Synovitis maps for the assessment of inflammatory diseases of the hand

Abstract

Objectives To compare accuracy and review times of FLASH-MRI-derived synovitis maps (SM) with conventional MR images (cMRI) in the assessment of articular synovitis and tenosynovitis of the hand. Methods 80 hands in 40 patients (mean age, 48 years; range, 15-72 years) were assessed for synovitis on cMRI and SM by two readers independently. Reporting times and diagnostic confidence (scale: 1=least, 5=most confident) were measured. Results from an assessment of a panel of senior musculoskeletal radiologists served as the standard of reference. Results Sensitivity and specificity for the detection of articular synovitis were 0.91/1.00 (R1) and 1.00/0.67 (R2) on cMRI and 0.87/0.75 (R1) and 0.91/0.45 (R2) on SM and for the detection of tenosynovitis 0.95/0.63 (R1) and 0.67/ 0.79 (R2) on cMRI and 0.67/0.89 (R1) and 0.38/1.00 (R2) on SM. Mean review times (cMRI/SM, sec) were 142/37 (R1) and 167/25 (R2). Mean diagnostic confidence (cMRI/SM) was 3.7/3.4 (R1) and 3.2/3.5 (R2) for articular synovitis and 4.0/4.0 (R1), 3.3/3.7 (R2) for tenosynovitis. Conclusion Synovitis maps provide a comparable diagnostic accuracy to conventional MR images in the assessment of articular synovitis and tenosynovitis of the hand. Because of short review times, synovitis maps provide a fast overview of locations with synovial enhancement.

Imaging Non-Specific Wrist Pain: Interobserver Agreement and Diagnostic Accuracy of SPECT/CT, MRI, CT, Bone Scan and Plain Radiographs

“…However, in another study assessing cartilage lesions of the wrist, MRI had a high specificity, but low interobserver agreement [25]. A fair interobserver agreement was found for synovial lesions of the hand [26]. Finding an “active” osseous lesion in MRI is predominantly based on the prevalence of “bone marrow edema”, a pattern of ill-defined hyperintense signal on T2-weighted images.…”

Bilateral MR Imaging of the Hand and Wrist in Early and Very Early Inflammatory Arthritis: Tenosynovitis Is Associated with Progression to Rheumatoid Arthritis

“…There were other limitations in that study, such as the inclusion of patients with disease duration up to 24 months, which exceeds the currently accepted definition of early RA (34,35), and the focus on groups of tendons, masking potential findings for individual tendons. An interesting recent study of synovitis maps by Karlo et al (42) included tenosynovitis evaluation, but it addressed unspecified…”

MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings

“…The training requirements, interpretation time, and need for double reading make the RAMRIS synovitis score impractical for routine clinical use [122][123][124]. One proposed way to decrease observer times for semiquantitative rating is to create coronal, maximum intensity projections from dynamic or static contrast-enhanced images that provide a visual overview of the involved joints (and tendon sheaths) [125,126]. Although this technique usually involves first subtracting precontrast images, it can also be done without subtraction, allowing a time saving by eliminating the need to acquire a matching precontrast sequence (Fig.…”