Abstract
Objective
To describe the frequency of inflammatory-like findings on MR imaging in asymptomatic volunteers and compare them with patients with known rheumatoid arthritis and psoriatic arthritis.
Materials and methods
MR images of fingers in 42 asymptomatic volunteers and 33 patients with rheumatoid/psoriatic arthritis were analyzed. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid/Psoriatic Arthritis MRI Scoring System (RAMRIS/PsAMRIS) and tenosynovitis scoring system were used to assess: bone marrow edema (BME), erosions, tendon sheath fluid/tenosynovitis, joint effusion, and soft-tissue edema. Findings and scores were compared between volunteers and patients. Inter-reader agreement was calculated (intraclass correlation coefficients, ICC).
Results
In volunteers, tendon sheath fluid was very common in at least one location (42/42 volunteers for reader 1, 34/42 volunteers for reader 2). BME, erosions, joint effusion, and soft-tissue edema were absent (except one BME in the 3rd proximal phalanx for reader 1). Tendon sheath fluid scores in volunteers and tenosynovitis scores in patients were high (reader 1, 7.17 and 5.39; reader 2, 2.31 and 5.45). Overall, inter-reader agreement was substantial (ICC = 0.696–0.844), except for tendon sheath fluid (ICC = 0.258).
Conclusion
Fluid in the finger flexor tendon sheaths may be a normal finding and without gadolinium administration should not be interpreted as tenosynovitis. Bone marrow edema, erosions, joint effusion, and soft-tissue edema in the fingers most likely reflect pathology if present.
Similar content being viewed by others
Abbreviations
- BME:
-
Bone marrow edema
- ICC:
-
Intraclass correlation coefficient
- OMERACT:
-
Outcome Measures in Rheumatology Clinical Trials
- PsAMRIS:
-
Psoriatic Arthritis MRI-Scoring System
- RAMRIS:
-
Rheumatoid Arthritis MRI-Scoring System
References
Rasch EK, Hirsch R, Paulose-Ram R, Hochberg MC. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: effect of different methods of case classification. Arthritis Rheum. 2003;48(4):917–26.
Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin N Am. 2015;41(4):545–68.
Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43(7):906–14.
Smolen JS, Aletaha D, Bijlsma JWJ, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631–7.
Haavardsholm EA, Ostergaard M, Hammer HB, Boyesen P, Boonen A, van der Heijde D, et al. Monitoring anti-TNFalpha treatment in rheumatoid arthritis: responsiveness of magnetic resonance imaging and ultrasonography of the dominant wrist joint compared with conventional measures of disease activity and structural damage. Ann Rheum Dis. 2009;68(10):1572-1579.
Navalho M, Resende C, Rodrigues AM, Ramos F, Gaspar A. Pereira da Silva JA, et al. bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology. 2012;264(3):823–33.
Lee EB, Fleischmann R, Hall S, Wilkinson B, Bradley JD, Gruben D, et al. Tofacitinib versus methotrexate in rheumatoid arthritis. N Engl J Med. 2014;370(25):2377–86.
Ostergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol. 2003;30(6):1385–6.
Ostergaard M, McQueen F, Wiell C, Bird P, Boyesen P, Ejbjerg B, et al. The OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS): definitions of key pathologies, suggested MRI sequences, and preliminary scoring system for PsA hands. J Rheumatol. 2009;36(8):1816–24.
Haavardsholm EA, Ostergaard M, Ejbjerg BJ, Kvan NP, Kvien TK. Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study. Ann Rheum Dis. 2007;66(9):1216–20.
Doyle JR, Botte MJ. Surgical anatomy of the hand and upper extremity. Philadelphia: Wolters Kluwer Health; 2002.
Hirschmann A, Sutter R, Schweizer A, Pfirrmann CW. The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers. Skelet Radiol. 2013;42(8):1105–12.
Hirschmann A, Sutter R, Schweizer A, Pfirrmann CW. MRI of the thumb: anatomy and spectrum of findings in asymptomatic volunteers. AJR Am J Roentgenol. 2014;202(4):819–27.
Dumont C, Lerzer S, Vafa MA, Tezval M, Dechent P, Sturmer KM, et al. Osteoarthritis of the carpometacarpal joint of the thumb: a new MR imaging technique for the standardized detection of relevant ligamental lesions. Skelet Radiol. 2014;43(10):1411–20.
Tan AL, Grainger AJ, Tanner SF, Shelley DM, Pease C, Emery P, et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum. 2005;52(8):2355–65.
Nieuwenhuis WP, Krabben A, Stomp W, Huizinga TW, van der Heijde D, Bloem JL, et al. Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 2015;67(4):869–76.
Lisbona MP, Pamies A, Ares J, Almirall M, Navallas M, Solano A, et al. Association of bone edema with the progression of bone erosions quantified by hand magnetic resonance imaging in patients with rheumatoid arthritis in remission. J Rheumatol. 2014;41(8):1623–9.
Rowbotham EL, Freeston JE, Emery P, Grainger AJ. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis. Eur Radiol. 2016;26(2):444–50.
Tamai M, Kawakami A, Uetani M, Fukushima A, Arima K, Fujikawa K, et al. 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. Modern Rheumatol. 2012;22(5):654–8.
Schueller-Weidekamm C, Lodemann KP, Grisar J, Schueller G, Weber M, Kainberger F, et al. Contrast-enhanced MR imaging of hand and finger joints in patients with early rheumatoid arthritis: do we really need a full dose of gadobenate dimeglumine for assessing synovial enhancement at 3 T? Radiology. 2013;268(1):161–9.
Riis RG, Gudbergsen H, Henriksen M, Ballegaard C, Bandak E, Rottger D, et al. Synovitis assessed on static and dynamic contrast-enhanced magnetic resonance imaging and its association with pain in knee osteoarthritis: a cross-sectional study. Eur J Radiol. 2016;85(6):1099–108.
Karlo C, Zanetti M, Stolzmann P, Steurer-Dober I, Brunner F, Hodler J, et al. Synovitis maps for the assessment of inflammatory diseases of the hand. Eur Radiol. 2011;21(7):1499–508.
Fernandez-Guerrero IM. WhatsAppitis. Lancet. 2014;383(9922):1040.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interests
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Agten, C.A., Rosskopf, A.B., Jonczy, M. et al. Frequency of inflammatory-like MR imaging findings in asymptomatic fingers of healthy volunteers. Skeletal Radiol 47, 279–287 (2018). https://doi.org/10.1007/s00256-017-2808-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-017-2808-1