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Skeletal Radiology
Published in: Skeletal Radiology 6/2023

28-11-2022 | Magnetic Resonance Imaging | Scientific Article

Towards a simplified fluid-sensitive MRI protocol in small joints of the hand in early arthritis patients: reliability between modified Dixon and regular Gadolinium enhanced TSE fat saturated MRI-sequences

Authors: Anna M. P. Boeren, Ellis Niemantsverdriet, Marloes Verstappen, Fenne Wouters, Johannes L. Bloem, Monique Reijnierse, Annette H. M. van der Helm-van Mil

Published in: Skeletal Radiology | Issue 6/2023

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Abstract

Objective

MRI of small joints plays an important role in the early detection and early treatment of rheumatoid arthritis. Despite its sensitivity to demonstrate inflammation, clinical use is hampered by accessibility, long scan time, intravenous contrast, and consequent high costs. To improve the feasibility of MRI implementation in clinical practice, we introduce a modified Dixon sequence, which does not require contrast and reduces total acquisition time to 6 min. Because the reliability in relation to conventional MRI sequences is unknown, we determined this.

Methods

In 29 consecutive early arthritis patients, coronal and axial T2-weighted modified Dixon acquisitions on 3.0 T MRI scanner were acquired from metacarpophalangeal 2–5 to the wrist, followed by the standard contrast-enhanced protocol on 1.5 T extremity MRI. Two readers scored osteitis, synovitis and tenosynovitis (summed as total MRI-inflammation), and erosions (all summed as total Rheumatoid Arthritis MRI Score (RAMRIS)). Intraclass correlation coefficients (ICCs) between readers, and comparing the two sequences, were studied. Spearman correlations were determined.

Results

Performance between readers was good/excellent. Comparing modified Dixon and conventional sequences revealed good/excellent reliability: ICC for total MRI-inflammation score was 0.84 (95% CI:0.70–0.92), for erosions 0.90 (95% CI:0.79–0.96), and for the total RAMRIS score 0.88 (95% CI:0.77–0.94). The scores of total MRI-inflammation, total erosions, and total RAMRIS were highly correlated (ρ = 0.80, ρ = 0.81, ρ = 0.82, respectively).

Conclusion

The modified Dixon protocol is reliable compared to the conventional MRI protocol, suggesting it is accurate to detect MRI inflammation. The good correlation may be the first step towards a patient-friendly, short and affordable MRI protocol, which can facilitate the implementation of MRI for early detection of inflammation in rheumatology practice.
Appendix
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Metadata
Title
Towards a simplified fluid-sensitive MRI protocol in small joints of the hand in early arthritis patients: reliability between modified Dixon and regular Gadolinium enhanced TSE fat saturated MRI-sequences
Authors
Anna M. P. Boeren
Ellis Niemantsverdriet
Marloes Verstappen
Fenne Wouters
Johannes L. Bloem
Monique Reijnierse
Annette H. M. van der Helm-van Mil
Publication date
28-11-2022
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 6/2023
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-022-04238-8

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