Role of magnetic resonance imaging in the diagnosis and prognosis of rheumatoid arthritis

Abstract

Objective To systematically evaluate the literature addressing the role of MRI in the diagnosis and prognosis of early undifferentiated inflammatory arthritis and RA. Methods We performed a systematic literature review of the performance characteristics of MRI for diagnosing and prognosticating RA. We searched Ovid, supplementing this with manual searches of bibliographies, journals, meeting proceedings, and ClinicalTrials.gov website. To identify Diagnostic studies, we included studies of any duration that prospectively examined whether MRI findings predicted RA diagnosis and reported adequate information to calculate sensitivity and specificity. To identify Prognostic studies, we included prospective studies with at least 12 month follow-up that measured both baseline MRI findings and clinical and/or radiographic outcomes. Results In “Diagnostic Studies” (N=11), sensitivity and specificity of MRI findings for RA diagnosis ranged from 20–100% and 0–100%, respectively, depending upon criteria used. MRI diagnostic performance improved when lower quality or longer disease duration studies were excluded. In “Prognostic Studies” (N=17), MRI findings did not predict clinical remission and the ability to predict radiographic progression varied significantly (range 18–100% for sensitivity and 5.9–97% for specificity). Restricting the analysis to specific MRI findings or earlier disease improved MRI prognostic performance. The only prognostic study reporting 100% of a priori quality criteria found MRI bone edema the strongest predictor of radiographic progression. Conclusion Data evaluating MRI for the diagnosis and prognosis of early RA are currently inadequate to justify widespread use of this technology for these purposes, although MRI bone edema may be predictive of progression in certain RA populations.

Prediction of radiographic progression in synovitis-positive joints on maximum intensity projection of magnetic resonance imaging in rheumatoid arthritis

“…Advances in RA treatments have been accompanied by widespread use of diagnostic imaging techniques such as US and contrastenhanced MRI for evaluating synovitis, because these techniques can evaluate synovitis with greater sensitivity than conventional physical findings [3,5,16]. US and MRI findings are also used as predictors of joint destruction, and there is evidence that power Doppler (PD)-positive findings in ultrasonography correlate with radiograph-based prognosis [17,18], and that the MRI-measured volume of hypertrophic synovial membrane correlates with joint destruction [7].…”

The prognostic value of 99mTc-glucosamine imaging in patients with rheumatoid arthritis: a single center prospective study

“…Other imaging modalities such as ultrasound (US) and MRI have also offered prognostic information in patients with RA by early identification of joints at risk of damage [5,6,26–29]. However, in their retrospective study of 138 patients, Sun et al .…”

“…This result may imply that grade 3 99m Tc-labeled glucosamine uptake might be associated with a worse prognosis in patients with RA. Other imaging modalities such as ultrasound (US) and MRI have also offered prognostic information in patients with RA by early identification of joints at risk of damage [5,6,[26][27][28][29]. However, in their retrospective study of 138 patients, Sun et al concluded that a high gray scale synovitis score at baseline does not always indicate a worse prognosis of RA [6].…”

The course of pain hypersensitivity according to painDETECT in patients with rheumatoid arthritis initiating treatment: results from the prospective FRAME-cohort study

“…Furthermore, RAMRIS synovitis predicted DAS28-CRP change in the unadjusted model ( p = 0.01), and RAMRIS synovitis change both in the unadjusted and the adjusted model ( p ≤ 0.02). The impact of RAMRIS synovitis score on clinical change is not well documented [ 38 , 39 ]. Although our group previously has found correlations between RAMRIS synovitis score and DAS28-CRP in another cohort of RA patients (in review), this may be the first study to indicate a possible prognostic value of RAMRIS synovitis score in relation to DAS28-CRP change within 4 months.…”