Fig. 8.

a, b, c, d Inflammatory. A 56-year-old rheumatoid arthritis (RA) male patient with pain and swelling in the left wrist. TWIST Angio 3D MIP imaging (a) clearly shows the inflammation with hypervascularization and edema (arrowheads) affecting the left wrist. Contrast-enhanced T1w imaging (b) demonstrates an abundant intra-articular effusion in the distal radioulnar joint (*) with thickening and enhancement of synovia (arrow), a condition referable to inflammation in the active phase. STIR coronal imaging (c) highlights the ELMSI affecting part of the ulna, lunate, triquetrum, hamate and capitate bones, and the effusion in radioscaphoid and radioulnar joints. Finally, the X-rays of the hand (d) taken at the same time shows a “soft-tissue sign” near the ulnar styloid process (arrow). but absence of erosions, while MRI is strongly positive for active inflammation [courtesy of Giovanni D'Elia, MD, Careggi University Hospital, Florence, Italy]