6Magnetic resonance imaging of peripheral joints in rheumatic diseases
Section snippets
MRI hardware
MRI of the peripheral joints can be performed using whole-body MR-units or dedicated extremity MR-units (E-MRI). Most studies have used whole-body MR-units. Low-field E-MRI has been commercially available for a few years19., 20. and as machines are getting continuously smaller, transportable units are now available21, increasing the potential for widespread rheumatological use. The advantages of E-MRI compared with whole-body units include markedly lower costs, more comfortable patient
MRI in the diagnosis of inflammatory joint diseases
The ability of MRI to contribute to the process of diagnosing RA or other inflammatory joint diseases can be divided into two fundamentally different aspects: first, the ability to correctly detect various joint pathologies, e.g. synovitis or erosions; second, the ability to correctly diagnose specific types of arthritides, e.g. RA or PsA, i.e. a differential diagnostic value.
Monitoring of therapy
Since MRI directly visualises both the inflammatory and the destructive aspects of arthritic disease with unprecedented detail, it has the potential for accurate monitoring of treatment efficacy.
MRI assessment methods are quantitative (measuring), semiquantitative (scoring) or qualitative (presence or absence), and the setting and question asked markedly influence which method should be chosen (Table 4). The quantitative synovitis methods estimate the inflammatory activity of the joint by
MRI in the prognosis of the clinical and radiological disease course
There is solid evidence that MRI findings (synovitis, bone oedema and MR imaged bone erosions) predict subsequent radiographical erosive progression.44., 45., 60., 79. A study of established RA wrists found a positive predictive value for high synovial membrane volumes of 80% for erosive progression the following year, while the negative predictive value of low volumes was 100%.60 Accordingly, a recent 1-year study of 40 early RA patients found no erosive progression in joints without synovitis.
Why and when to use MRI in routine clinical practice
Considering the described evidence on the validity and predictive value of MRI (Table 2, Table 3) and the obvious shortcomings of conventional methods, it appears to be justified to recommend the introduction of MRI for specific indications in the routine clinical management of patients with diagnosed or suspected inflammatory joint diseases. Clinical situations where the use of MRI can be suggested include clinical presentations in suspected but not definite arthritis, in early unclassified
Future perspectives and research priorities
MRI has multiple potential applications in RA clinical trials. In human phase I/II studies it could be useful for the sensitive assessment of a compound's anti-inflammatory effectiveness (‘proof of concept’ studies) and for pre-trial selection of the patients most likely to progress. In phase III/IV studies, the superior sensitivity of MRI for structural joint damage may allow reductions in trial size and length due to more sensitive separation of responders from non-responders. In the future,
Summary
The obvious need in the management of inflammatory joint diseases for better diagnostic, monitoring and prognostic methods than conventional clinical examination, laboratory tests and radiography, has increased the interest in new imaging modalities such as magnetic resonance imaging (MRI).
MRI allows the detailed assessment of inflammatory and destructive manifestations of rheumatic diseases, including synovitis, tenosynovitis, enthesitis, bone marrow oedema and bone erosion. Good evidence is
Acknowledgements
The Danish Rheumatism Association is acknowledged for financial support. Photographer Susanne Østergaard is acknowledged for excellent technical assistance.
References (91)
- et al.
Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial
The Lancet
(2000) - et al.
Dedicated extremity MR imaging. An emerging technology
Magnetic Resonance Imaging Clinics of North America
(1997) - et al.
Discrimiation between fluid, synovium, and cartilage in patients with rheumatoid arthritis: contrast enhanced spin echo versus non-contrast enhanced fat-suppressed gradient echo MR imaging
Clinical Radiology
(1999) - et al.
Quantification of synovitis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation
Magnetic Resonance Imaging
(1998) - et al.
Classification of inflammatory arthritis by enthesitis
The Lancet
(1998) The optimal management of early rheumatoid disease: the key to preventing disability
British Journal of Rheumatology
(1994)Guidelines for the management of rheumatoid arthritis: Update
Arthritis Rheum
(2002)- et al.
Criteria for early rheumatoid arthritis: from Bayes' law revisited to new thoughts on pathogenesis
Arthritis & Rheumatism
(2002) - et al.
Infliximab and methotrexate in the treatment of rheumatoid arthritis
New England Journal of Medicine
(2000) - et al.
