Article

Pitfalls in scoring MR images of rheumatoid arthritis wrist and metacarpophalangeal joints

F McQueen¹, M Østergaard², C Peterfy³, M Lassere⁴, B Ejbjerg⁵, P Bird⁶, P O’Connor⁷, H Genant⁸, R Shnier⁹, P Emery¹⁰, J Edmonds¹¹, P Conaghan¹²

¹ Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
² Departments of Rheumatology, Copenhagen University Hospitals at Herlev and Hvidovre, Copenhagen, Denmark
³ Synarc Inc, San Francisco, CA, USA
⁴ Department of Rheumatology, St George Hospital, University of NSW, Sydney, Australia
⁵ Departments of Rheumatology, Radiology and MRI, Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark
⁶ Department of Rheumatology, St George Hospital, University of NSW, Sydney, Australia
⁷ Department of Radiology, Leeds General Infirmary, Leeds, UK
⁸ Department of Radiology, University of California at San Francisco, San Francisco, CA, USA
⁹ Department of Diagnostic Imaging, Mayne Nickless, Sydney, Australia
¹⁰ Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
¹¹ Department of Rheumatology, St George Hospital, University of NSW, Sydney, Australia
¹² Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK

Correspondence to:
Correspondence to:
Prof M Østergaard
Department of Rheumatology, Copenhagen University Hospital at Hvidovre, Kettegaard alle 30, DK-2650 Hvidovre, Denmark; mo{at}dadlnet.dk

This paper outlines the most important pitfalls which are likely to be encountered in the assessment of magnetic resonance images of the wrist and metacarpophalangeal joints in patients with rheumatoid arthritis. Imaging artefacts and how these can be recognised using various sequences and views are discussed. Normal structures such as interosseous ligaments and nutrient foramina may appear prominent on certain images and need to be identified correctly. Pathological change in the rheumatoid hand involves many tissues and when substantial damage has occurred, it may be difficult to identify individual structures correctly. Bone erosion, bone oedema, synovitis, and tenosynovitis frequently occur together and in close proximity to each other, potentially leading to false positive scoring of any of these. Examples are given to illustrate the various dilemmas the user of this atlas may face when scoring the rheumatoid hand and suggestions are made to assist correct interpretation of what can be very complex images.

Abbreviations: EULAR, European League Against Rheumatism; FOV, field of view; MCP, metacarpophalangeal; MRI, magnetic resonance imaging; OMERACT, Outcome Measures in Rheumatology Clinical Trials; RA, rheumatoid arthritis

Keywords: magnetic resonance imaging; bone oedema; erosion; rheumatoid arthritis; synovitis

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