Gadolinium-enhanced MR imaging of the wrist in rheumatoid arthritis: value of fat suppression pulse sequences

Nakahara, Nobuya; Uetani, Masataka; Hayashi, Kuniaki; Kawahara, Yasuhiro; Matsumoto, Tomoko; Oda, Junji

doi:10.1007/s002560050151

Cited by 49 publications

(35 citation statements)

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“…One major problem with the validation of Vsm determination by MRI lies in the identification of appropriate gold standards. A semi-automated method based on computerized counting of pixels fulfilling certain criteria can be used [16,17,18,19], volume measurements can be restricted to one or few slices per joint, or a semi-quantitative grading of synovial hypertrophy can be performed [3,20,21,22]. These methods are less time-consuming and faster and more attractive for applicability in larger clinical studies or in clinical routine.…”

Section: Discussionmentioning

confidence: 99%

“…This can prolong imaging and hereby increase the risk of motion artifacts; however, this was not the case in the present study. Furthermore, low-field MRI cannot perform fat-suppressed techniques, which provide higher post-Gd contrast between synovium and surrounding tissue [22,35]. On the other hand, 3D gradient-echo sequences allow very thin slices, which is useful in arthritic disease [36].…”

Section: Discussionmentioning

confidence: 99%

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MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)

et al. 2001

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The aim of this study was to compare the diagnostic capabilities of extremity MRI (E-MRI) with high-field MRI in arthritic small joints, and to evaluate the patients' acceptance and perceptions of the two MR systems. One hundred three patients (group 1 = 28 patients with RA < 3 years, group 2 = 25 patients with reactive and psoriatic arthritis and mixed connective tissue disease, group 3 = 25 patients with rheumatoid arthritis (RA) more than 3 years and group 4 = 25 patients with arthralgia) underwent dedicated E-MRI and high-field MRI of the wrist and finger joints. Coronal short tau inversion recovery and transversal 3D T1-weighted images before and after gadodiamide (Gd) were performed in both cases to outline the volume of the synovial membrane (Vsm) and to evaluate joints with enhancement, effusion, bone edema, and erosions. Investigators blinded to the clinical findings evaluated the images. Patients' compliance and acceptance of E-MRI and high-field MRI were evaluated. The median Vsm obtained on E-MRI did not differ significantly from that obtained on high-field MRI. Vsm = 1 ml (E-MRI) and 1.1 ml (high-field MRI) before Gd and Vsm = 0.1 ml (E-MRI) and 0 ml (high-field MRI) after Gd (Wilcoxon test, p > 0.05). The difference in agreement was 8% for joint enhancement, 2% for joint effusion, 3% for bone edema, and 4% for bone erosions. Of the patients, 64% preferred E-MRI due to more comfortable positioning and less claustrophobia and noise. Extremity MRI of the small arthritic joints is comparable to high-field MRI and more readily accepted than high-field MRI by this patient group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)

et al. 2001

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confidence: 99%

“…Furthermore, in these studies, the MR images are most often obtained and evaluated in 1 plane only (6,8,(10)(11)(12)(13)(14), increasing the risk of misinterpretations, particularly due to partial volume artifacts being wrongly interpreted as erosive changes or synovitis. Bone marrow edema was assessed in only a few studies (6)(7)(8)11), and only 1 report describes dynamic contrast-enhanced MRI of MCP joints in the peripheral joints of healthy persons (15). The objectives of the present study were 1) to explore the presence of bone changes resembling erosions, bone marrow edema, and soft tissue changes resembling synovitis in MCP and wrist joints of healthy persons on MR images obtained and evaluated according to the latest recommendations of the international initiative to harmonize outcome measures in rheumatology (Outcome Measures in Rheumatology Clinical Trials [OMERACT]) (16); and 2) to compare the MRI findings with conventional radiographic, clinical, and biochemical findings.…”

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confidence: 99%

Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Ejbjerg

Narvestad

Rostrup

et al. 2004

Arthritis & Rheumatism

160

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Objective. To explore the presence of changes resembling rheumatoid arthritis erosions and synovitis in metacarpophalangeal (MCP) and wrist joints of healthy individuals on magnetic resonance imaging (MRI) and to compare the MRI findings with conventional radiographic, clinical, and biochemical findings.Methods. Twenty-eight healthy individuals were studied. Contrast-enhanced MRI and conventional radiography of the dominant wrist and second through fifth MCP joints were performed, coupled with standard clinical assessments and biochemical analyses. MR images were evaluated according to the latest OMER-ACT (Outcome Measures in Rheumatology Clinical Trials) recommendations with respect to synovitis, erosions, and bone marrow edema.Results. Conventional radiography revealed erosion-like changes in 1 of 224 MCP joint bones (0.4%) and in 1 of 420 wrist joint bones (0.2%). MRI depicted low-grade erosion-like changes in 5 of 224 MCP joint bones (2.2%) and in 7 of 420 wrist joint bones (1.7%), but postcontrast enhancement within the lesion was detected in only 8.3% of these. MRI depicted low-grade synovitis-like changes in 10 of 112 MCP joints (8.9%) and in 8 of 84 assessed wrist areas (9.5%), while only minimal early synovial enhancement was detected by dynamic MRI. Three subjects had elevated serum levels of C-reactive protein, and these subjects displayed 44.5% of the synovitis-like changes and 41.7% of the erosion-like changes. Bone marrow edema-like changes were not found in any joints.Conclusion. Changes resembling mild synovitis or small bone erosions are occasionally found in the MCP and wrist joints of healthy controls. Signs of synovitis on dynamic MRI, enhancement within bone erosion-like changes, and signs of bone marrow edema appear rarely or are absent in healthy controls. These signs may thus prove to be very specific in the distinction between arthritic and normal joints.Conventional radiography is the standard reference method for assessing destructive skeletal changes in rheumatoid arthritis (RA) and is part of the American College of Rheumatology (formerly, the American Rheumatism Association) 1987 revised criteria for the classification of RA (1). Magnetic resonance imaging (MRI) is more sensitive for the detection of synovitis and bone erosions in RA than are conventional radiography and clinical assessment (2-4). However, the specificity of the MRI findings in this context remains to be established.A review of the literature describing erosions, synovitis, and bone marrow edema in wrist and metacarpophalangeal (MCP) joints on MRI revealed that very few studies have assessed the prevalence of these findings in healthy persons (Table 1). To our knowledge, only one reported study had the primary aim of describing signs of arthritis in healthy persons. Investigators in that study only examined signs of synovitis in wrist joints (5).Studies involving healthy controls are often perSupported by the Danish Rheumatism Association.

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“…One study described tenosynovium enhancement in 8 out of 36 wrists with RA [74]. A different study that followed 34 patients for 1 year, showed that tenosynovitis was present in 81% of patients who had established RA, in 60% of patients who had new RA, and in 38% of patients who had unclassified polyarthritis at baseline [25].…”

Section: Tenosynovitismentioning

confidence: 97%

Advanced imaging of early rheumatoid arthritis

Tehranzadeh

Ashikyan

Dascalos

et al. 2004

Magnetic Resonance Imaging Clinics of North America

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Gadolinium-enhanced MR imaging of the wrist in rheumatoid arthritis: value of fat suppression pulse sequences

Cited by 49 publications

References 0 publications

MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)

MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)

Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Advanced imaging of early rheumatoid arthritis

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