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Modified Dixon MRI to detect subclinical inflammation in clinically suspect arthralgia as a risk factor for

Daniek van der Kaaij1,2, Stijn Claassen3, Hanna W van Steenbergen3

  • 1Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands d.vanderkaaij@erasmusmc.nl.

RMD Open
|March 4, 2026
PubMed
Abstract

Insights

Bilateral modified Dixon MRI of the hands is superior for detecting subclinical inflammation in clinically suspect arthralgia (CSA), improving prediction of inflammatory arthritis (IA) and rheumatoid arthritis (RA) development.

Area of Science:

  • Rheumatology
  • Radiology
  • Medical Imaging

Background:

  • Subclinical inflammation on MRI in clinically suspect arthralgia (CSA) predicts progression to inflammatory arthritis (IA) and rheumatoid arthritis (RA).
  • Modified Dixon (mDixon) MRI offers a faster, contrast-free alternative to conventional MRI for detecting inflammation.
  • Optimizing mDixon MRI utility requires evaluating bilateral versus unilateral hand analysis and understanding inflammation distribution in CSA.

Purpose of the Study:

  • To compare the diagnostic and prognostic performance of bilateral versus unilateral mDixon MRI for detecting subclinical inflammation in CSA.
  • To investigate the distribution of subclinical inflammation in the hands of CSA patients.

Main Methods:

  • 139 CSA patients underwent bilateral wrist and metacarpophalangeal joint mDixon MRI, scored for subclinical inflammation.
  • Unilateral analysis used the hand with the most self-reported painful joints.
  • Patients were followed for ≥6 months to assess IA and RA development, comparing prognostic performance of bilateral vs. unilateral MRI findings.

Main Results:

  • Bilateral MRI showed a stronger association with IA development (HR 4.80) than unilateral MRI (HR 2.34).
  • Bilateral analysis yielded 25% higher sensitivity and 20% higher sensitivity for RA development.
  • Subclinical inflammation was unilateral in 52% of patients, meaning unilateral scanning would miss a quarter of affected individuals.

Conclusions:

  • Bilateral hand MRI is preferable to unilateral MRI for detecting subclinical inflammation in CSA due to its asymmetrical distribution.
  • Bilateral analysis improves the prediction of progression to IA and RA in CSA patients.
Keywords:
Arthritis, RheumatoidInflammationMagnetic Resonance ImagingRisk Factors

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