High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis

Abstract

Background: To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel highresolution hand coil. Methods: Seventeen patients with active PsA, 20 patients with active RA, and 16 healthy controls (HC) underwent high-resolution 3 T MRI using the dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, thickness of flexor tendon pulleys, and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores. For correlation analyses, Spearman rho correlation was calculated. Results: Flexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm, p < 0.001) and HC (mean difference 0.2 mm, p < 0.001) and showed a higher degree of associated inflammatory changes (mean difference from RA 4.7, p = 0.048; mean difference from HC 14.65, p < 0.001). Additionally, there was a strong correlation of accessory pulley inflammation and PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis, and periarticular inflammation (for the second digit synovitis ρ = 0.72, flexor tenosynovitis ρ = 0.7, overall PsAMRIS ρ = 0.72, p < 0.01). Similar robust correlations were evident in digits 3-5. Weaker correlations were evident in RA (synovitis ρ = 0.49, flexor tenosynovitis ρ = 0.49, periarticular inflammation ρ = 0.4). Conclusion: The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection in PsA, as well as for its distinction from RA and HC.

Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging features—preliminary findings

“…The only other imaging feature that was significantly associated with one of the two disease entities was flexor tenosynovitis, which was strongly associated with the presence of RA, as already shown in previous studies [ 10 , 40 , 42 ]. Only for MCP2 did we find significant values, while for MCP4, a similar, yet nonsignificant, trend was seen.…”

“…A total of 17 patients with PsA (mean age 53.7 ± 11.6; range 26–72 years; 9 males, 8 females), who fulfilled the CASPAR criteria [ 5 ], had a mean disease duration of 2.6 ± 3.3 years, and suffered from peripheral joint involvement, were prospectively recruited for the “Analysis of the DActylic Melange” (ADAM) research initiative [ 10 ]. All patients had failed monotherapy with the conventional synthetic disease-modifying antirheumatic drug (csDMARD) methotrexate (MTX) and were escalated to anti-TNF therapy following an MRI scan.…”

“…Despite the fact that imaging plays only a minor role in commonly applied clinical classification schemes [ 6 , 7 ], characteristic imaging features exist for both entities and may be visualized using radiography, ultrasound, or magnetic resonance imaging (MRI) [ 8 ]. MRI can provide crucial information on a range of pathological manifestations such as synovitis, enthesitis, bone edema, erosion, and osteoproliferation [ 9 , 10 ]. Even though MRI is not used as the primary diagnostic imaging modality for RA or PsA, it is increasingly used to evaluate treatment response.…”

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

“…Compared to the other groups, PsA patients had significantly thicker A1 and A2 flexor tendon pulleys. This study corroborates the role of enthesitis in the pathogenesis of SpA (22).…”

Power Doppler Ultrasound Assessment of A1 Pulley. A New Target of Inflammation in Psoriatic Arthritis?

“…In a case report, inflammatory involvement of annular pulleys was depicted by US in a PsA patient (8), and power Doppler (PD) enhancement of annular pulleys was found in active psoriatic dactylitis (9). Moreover, in a very recent article, MRI signs of inflammatory involvement of annular pulleys were more often encountered in a small cohort of PsA patients compared to RA patients and healthy controls (10). Thus, we believe that PD US potential in the assessment of A1 pulley involvement in PsA has not been adequately investigated yet.…”