Maximum intensity projection as a tool to diagnose early rheumatoid arthritis

Abstract

In this study, we investigated the usefulness of contrast-enhanced MRI with maximum intensity projection (MIP) as a convenient tool for detecting early rheumatoid arthritis (RA). A total of 21 patients with undiagnosed arthritis of the hands at the initial visit were enrolled in a prospective study over a 1-year period. The number of swollen joints found during physical examination at this first visit, the results of serological tests and the number of synovitis joints diagnosed on MIP images were compared between the RA group and non-RA group. Of the 21 patients, 17 (81%) from the initial study who were followed up for an additional 1 year entered this study. Of these, 5 met the conditions for diagnosis of RA during follow-up, and 12 did not. MIP images were used to review the arthritis of RA patients, and a significant difference was found in the number of synovitis inflammations detected with MIP images when compared with findings after physical examinations. The two criteria of positive CARF and/or anti-CCP antibody and symmetrical synovitis in bilateral hands on MIP images allowed the prediction of RA with 100% sensitivity and 75% specificity. Thus, MIP is a useful tool for making early diagnosis of RA because it yields clear visualization even with just one image.

Prediction of radiographic progression in synovitis-positive joints on maximum intensity projection of magnetic resonance imaging in rheumatoid arthritis

“…US and MRI findings are also used as predictors of joint destruction, and there is evidence that power Doppler (PD)-positive findings in ultrasonography correlate with radiograph-based prognosis [17,18], and that the MRI-measured volume of hypertrophic synovial membrane correlates with joint destruction [7]. We have been using MRI-MIP images for early diagnosis and evaluation of RA disease activity, because it is a convenient method that allows evaluation of synovitis over the whole of both hands on a single image [11,12]. Like US and contrastenhanced MRI, MRI-MIP images of RA hands can detect synovitis with greater sensitivity than physical findings and we have previously reported that scoring of MIP images correlates with synovitis evaluation in normal contrast-enhanced MRI and with PD scores on US [12].…”

“…A single MIP image of the hands allows observation of the whole of both hands, like plain radiographs (Fig. 1); we have previously reported the usefulness of MRI-MIP of the hand for the early diagnosis of RA [11] and evaluating synovitis; the agreement on the synovitis score between MIP and conventional MRI was excellent [12]. However, these previous studies did not clarify whether MRI-MIP images could be directly used for prediction of joint destruction.…”

“…MIP is a method of image processing in which the brightest regions of different slices are superimposed on each other to create a single, three-dimensional (3D) image [9]. Contrast-enhanced MRI with MIP (MRI-MIP) of the hand in RA provides clear visualization of synovitis and also enables differentiation of articular synovitis and tenosynovitis anatomically [10,11]. A single MIP image of the hands allows observation of the whole of both hands, like plain radiographs (Fig.…”

The Value of Magnetic Resonance Imaging and Ultrasound in Undifferentiated Arthritis: A Systematic Review

“…After title and abstract screening, 15 articles 8,9,10,11,12,13,14,15,16,17,18,19,20,21,22 , 3 meeting abstracts (already published or later published in article format 10,11,23 , and one additional paper from hand searching 24 remained for review. The inclusion criteria were fulfilled by 11 articles 8,9,10,11,12,13,14,15,16,17,23 , which were included in the systematic review. Two articles included truly undifferentiated populations 8,23 while the other 9 included mixed populations 9,10,11,12,13,14,15,16,17 at baseline.…”

“…The inclusion criteria were fulfilled by 11 articles 8,9,10,11,12,13,14,15,16,17,23 , which were included in the systematic review. Two articles included truly undifferentiated populations 8,23 while the other 9 included mixed populations 9,10,11,12,13,14,15,16,17 at baseline. A detailed flowchart can be found in Appendix 4 and reasons for exclusion after full article review can be found in Appendix 6 of the online version (www.3eupia.com).…”