Savnik, et al: MRI, arthritis, clinical status 2193 From the Parker Institute, Department of Rheumatology and Department of Radiology, Frederiksberg Hospital; and Department of Radiology and Department of Rheumatology, University Hospital at Herlev, Copenhagen, Denmark. Supported by The OAK Foundation, Lykfeldt’s Foundation, Bodil Pedersen’s Foundation, and HS Research Foundation. A. Savnik, MD, Parker Institute, Department of Rheumatology and Department of Radiology, Frederiksberg Hospital, Department of Radiology, University Hospital at Herlev; H. Malmskov, MD, Parker Institute, Department of Rheumatology, Frederiksberg Hospital; H.S. Thomsen, MD, DMS, Professor, Department of Radiology, University Hospital at Herlev; L.B. Graff, MD, PhD, Parker Institute, Department of Rheumatology, Frederiksberg Hospital; H. Nielsen, MD, DMS, Department of Rheumatology, University Hospital at Herlev; B. Danneskiold-Samsøe, MD, DMS, Parker Institute, Department of Rheumatology, Frederiksberg Hospital; J. Boesen, MD, Department of Radiology, Frederiksberg Hospital; H. Bliddal, MD, DMS, Professor, Parker Institute, Department of Rheumatology, Frederiksberg Hospital. Address reprint requests to Dr. A. Savnik, Hovmarskvej 39, DK-2920 Charlottenlund, Denmark. E-mail: anettesavnik@yahoo.dk Submitted July 10, 2000; revision accepted May 31, 2001. Magnetic resonance imaging (MRI) allows direct visualiza- tion of inflammatory soft tissue and cartilage and bone changes in rheumatoid arthritis (RA), a “whole organ assessment” 1 . MRI has the potential to assess both the inflammatory process and the resulting structural damage of surrounding tissue and thus may provide quantitative infor- mation about the severity and activity of the synovial inflammation. MRI studies in RA have mainly evaluated the knee, the wrist, or the metacarpophalangeal (MCP) joints 2,3 . MRI is more sensitive as well in the detection of inflammatory changes (synovitis) and bone changes (erosions) than the clinical examination and radiography 4 . The volume of the synovial membrane after contrast can be estimated by different methods 5 . This volume has been found to be correlated with histologic findings and to some extent with clinical variables 6-9 . Thus, synovial Magnetic Resonance Imaging of the Wrist and Finger Joints in Patients with Inflammatory Joint Diseases ANETTE SAVNIK, HANNE MALMSKOV, HENRIK S. THOMSEN, LYKKE BJERGLUND GRAFF, HENRIK NIELSEN, BENTE DANNESKIOLD-SAMSØE, JENS BOESEN, and HENNING BLIDDAL ABSTRACT. Objective. To study magnetic resonance imaging (MRI) features in the wrist and metacarpopha- langeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints in 4 patient groups: early rheumatoid arthritis (RA) (< 3 yrs); established RA (> 3 yrs); other arthritis; arthralgia. Methods. MRI was obtained before and after contrast (gadodiamide) injection of the wrist and finger joints in 103 patients and 7 controls. The study included: (1) 28 patients with disease duration < 3 yrs who fulfilled the American College of Rheumatology (ACR) criteria for RA; (2) 25 patients with RA disease duration > 3 yrs who fulfilled the ACR criteria; (3) 25 patients with reactive arthritis, psoriatic arthritis, or mixed connective tissue disease; and (4) 25 patients with arthralgia. The following MRI variables were assessed: number of joints with enhancement after contrast injection, number of joints with joint fluid, and number of bones with edema in the wrist and fingers. The volume of the enhancing synovial membrane after contrast injection in the MCP, PIP, and DIP joints was manually outlined. MR images were scored independently under blinded conditions. Results. Bone marrow edema was found in 68% of the patients with established RA, and the number of bones with edema was significantly higher in patients with established RA compared to patients with early RA, other arthritis, and arthralgia (Mann-Whitney p < 0.04). Bone edema was not found in patients with arthralgia. There was marked overlap within and between the patient groups. No differences in MRI features were found between patients with early RA and patients with other arthritis. The volumes of the synovial membrane in the MCP, PIP, and DIPjoints were significantly higher in patients with arthritis compared to patients with arthralgia. Conclusion. Although there was marked overlap between the arthritis patient groups, MRI deter- mined bone marrow edema and synovial membrane volumes provided additional information about disease activity and may be used as a marker of it. Bone marrow edema appeared with the highest percentage in patients with long duration of RA (> 3 yrs) and is probably secondary to changes in inflammatory activity. (J Rheumatol 2001;28:2193–200) Key Indexing Terms: RHEUMATOID ARTHRITIS ARTHRITIS MAGNETIC RESONANCE IMAGING ACUTE PHASE PROTEINS BONE EDEMA GADOLINIUM Personal non-commercial use only. The Journal of Rheumatology Copyright © 2001. All rights reserved. www.jrheum.org Downloaded on November 20, 2022 from