A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis
New England Journal of Medicine
(2000)
Use of the radiograph to measure the course of rheumatoid artrhitis. The gold standard versus fool's gold
Arthritis & Rheumatism
Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosion at four months after symptom onset
Annals of the Rheumatic Diseases
Arthritis of the finger joints. A comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging
Arthritis & Rheumatism
Rheumatoid arthritis: evaluation of wrist extensor tendons with clinical examination versus MR imaging—a preliminary report
Radiology
MR imaging of the hands in early rheumatoid arthritis: preliminary results
Radiographics
MR imaging of rheumatoid hand lesions: comparison with conventional radiology in 31 patients
Clinical and Experimental Rheumatology
Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis
Clinical and Experimental Rheumatology
Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist
Scandinavian Journal of Rheumatology
Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis by contrast-enhanced (Gd-DTPA) magnetic resonance imaging
Skeletal Radiology
Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy
Arthritis & Rheumatism
The relationship between synovitis and bone changes in early untreated rheumatoid arthritis. A controlled magnetic resonance imaging study
Arthritis & Rheumatism
Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis
Annals of the Rheumatic Diseases
MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)
European Radiology
Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset
Annals of the Rheumatic Diseases
Identification of wrist and metacarpophalangeal joint erosions using portable in-office high resolution magnetic resonance imaging compared to conventional X-ray
Arthritis & Rheumatism
Optimized low-cost low-field dedicated extremity MRI can provide similar information on wrist and MCP joint synovitis and bone erosions as expensive conventional high-field MRI arthritis—a comparison with ‘conventional’ high-field MRI
Annals of the Rheumatic Diseases
Gadolinium-enhanced MR imaging of the wrist in rheumatoid arthritis: value of fat suppression pulse sequences
Skeletal Radiology
Magnetic Resonance in Medicine. The Basic Textbook of the European Magnetic Resonance Forum
OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system
The Journal of Rheumatology
Reducing costs, duration and invasiveness of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous gadolinium injection—does it affect assessments of synovitis, bone erosions and bone edema?
Annals of the Rheumatic Diseases
MR imaging of the arthritic knee: improved discrimination of cartilage, synovium, and effusion with pulsed saturation transfer and fat-suppressed T1-weighted sequences
Radiology
New approaches to imaging of early rheumatoid arthritis
Clinical and Experimental Rheumatology
The value of contrast enhanced magnetic resonance imaging in evaluation of drug therapy in rheumatoid arthritis—a prospective study on hand joints in 65 patients
Acta Phalmacologica
Early stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis
Radiology
Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis
Arthritis & Rheumatism
Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with gd-DTPA
Radiology
Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis: comparison with the macroscopic and microscopic appearance of the synovium
Arthritis & Rheumatism
Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging
Annals of the Rheumatic Diseases
Patterns of gadopentetate-enhanced MR imaging of radiocarpal joints of healthy subjects
American Journal of Roentgenology
Role of metacarpophalangeal joint anatomic factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis
Arthritis & Rheumatism
Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis
Arthritis & Rheumatism
MRI of the hand in psoriatic and rheumatical arthritis
European Radiology
Subclinical joint involvement in psoriasis: magnetic resonance imaging and X-ray findings
Acta Dermato Venereologica
Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement
Annals of the Rheumatic Diseases
MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions
European Radiology
Cited by (31)
Imaging in Pediatric Rheumatic Diseases
2015, Textbook of Pediatric RheumatologyImaging the Laboratory Mouse in vivo
2012, The Laboratory MouseWhole-body MR imaging in psoriatic arthritis: Additional value for therapeutic decision making
2011, European Journal of RadiologyRole of cross-sectional imaging for early diagnosis and follow-up of rheumatoid arthritis
2010, Journal de RadiologieOutcome Measurement in Rheumatoid Arthritis: Magnetic Resonance Imaging
2009, Rheumatoid ArthritisMR imaging features of foot involvement in patients with psoriasis
2008, European Journal of RadiologyCitation Excerpt :Clinical and radiological changes in the foot should be evaluated with care, as they provide valuable diagnostic and prognostic information to guide treatment in patients with inflammatory arthritis [1,11]. It has been well recognized that MR imaging is more sensitive than clinical examination in the detection of inflammatory changes such as synovitis, tenosynovitis, and enthesopathy and also bone erosions earlier than conventional radiography [12]. Therefore, we performed MR imaging to evaluate possible foot abnormalities in patients with psoriasis.