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European Radiology
Published in: European Radiology 10/2014

01-10-2014 | Musculoskeletal

Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?

Authors: Wouter Stomp, Annemarie Krabben, Désirée van der Heijde, Tom W. J. Huizinga, Johan L. Bloem, Annette H. M. van der Helm-van Mil, Monique Reijnierse

Published in: European Radiology | Issue 10/2014

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Abstract

Purpose

To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA).

Material and methods

In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference.

Results

Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80–0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %).

Conclusion

T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA.

Key Points

• Bone marrow oedema scores are equal on T2 and T1-Gd-chelate enhanced sequences.
• Agreement between scores based on T2 and T1-Gd-chelate images was excellent.
• Sensitivity and specificity for presence of bone marrow oedema were high.
• A short protocol without T2 images suffices in rheumatoid arthritis patients.
Literature
1.
2.
Bugatti S, Manzo A, Caporali R, Montecucco C (2012) Inflammatory lesions in the bone marrow of rheumatoid arthritis patients: a morphological perspective. Arthritis Res Ther 14:229CrossRefPubMedPubMedCentral
3.
Hetland ML, Ejbjerg B, Hørslev-Petersen K et al (2009) MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA). Ann Rheum Dis 68:384–390CrossRefPubMed
4.
Bøyesen P, Haavardsholm EA, Ostergaard M et al (2011) MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression. Ann Rheum Dis 70:428–433CrossRefPubMed
5.
McQueen FM, Benton N, Perry D et al (2003) Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 48:1814–1827CrossRefPubMed
6.
Østergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386PubMed
7.
Henkelman RM, Hardy PA, Bishop JE et al (1992) Why fat is bright in RARE and fast spin-echo imaging. J Magn Reson Imaging 2:533–540CrossRefPubMed
8.
Schmid MR, Hodler J, Vienne P et al (2002) Bone marrow abnormalities of foot and ankle: STIR versus T1-weighted contrast-enhanced fat-suppressed spin-echo MR imaging. Radiology 224:463–469CrossRefPubMed
9.
Mayerhoefer ME, Breitenseher MJ, Kramer J et al (2005) STIR vs. T1-weighted fat-suppressed gadolinium-enhanced MRI of bone marrow edema of the knee: computer-assisted quantitative comparison and influence of injected contrast media volume and acquisition parameters. J Magn Reson Imaging 22:788–793CrossRefPubMed
10.
Ostergaard M, Conaghan PG, O’Connor P et al (2009) Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection – does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol 36:1806–1810CrossRefPubMed
11.
Tamai M, Kawakami A, Uetani M et al (2012) Magnetic resonance imaging (MRI) detection of synovitis and bone lesions of the wrists and finger joints in early-stage rheumatoid arthritis: comparison of the accuracy of plain MRI-based findings and gadolinium-diethylenetriamine pentaacetic acid-enhanced MRI-based findings. Mod Rheumatol 22:654–658CrossRefPubMed
12.
Tehranzadeh J, Ashikyan O, Anavim A, Tramma S (2006) Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skelet Radiol 35:814–822CrossRef
13.
De Rooy DPC, van der Linden MPM, Knevel R et al (2011) Predicting arthritis outcomes–what can be learned from the Leiden Early Arthritis Clinic? Rheumatology (Oxford) 50:93–100CrossRef
14.
Jimenez-Boj E, Nöbauer-Huhmann I, Hanslik-Schnabel B et al (2007) Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 56:1118–1124CrossRefPubMed
15.
Dalbeth N, Smith T, Gray S et al (2009) Cellular characterisation of magnetic resonance imaging bone oedema in rheumatoid arthritis; implications for pathogenesis of erosive disease. Ann Rheum Dis 68:279–282CrossRefPubMed
16.
Hodgson R, Grainger A, O’Connor P et al (2008) Dynamic contrast enhanced MRI of bone marrow oedema in rheumatoid arthritis. Ann Rheum Dis 67:270–272CrossRefPubMed
17.
Van der Heijde DM, van’t Hof M, van Riel PL, van de Putte LB (1993) Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol 20:579–581PubMed
Metadata
Title
Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?
Authors
Wouter Stomp
Annemarie Krabben
Désirée van der Heijde
Tom W. J. Huizinga
Johan L. Bloem
Annette H. M. van der Helm-van Mil
Monique Reijnierse
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3272-0

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