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. 2005 Feb;64(Suppl 1):i23–i47. doi: 10.1136/ard.2004.031823

The EULAR–OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint

B Ejbjerg, F McQueen, M Lassere, E Haavardsholm, P Conaghan, P O'Connor, P Bird, C Peterfy, J Edmonds, M Szkudlarek, H Genant, P Emery, M Ostergaard
PMCID: PMC1766827  PMID: 15647419

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 Synovitis reference image sheets (pages i24–i29, total 6). Reference image sheets for synovitis in the distal radioulnar joint, the radiocarpal joint, and the intercarpal-carpometacarpophalangeal joints are illustrated on two single-page sheets each. Examples are provided from the low end and high end of each grade (0–3). Synovitis is graded 0–3 (normal, mild, moderate, severe) as estimated by thirds of the presumed maximum volume of enhancing tissue as described in the OMERACT RAMRIS (see table 1, reference 11). The MRI set to be assessed should be compared with the axial precontrast and postcontrast T1 weighted reference images and the joint assigned the score of the best possible match. The first carpometacarpal joint should not be scored. All axial slices covering the joint should be taken into account. A total score (range 0–9) can be calculated. The diagram above describes the positions and types of images included.

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 Bone oedema reference image sheets (pages i30–i34, total 5). Bone oedema in the radius, scaphoid, lunate, capitate, and a metacarpal base is illustrated on a single-page sheet each. All grades (0–3) are presented except when appropriate examples could not be found. Bone oedema is graded by percentage volume (0–3, by 33% volume increments) of the assessed bone as described in the OMERACT RAMRIS (see table 1, reference 17). For long bones (radius, ulna, metacarpal bases), the "assessed bone volume" is from the articular surface (or its best estimated position if absent) to a depth of 1 cm, and in carpal bones it is the whole bone. If erosion and oedema are concurrently present, oedema is scored as the proportion of the original bone. All coronal slices (T2 weighted fat saturated or short tau inversion recovery (STIR)) covering the bone need to be assessed to estimate the percentage of the total volume occupied by the oedema. The atlas reference images can be used for guidance and calibration. Each bone of the wrist should be scored separately. A total score (range 0–45) can be calculated. The diagram above describes the positions and types of images included. The varying number of coronal slices needed to cover the bone reflects varying bone sizes and varying slice thickness (2–3 mm).

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 Bone erosion reference image sheets (pages i36–i45, total 10). Bone erosion in the radius, scaphoid, lunate, capitate and a metacarpal base is illustrated on two single-page sheets each. Grades 0–3 supplemented with examples of three higher grades are provided. Bone erosion is graded by assessing percentage volume (1–10, by 10% volume increments) of the assessed bone volume as described in the OMERACT RAMRIS (see table 1, reference 17). The "assessed bone volume" is defined as described above. It should be emphasised that all coronal slices covering the bone should be assessed to estimate the percentage of the total volume occupied by the erosion. The atlas reference images can be used for guidance and calibration. Each bone of the wrist should be scored separately. A total score (range 0–150) can be calculated. The drawing above explains the types and positions of images presented. The varying number of coronal slices needed to cover the bone reflects varying bone sizes and varying slice thickness (2–3 mm).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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