Precontrast and postcontrast (Gd-DTPA) magnetic resonance imaging of hand joints in patients with rheumatoid arthritis

Jevtič, V.; Watt, Iain; Rozman, B; Kos-Golja, M; Rupenovic, S.; Logar, D; Presetnik, M.; Jarh, O.; Demšar, Franci; Musikic, Predrag; Campion, G.

doi:10.1016/s0009-9260(05)80277-6

Cited by 46 publications

(18 citation statements)

References 10 publications

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“…However, in five synovial proliferation was associated with minor erosions representing early destructive pannus, and conformed with the Larsen index grade II changes on plain film. There was thus good correlation between MRI and plain film features in the RA group, as well as consistent findings with previously published work [3]. However, in all the RA cases soft tissue inflammatory changes were confined within the joint capsule, involving both sides of the joint.…”

Section: Discussionsupporting

confidence: 90%

“…These results support intuitive expectations of others that high contrast enhancement is due to hypervascularity, implying inflammatory synovial proliferation and enabling differentiation from non-vascular, non-inflammatory fibrous pannus. Based on these results, previous work by the present authors [3] has shown that demonstration and morphological categorisation of synovitis and pannus in small joint RA of the hand is possible using T l W precontrast, T2W, and, in particular, T1W postcontrast spin echo images.…”

Section: Discussionsupporting

confidence: 73%

“…MRI findings were consistent with the presence of active synovitis ( l l j o i n t s ) or early destructive pannus (5 joints) [3], revealing synovial proliferation in a curvilinear or ovoid distribution, with low to intermediate signal intensity on T l W precontrast images. T2W images showed synovial proliferation with high signal intensity with marked enhancement on T1W postcontrast images.…”

Section: Ragroupsupporting

confidence: 53%

“…Thus MRI may be crucial in making a differential diagnosis between patients with PsA and those with RA, and have major therapeutic implications. MRI distinguishes not only different phases of RA in small joints [3] but offers subdivision of patients with PsA into those who have a distinct pattern, also found in RS, and those whose disease resembles RA.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the final MRI diagnosis still depends largely on the morphological characteristics of the joint disease. However, whilst occasional reports have drawn attention to differing morphological subtypes within an RA group [3], very little attention has been paid to possible differences between RA and SNSA. The objective of this study was to evaluate possible differential diagnostic features in individual small hand joints of patients with clinically active RA and SNSA by comparing the early morphological intra-and extra-articular findings in spin echo Tl-weighted (TlW) precontrast, TlW postcontrast and T2-weighted (T2W) MRI images.…”

mentioning

confidence: 99%

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Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging

et al. 1995

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A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflammatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter's syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular disease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 73%

Section: Ragroupsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging

et al. 1995

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Quantification of rheumatoid synovitis by magnetic resonance imaging

Gaffney

Cookson

Blake

et al. 1995

Arthritis & Rheumatism

128

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Objective. To develop a method for quantifying acute synovial inflammation in rheumatoid arthritis (RA), utilizing magnetic resonance imaging (MRI).Methods. Gadolinium4iethylenetriamine pentaacetic acid-enhanced MRI was performed in 21 patients with knee synovitis. Changes in synovial membrane signal intensity were identified and quantified by line profile analysis. Multiple synovial biopsies were obtained by a blind biopsy technique, and standard clinical and laboratory measurements of disease activity were recorded.Results. The rate of synovial membrane enhancement correlated with histologic features of acute inflammation (r = 0.63, P < 0.01), but not with clinical or laboratory assessments.Conclusion. Dynamic MRI is a valuable technique for assessing acute synovial inflammation in RA.Magnetic resonance imaging (MRI) allows direct visualization of rheumatoid synovium following intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) and has been proposed as a potentially valuable tool for evaluating synovitis (14). Synovial membrane uptake of Gd-DTPA (enhancement) is dependent on tissue perfusion and microvascular permeability, and manifests as increased signal intensity (brightness) on T1-weighted images. Therefore, since both increased tissue perfusion and microvascular permeability are cardinal features of all acute inflammatory processes, quantification of the rate of synovial membrane enhancement Supported by the Arthritis and Rheumatism Council (UK).

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Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalangeal joints of the hands remain normal

Ostendorf¹,

Scherer²,

Mödder³

et al. 2004

Arthritis & Rheumatism

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Objective. To investigate the diagnostic role of magnetic resonance imaging (MRI) of the forefeet in patients with early rheumatoid arthritis (RA) in whom findings on MR images of the hands are normal and conventional radiographs of the hands and feet do not show erosions.Methods. The study group comprised 25 patients with early RA (disease duration of <12 months) in whom erosions were not demonstrated on conventional radiographs of the hands and feet. These patients underwent MRI of the clinically dominant hand to detect signs of arthritis. If results of MRI of the hand were normal according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA-MRI scoring system (RAMRIS), MRI of the dominant forefoot was performed. The MRI protocol comprised coronal and sagittal T1-weighted spin-echo (before and after administration of contrast medium), coronal fatsuppressed short tau inversion recovery sequences, coronal and sagittal T2-weighted turbo spin-echo sequences, and axial fat-suppressed T1-weighted spinecho sequences after administration of contrast medium. MRI of the forefeet was analyzed on the basis of a modified RAMRIS.Results. MRI revealed pathologic findings in the hands of 15 of 25 patients (edema in 9 patients, synovitis in 12, erosions in 6, defects in 3). In 10 patients with a mean disease duration of 9.4 weeks, hand MRI scans were normal according to RAMRIS. Four of these 10 patients had tenosynovitis of the finger flexor tendons (there was no OMERACT criterion for tenosynovitis). RAMRIS analysis of the corresponding MRI scans of the forefeet of these patients revealed signs of edema in 7 patients, synovitis in all 10 patients (at the third metatarsophalangeal [MTP] joint in 7, at the fourth MTP joint in 6, at the first MTP joint in 4, and at the fifth MTP joint in 2 patients), tenosynovitis of the foot flexor tendons in 2 patients, erosions at the second and third MTP joints in 1 patient, and a single defect at the first MTP joint in 1 patient.Conclusion. RAMRIS analysis of MRI scans of the forefeet detected synovitis and bone edema in patients with early RA in whom MRI of the finger joints was normal. MRI of the forefeet contributes an additional tool aimed at earlier and more accurate diagnosis and thus might allow an earlier decision to start appropriate medication in patients with early RA.

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Precontrast and postcontrast (Gd-DTPA) magnetic resonance imaging of hand joints in patients with rheumatoid arthritis

Cited by 46 publications

References 10 publications

Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging

Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging

Quantification of rheumatoid synovitis by magnetic resonance imaging

Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalangeal joints of the hands remain normal

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