585 Rheumatoid Arthritis of the Craniocervical Region by MR Imaging: Detection and Characterization M. A. Stiskal’ A. Neuhold2 0. H. Szolar3 M. Saeed3 C. Czerny2 B. Leeb4 J. Smolen4 H. Czembirek1 Received November 14, 1994; accepted after revision April 21 , 1995. 1 Department of Radiology, Krankenhaus Lainz, Wolkersbergenstr. 1 , A-i 1 30, Vienna, Austria. Ad- dress correspondence to M. A. 5tiskal. 2Privatkrankenhaus Rudolfinerhaus, Billrothstr. 113, A-1190, Vienna, Austria. 3Department of Radiology, University of Califor- nia San Francisco, San Francisco, CA 94143. 4Department of Intemal Medicine, Krankenhaus Lainz,A-1130, Vienna, Austria. 0361-803X/95/1653-585 ©Amencan Roentgen Ray 5ociety OBJECTIVE. The purpose of our study was to evaluate the potential of contrast- enhanced MR imaging to detect and to characterize craniocervical rheumatoid arthrl- tis in a large population group, to compare MR imaging with clinical and conventional radiographic findings, and to examine the relationship between the hlstopathologlc and MR Imaging findings in seven patients. SUBJECTS AND METHODS. We performed contrast-enhanced MR Imaging using T2- weighted gradient-echo sequences and TI-weighted spin-echo sequences In 136 patIents with rheumatoid arthritis. Sequential Ti-weighted Images were obtained before, 3 mm after, and 15 mm after injection of contrast material. Plain films were acquired In all patIents. Serologic status and neurologlc status were determined In each patient within 2 days of MR imaging. Patients were categorized into one of four groups, depending upon whether they had joint effusion, hypervascular pannus, hypovascular pannus, or fibrous pannus according to signal patterns on contrast-enhanced MR Images. Signal Intensity was measured to assess the enhancement of synovial hypertrophy, joint capsule, joint effusion, and the various stages of pannus tissue. Histologic specimens were obtained from seven patients and were correlated with MR Imaging findings. RESULTS. Acute and chronic synovitis were differentiated with contrast-enhanced MR imaging as follows: joint effusion (n = 29), hypervascular pannus (n = 54), hypovascular pannus tissue (n = 8), and fibrous pannus (n = 22). SIgnal Intensity dif- fered significantly among the four groups on contrast-enhanced Ti-weighted images. In 59 patIents with effusion or hypervascular pannus tissue, atlantoaxlal subluxation was diagnosed with plain films. Patients with negative findings on radiographic stud- les (n = 20) had joint effusion, hypervascular pannus tIssue, hypovascular pannus formation, or fibrous pannus tissue on MR Imaging studies. Cord compression was found in 10% of all cases and isolated sac compression in 16%. Neurologlc findings showed no correlation with MR Imaging features. CONCLUSION. Contrast-enhanced Ti-weighted spin-echo MR imaging can discrim- mate between joint effusion and various forms of pannus In patients with rheumatoId arthritis of the craniocervical region. MR Imaging also can detect joint effusion and pannus tissue In patients with negative radiographic findings. No relationship between MR imaging findings and clinical symptoms were found. Tissue enhance- ment and histopathologic findings correlated In a limited number of autopsies. AJR 1995;165:585-592 The cervic al spine, particularly the craniocervi al junction, is one ofthe most com- mon sites of rheumatoid arthritis in adults [1-4]. Involvement of the craniocervical junction causes pain, instability, and cord compression, which may necessitate sur- gical intervention [4]. Evaluating the craniocervical junction is clinically difficult and is therefore frequently supplemented with plain radiographs [5, 6]. Conventional radi- ography can detect only advanced stages of the disease, such as atlantoaxial sub- luxation, leaving only surgical options [7]. Thus, radiographic results are unreliable for assessment and follow-up of therapy of craniocervical rheumatoid arthritis. MR imaging is well suited for imaging patients with arthritis because of its ability to acquire multiplanar images and its unique potential of directly visualizing synovial tis- sue [8-12]. Gadopentetate dimeglumine has been used for delineation and character- Downloaded from www.ajronline.org by 34.228.24.229 on 06/12/20 from IP address 34.228.24.229. Copyright ARRS. For personal use only; all rights reserved