Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI

Schirmer, Claudia; Scheel, Alexander; Althoff, Christian E.; Schink, Tania; Eshed, Iris; Lembcke, Alexander; Burmester, Gerd-RÃ1⁄4diger; Backhaus, Marina; Hamm, Bernd; Hermann, Kay-Geert A.

doi:10.1136/ard.2006.056366

Cited by 51 publications

(30 citation statements)

References 31 publications

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“…However, MRI costs represent only a fraction of the total expense incurred in the management of RA patients when the costs of biological RA treatment or the indirect costs of sick leave/early retirement are considered. Dedicated extremity MRI units are increasingly used and offer improved patient comfort at lower cost than conventional MRI units [72][73][74][75][76][77][78][79][80]. The better of the dedicated low-field MRI units provide similar information on erosions and synovitis as conventional high-field MRI devices [75,76].…”

Section: Mri In Rheumatoid Arthritismentioning

confidence: 99%

The impact of MRI on the clinical management of inflammatory arthritides

et al. 2011

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In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.

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Section: Mri In Rheumatoid Arthritismentioning

confidence: 99%

The impact of MRI on the clinical management of inflammatory arthritides

et al. 2011

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“…Wissenschaftliche Untersuchungen zur Niederfeldtechnologie in der Rheumatologie belegen eine hohe Sensitivität, Spezifität und Reliabilität [20] (s. Kapitel: Indikationen und potentieller Stellenwert der Niederfeld-MRT bei RA).…”

Section: Untersuchungsprotokolleunclassified

“…Hochauflö-sende CT-Untersuchungen konnten im Vergleich exakt die Topographie von Erosionen an Hand-und Fingergelenken aus Niederfeldmessungen bestätigen [3]. Bei gleichem Bildausschnitt zeigen sich für die Darstellung von Erosionen an Hand-und Fingergelenken keine signifikanten Unterschiede zwischen Nieder-und Hochfeld-MRT [20].…”

Section: Indikationen Und Potentieller Stellenwert Der Niederfeld-mrtunclassified

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Niederfeldmagnetresonanztomographie bei rheumatoider Arthritis

Ostendorf

Edelmann²,

Kellner

et al. 2009

Z. Rheumatol.

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Magnetic resonance imaging (MRI) as a cross-sectional imaging procedure allows a three-dimensional representation of musculature, ligaments, tendons, capsules, synovial membranes, bones and cartilage with high resolution quality. An activity assessment is further possible by application of a contrast medium (gadolinium-DTPA) to differentiate between active and chronic inflammatory processes. Evidence of a bone marrow edema detected by MRI in patients with rheumatoid arthritis (RA) can be interpreted as a prognostic and predictive factor for the development of bone erosions. On the basis of these advantages MRI is being employed more and more in the early diagnosis of inflammatory joint diseases. Semi-quantitative scores for analysis and grading of findings have already been developed and are in clinical use. Because MRI technical performances are invariably reproducible they can be practically retrieved in the course of examination which is particularly relevant in rheumatology. Therapy response or progression can thus be adequately displayed. Open, dedicated low-field MRI with a low signal strength of 0.2 Tesla (T) has been known since the 90s and now represents new MRI examination options in rheumatology. Smaller devices with lower acquisition and maintenance expenses as well as considerably more convenience due to the device itself result in a higher subjective acceptability by the patients as well as objectively more data records of low-field MRI scans of RA, which underline the significance of this new technical method. The German Society for Rheumatology (DGRh), represented by the Committee for "Diagnostic Imaging", meets this development with the release of recommendations and standards for the procedures of low-field MRI and their scoring and summarizes the most important technical data and information on clinical indications.

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“…Ein deutlich besserer Komfort sowie eine höhere Akzeptanz durch den Patienten einerseits [10] und eine immer dichtere und vergleichbarere Datenlage zu Niederfeld-MRT-Messungen [5,18] bei z. B. Patienten mit RA andererseits unterstreichen den Stellenwert und die Weiterentwicklung dieses neuen technischen Verfahrens (.…”

Section: Magnetresonanztomographieunclassified

Projekt REMISSIONPLUS: klinische und radiologische Remission

et al. 2008

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In a large number of patients with rheumatoid arthritis (RA), chronic inflammatory processes cause joint changes and loss of function even in the early stages of disease. Early, targeted use of disease-modifying antirheumatic drugs [DMARDs and TNF-alpha blockers ("biologicals")] can significantly reduce the risk of aggressive progression and irreversible joint damage. Hence, early identification of disease-specific processes of joint inflammation and erosion - at the onset of disease or later - is of key importance for the patient's prognosis and therapeutic strategy. This can be achieved today with great precision and reliability through the use of modern imaging methods like arthrosonography and magnetic resonance imaging (MRI). The REMISSION(PLUS) initiative aspire to integrate modern imaging technologies as standard methods in the care and management of RA patients. The main areas on which this initiative will be focusing are the conceptualization and implementation of educational programs and training seminars on sonography and MRI, the development and establishment of case report forms for standardized documentation of findings, and the systematic monitoring of patients on treatment, with the aim of producing very precise documentation of structural change processes in RA and also, if possible, to document radiological remission or even progression. The REMISSION(PLUS) project also includes the setting up of specialized centers of excellence, which will network to support the implementation and access to the various imaging procedures at hospitals, rheumatology clinics and rheumatology practices nationwide.

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Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI

Abstract: Dedicated, lfMRI shows high agreement with cMRI in diagnosing and scoring synovitis, tenosynovitis and erosions in rheumatoid arthritis when using standardised scoring systems.

Cited by 51 publications

References 31 publications

The impact of MRI on the clinical management of inflammatory arthritides

The impact of MRI on the clinical management of inflammatory arthritides

Niederfeldmagnetresonanztomographie bei rheumatoider Arthritis

Projekt REMISSIONPLUS: klinische und radiologische Remission

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