MR imaging of the hands in early rheumatoid arthritis: preliminary results

Several magnetic resonance (MR) imaging pulse sequences (unenhanced T1 weighted spin echo, with and without fat suppression; unenhanced T2 weighted with fat suppression; and spoiled gradient-recalled acquisition in the steady state [GRASS], with fat suppression, before and after gadolinium enhancement) were analyzed in 30 patients with early rheumatoid arthritis to determine which sequences were best for imaging various aspects of the disease as manifested in the hands and wrists. A single hand was imaged in all patients. Inflammation and erosions were best seen on spoiled GRASS images with fat suppression and gadolinium enhancement, with the latter also being well seen on T1-weighted images. Articular cartilage was best seen on unenhanced spoiled GRASS or T1-weighted images with fat suppression. For the latter application, increased resolution is needed before the results will be meaningful. MR imaging has potential as an objective method for evaluating rheumatoid arthritis. However, change in MR imaging findings in a single hand must be carefully monitored and compared with the overall disease course for a long period in a large number of patients to establish the clinical value of MR imaging.