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. 2005 Jan 13;64(9):1280–1287. doi: 10.1136/ard.2004.029850

Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography

B Ejbjerg 1, E Narvestad 1, S Jacobsen 1, H Thomsen 1, M Ostergaard 1
PMCID: PMC1755626  PMID: 15650012

Abstract

Objective: To evaluate a low field dedicated extremity MRI unit for detection of bone erosions, synovitis, and bone marrow oedema in wrist and metacarpophalangeal (MCP) joints, with a high field MRI unit as the standard reference.

Methods: In 37 patients with RA and 28 healthy controls MRI of the wrist and 2nd–5th MCP joints was performed on a low field MRI unit (0.2 T Esaote Artoscan) and a high field MRI unit (1.0 T Siemens Impact) on 2 subsequent days. MRI was performed and evaluated according to OMERACT recommendations. Additionally, conventional x ray, clinical, and biochemical examinations were performed. In an initial low field MRI "sequence selection phase", based on a subset of 10 patients and 10 controls, sequences for comparison with high field MRI were selected.

Results: With high field, spin echo MRI considered as the reference method, the sensitivity, specificity, and accuracy of low field 3D gradient echo MRI for erosions were 94%, 93%, 94%, while the corresponding values for x ray examination were 33%, 98%, and 83%. Sensitivity, specificity, and accuracy of low field MRI for synovitis were 90%, 96%, and 94%, and for bone marrow oedema 39%, 99%, and 95%. Intraclass correlation coefficients between low field and high field scores were 0.936 (p<0.005) for bone erosions and 0.923 (p<0.05) for synovitis.

Conclusion: Low field MRI provides high accuracy for detection and grading of erosions and synovitis, with high field MRI as the standard reference. For bone marrow oedema, specificity is high, but sensitivity only moderate. Low cost, patient compliant, low field dedicated extremity MRI provides similar information on bone erosions and synovitis as expensive high field MRI units.

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Figure 1.

Figure 1

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 Erosions in RA MCP joint bones visualised by high field and low field MRI. High field (A, B, C, D) and low field (E, F, G, H) coronal (A, C, E, G) and axial (B, D, F, H) images of the 2nd–5th MCP joints. On high field MRI as well as low field MRI, an erosion (OMERACT grade 2) (arrows) is depicted in the 3rd metacarpal head (A, B, E, F) in patient 1 (upper four images). In patient 2 (lower four images) an erosion (OMERACT grade 3) (arrows) is depicted in the 2nd metacarpal head at both field strengths. All displayed images were obtained before contrast injection.

Figure 2.

Figure 2

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 Erosions in RA wrist joint bones visualised by high field and low field MRI. High field (A, B, C, D) and low field (E, F, G, H) coronal (A, C, E, G) and axial (B, D, F, H) images of the wrist joints. On high field MRI as well as low field MRI, an erosion (OMERACT grade 5) (arrows) is depicted in the lunate (A, B, E, F) in patient 1 (upper four images). In patient 2 (lower four images) an erosion (OMERACT grade 1) (arrows) is depicted in radius (C, D, G, H) at both field strengths. All displayed images were obtained before contrast injection.

Figure 3.

Figure 3

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 Synovitis in RA MCP joints visualised by high field and low field MRI. High field (A, B) and low field (C, D) axial images of the 2nd-5th MCP joints before (A, C) and after (B, D) intravenous contrast injection. Post-contrast images show high grade synovitis (OMERACT grade 3) (arrows) in the 2nd MCP joint on high field MRI as well as on low field MRI, while low grade synovitis (OMERACT grade 1) (thin arrows) is seen in the 3rd MCP joint on images obtained at both field strengths.

Figure 4.

Figure 4

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 Synovitis in RA wrist joints visualised by high field and low field MRI. High field (A, B, C, D) and low field (E, F, G, H) axial images of the wrist joint before (A, C, E, G) and after (B, D, F, H) intravenous contrast injection. Post-contrast images in patient 1 (upper four images) show low grade synovitis (OMERACT grade 1) (arrows) in the intercarpal area of the wrist joint on high field MRI as well as on low field MRI, while high grade synovitis (OMERACT grade 3) (arrows) is seen in the radiocarpal area of the wrist joint in patient 2 (lower four images) on images obtained at both field strengths.

Figure 5.

Figure 5

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 Bone marrow oedema in RA wrist joint bones visualised by high field and low field MRI. High field (A) and low field (B) STIR images of the wrist. On high field MRI, a low grade bone marrow oedema (OMERACT grade 1) (arrow) is seen in the distal radius. The oedema at this site is not detected on low field MRI.

Selected References

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