial for risk-stratifying patients with arthralgia for rheumatoid arthritis (RA).
- Contrast-enhanced MRI is standard for RA but has drawbacks and can show inflammation-like features in the general population, especially in older individuals.
- The modified-Dixon (mDixon) technique offers a reliable, patient-friendly alternative without contrast enhancement.
Purpose of the Study:
- To investigate whether the mDixon MRI technique reveals inflammation-like features in the hands of the general population.
- To support the accurate clinical application of mDixon MRI for hand assessments.
- To determine the prevalence of synovitis, tenosynovitis, and bone marrow edema (BME) in asymptomatic individuals using mDixon MRI.
Main Methods:
- Two hundred twenty symptom-free volunteers across different age groups underwent mDixon MRI of both hands.
- Two independent readers scored MRIs for synovitis, tenosynovitis, and BME in metacarpophalangeal joints and wrists using RAMRIS criteria.
- Features were considered present if scored by both readers; frequencies >5% were deemed relevant for specificity and analyzed per age category (<40, 40-60, ≥60 years).
Main Results:
- Higher age correlated with increased BME scores (p<0.005), but not with synovitis or tenosynovitis.
- Grade 1 BME was observed in some bones of individuals aged ≥60 years (e.g., 14% in the lunate).
- Synovitis and tenosynovitis occurred in less than 5% of participants, with a minor exception of grade-1 synovitis in the distal radio-ulnar joint in those ≥60 years (11%).
Conclusions:
- Inflammatory features are uncommon in the hands of the general population when assessed with mDixon MRI, aiding image interpretation.
- The mDixon technique demonstrates high specificity for detecting RA-related inflammation.
- When evaluating individuals aged ≥60 years, clinicians should consider specific locations to prevent overinterpretation of findings.
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