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. 2004 May;63(5):473–477. doi: 10.1136/ard.2003.014837

MRI of the wrist in early rheumatoid arthritis

C Peterfy 1
PMCID: PMC1754980  PMID: 15082474

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Figure 1 .

Figure 1

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Technical demand-performance relationships for radiography and MRI in RA. (A) Before the availability of effective structure modifying treatment, clinical rheumatology's demand for technical performance in imaging (broken line) was modest and flat, increasing only slightly over time. Radiography (thin line) met these technical demands, and was the dominant imaging method used. MRI (thick line) was technically better than radiography, but rheumatologists were satisfied with radiography's performance, and therefore not willing to pay more for MRI. MRI exhibited a performance surplus, and was not used. (B) With the introduction of effective treatments for RA, rheumatology's technical requirements for imaging have increased beyond the delivery ability of radiography, creating a new demand for MRI's added performance. (C) Rheumatology's technical demands for imaging will continue to increase over time, and this will drive further technical development in MRI to keep pace.

Figure 2 .

Figure 2

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MRI is more sensitive than radiography for bone erosions. Radiographs and coronal T1 weighted images at baseline (A); 3 months (B); 6 months (C); and 24 months (D) of a patient treated with methotrexate show a penetrating bone erosion in the distal pole of the scaphoid bone with a large intramedullary component. Despite the size of this erosion, it is barely visible with radiography. Follow up images show gradual filling in of the erosion over 2 years. Reproduced with permission of the copyright holder from Peterfy CG. Magnetic resonance imaging of the wrist in rheumatoid arthritis. Semin Musculoskelet Radiol 2001;5:275–88.[CrossRef][Medline]

Figure 3 .

Figure 3

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Pre-erosive osteitis. Coronal T1 weighted (A) and fat suppressed T2 weighted (B) spin echo images of the metacarpophalangeal joints of a patient with RA show areas of osteitis in the distal second and third metacarpals. The more sensitive fat suppressed T2 weighted images also show these changes in the adjacent proximal phalanges. Fat suppressed T1 weighted spin echo with Gd-DTPA (C) shows enhancement of these areas consistent with inflammation. Follow up images 17 months later (T1 weighted images without (D) and with (E) fat suppression and Gd-DTPA) show development of bone erosions with sharply defined rim enhancing margins at these sites of previous osteitis, and a new focus of osteitis in the previously quiescent fourth metacarpal head. Reproduced with permission of the copyright holder from Peterfy CG. Magnetic resonance imaging of the wrist in rheumatoid arthritis. Semin Musculoskelet Radiol 2001;5:275–88.[CrossRef][Medline]

Selected References

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