Magnetic resonance characterisation of primary Raynaud’s phenomenon

Abstract

The objective findings of phalangeal T2-weighted hyperintense and T1weighted hypointense bone marrow signal on MRI without features of seronegative arthropathy or osteomyelitis may assist clinicians in making a diagnosis in the appropriate clinical context.

Test Yourself Answer To Question: a 36-year-old female with a 10-year history of intermittent numbness and loss of color in the fingers, toes, and nose

“…Nonetheless, marrow changes on MRI have been described and may be helpful in cases of diagnostic uncertainty [2]. Edema-like marrow signal is the key feature and follows a predictable pattern, starting at the tuft of the distal phalanx and progressing proximally as severity increases [2,6,7]. Enhancement of the affected marrow may occur [7], and sites of signal abnormality may be seen in areas of subclinical disease [2].…”

“…Edema-like marrow signal is the key feature and follows a predictable pattern, starting at the tuft of the distal phalanx and progressing proximally as severity increases [2,6,7]. Enhancement of the affected marrow may occur [7], and sites of signal abnormality may be seen in areas of subclinical disease [2]. It is unclear whether these MRI features are reversible or chronic, although progression was seen over a 2.5-year period in a recent case [6].…”

“…Radiographs have a limited role, but can demonstrate the absence of features that would suggest alternative diagnoses [7]. Thermography, laser Doppler and nail fold capillaroscopy have shown recent advances [6,8].…”

“…The differential diagnosis of marrow changes seen in Raynaud's phenomenon are broad and can be seen in coldinduced thermal injuries, phalangeal microgeodic syndrome, chilblains, cold agglutinin disease, trauma, infection, and seronegative spondyloarthropathies [2,6]. The latter may be suggested by erosions, synovitis, and tenosynovitis [7]. Bone marrow transformation is another important differential and reflects the replacement of normal marrow by a highly hydrated proteoglycan matrix, occurring in conditions such as malnutrition, alcoholism, and chronic renal failure and can be limited to the phalanges [2].…”