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Towards a simplified fluid-sensitive MRI protocol in small joints of the hand in early arthritis patients: reliability between modified Dixon and regular Gadolinium enhanced TSE fat saturated MRI-sequences

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Abstract

Objective

MRI of small joints plays an important role in the early detection and early treatment of rheumatoid arthritis. Despite its sensitivity to demonstrate inflammation, clinical use is hampered by accessibility, long scan time, intravenous contrast, and consequent high costs. To improve the feasibility of MRI implementation in clinical practice, we introduce a modified Dixon sequence, which does not require contrast and reduces total acquisition time to 6 min. Because the reliability in relation to conventional MRI sequences is unknown, we determined this.

Methods

In 29 consecutive early arthritis patients, coronal and axial T2-weighted modified Dixon acquisitions on 3.0 T MRI scanner were acquired from metacarpophalangeal 2–5 to the wrist, followed by the standard contrast-enhanced protocol on 1.5 T extremity MRI. Two readers scored osteitis, synovitis and tenosynovitis (summed as total MRI-inflammation), and erosions (all summed as total Rheumatoid Arthritis MRI Score (RAMRIS)). Intraclass correlation coefficients (ICCs) between readers, and comparing the two sequences, were studied. Spearman correlations were determined.

Results

Performance between readers was good/excellent. Comparing modified Dixon and conventional sequences revealed good/excellent reliability: ICC for total MRI-inflammation score was 0.84 (95% CI:0.70–0.92), for erosions 0.90 (95% CI:0.79–0.96), and for the total RAMRIS score 0.88 (95% CI:0.77–0.94). The scores of total MRI-inflammation, total erosions, and total RAMRIS were highly correlated (ρ = 0.80, ρ = 0.81, ρ = 0.82, respectively).

Conclusion

The modified Dixon protocol is reliable compared to the conventional MRI protocol, suggesting it is accurate to detect MRI inflammation. The good correlation may be the first step towards a patient-friendly, short and affordable MRI protocol, which can facilitate the implementation of MRI for early detection of inflammation in rheumatology practice.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Funding

This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Starting grant, agreement No 714312), the Dutch Arthritis Society, and the 2021 International Skeletal Society Seed Grant.

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Authors and Affiliations

  1. Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands

    Anna M. P. Boeren, Ellis Niemantsverdriet, Marloes Verstappen, Fenne Wouters & Annette H. M. van der Helm-van Mil

  2. Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands

    Anna M. P. Boeren & Annette H. M. van der Helm-van Mil

  3. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Johannes L. Bloem & Monique Reijnierse

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  1. Anna M. P. Boeren
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Correspondence to Anna M. P. Boeren.

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EAC Leiden was approved by the Local Medical Ethics Committee, named ‘Commissie Medische Ethiek’. Informed consent was obtained from all patients. The study complies with the Declaration of Helsinki.

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Anna M. P. Boeren and Ellis Niemantsverdriet shared the first authorship.

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Boeren, A.M.P., Niemantsverdriet, E., Verstappen, M. et al. Towards a simplified fluid-sensitive MRI protocol in small joints of the hand in early arthritis patients: reliability between modified Dixon and regular Gadolinium enhanced TSE fat saturated MRI-sequences. Skeletal Radiol 52, 1193–1202 (2023). https://doi.org/10.1007/s00256-022-04238-8

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