Skeletal Radiology

, Volume 36, Issue 4, pp 269–279 | Cite as

Advanced imaging in rheumatoid arthritis

Part 1: Synovitis
  • J. M. Farrant
  • P. J. O’Connor
  • A. J. GraingerEmail author
Review Article


Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium. We now recognise that conventional radiographic images show changes of rheumatoid arthritis long after irreversible joint damage has occured. With the advent of powerful disease-modifying drugs, there is a need for early demonstration of rheumatoid arthritis and a need to monitor progress of the disease and response to therapy. Advanced imaging techniques such as ultrasound and MRI have focussed on the demonstration and quantification of synovitis and erosions and allow early diagnosis of RA. The technology to quantify synovitis and erosions is developing rapidly and now allows change in disease activity to be assessed. However, problems undoubtedly exist in quantification techniques, and this review serves to highlight them. Much of the literature on advanced imaging in RA appears in rheumatological journals and may not be familiar to radiologists. This review article aims to increase the awareness of radiologists about this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration, it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. The first part addresses synovitis imaging. The second part will look at advanced imaging of erosions in RA.


Rheumatoid arthritis Synovitis Erosion Magnetic resonance imaging Ultrasound 


  1. 1.
    Markenson JA. Worldwide trends in the socioeconomic impact and long-term prognosis of rheumatoid arthritis. Semin Arthritis Rheum 1991;21(2 Suppl 1):4–12.PubMedCrossRefGoogle Scholar
  2. 2.
    Lard LR, Visser H, Speyer I, van der Horst-Bruinsma IE, Zwinderman AH, Breedvel FC, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001;111:446–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Tsakonas E, Fitzgerald AA, Fitzcharles MA, Cividino A, Thorne JC, M'Seffar A, et al. Consequences of delayed therapy with second-line agents in rheumatoid arthritis: a 3 year followup on the hydroxychloroquine in early rheumatoid arthritis (HERA) study. J Rheumatol 2000;27:623–9.PubMedGoogle Scholar
  4. 4.
    Arend WP, Dayer JM. Inhibition of the production and effects of interleukin-1 and tumor necrosis factor alpha in rheumatoid arthritis. Arthritis Rheum 1995;38:151–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Taylor PC. Serum vascular markers and vascular imaging in assessment of rheumatoid arthritis disease activity and response to therapy. Rheumatology (Oxford) 2005;44(6):721–8.CrossRefGoogle Scholar
  6. 6.
    Hirohata S, Sakakibara J. Angioneogenesis as a possible elusive triggering factor in rheumatoid arthritis. Lancet 1999;353:1331.PubMedCrossRefGoogle Scholar
  7. 7.
    Ostergaard M, Hansen M, Stoltenberg M, Gideon P, Klarlund M, Jensen KE, et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 1999;42:918–29.PubMedCrossRefGoogle Scholar
  8. 8.
    McGonagle D, Conaghan PG, O’Connor P, Gibbon W, Green M, Wakefield R, et al. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Arthritis Rheum 1999;42:1706–11.PubMedCrossRefGoogle Scholar
  9. 9.
    McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PLJ, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999;58:156–63.PubMedCrossRefGoogle Scholar
  10. 10.
    McQueen FM. Magnetic resonance imaging in early inflammatory arthritis: what is its role? Rheumatology (Oxford) 2000;39:700–6.CrossRefGoogle Scholar
  11. 11.
    McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis 1998;57:350–56.PubMedGoogle Scholar
  12. 12.
    Backhaus M, Burmester GR, Sandrock D, Loreck D, Hess D, Scholz A, et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002;61:895–904.PubMedCrossRefGoogle Scholar
  13. 13.
    Alasaarela E, Suramo I, Tervonen O, Lahde S, Takalo R, Hakala M. Evaluation of humeral head erosions in rheumatoid arthritis: a comparison of ultrasonography, magnetic resonance imaging, computed tomography and plain radiography. Br J Rheumatol 1998;37:1152–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Peterfy CG. Magnetic resonance imaging in rheumatoid arthritis: current status and future directions. J Rheumatol 2001;28(5):1134–42.PubMedGoogle Scholar
  15. 15.
    Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology 2000;216:569–75.PubMedGoogle Scholar
  16. 16.
    Goupille P, Roulot B, Akoka S, Avimadje AM, Garaud P, Naccache L, et al. Magnetic resonance imaging: a valuable method for the detection of synovial inflammation in rheumatoid arthritis. J Rheumatol 2001;28:35–40.PubMedGoogle Scholar
  17. 17.
    Conaghan P, Edmonds J, Emery P, Genant H, Gibbon W, Klarlund M, et al. Magnetic resonance imaging in rheumatoid arthritis: summary of OMERACT activities, current status, and plans. J Rheumatol 2001;28(5):1158–62.PubMedGoogle Scholar
  18. 18.
    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;30:1385–6.PubMedGoogle Scholar
  19. 19.
    Ejbjerg B, Narvestad E, Rostrup E, Szkudlarek M, Jacobsen S, Thomsen HS, et al. Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis. Arthritis Rheum 2004;50:1097–106.PubMedCrossRefGoogle Scholar
  20. 20.
    Winalski CS, Aliabadi P, Wright RJ, Shortkroff S, Sledge CB, Weissman BN. Enhancement of joint fluid with intravenously administered gadopentetate dimeglumine: technique, rationale, and implications. Radiology 1993;187(1):179–85.PubMedGoogle Scholar
  21. 21.
    Peterfy CG, Majumdar S, Lang P, van Dijke CF, Sack K, Genant HK. MR imaging of the arthritic knee: improved discrimination of cartilage, synovium, and effusion with pulsed saturation transfer and fat-suppressed T1-weighted sequences. Radiology 1994;191:413–9.PubMedGoogle Scholar
  22. 22.
    Peterfy CG. Magnetic resonance imaging of rheumatoid arthritis: the evolution of clinical applications through clinical trials. Semin Arthritis Rheum 2001;30:375–96.PubMedCrossRefGoogle Scholar
  23. 23.
    Ostergaard M, Klarlund M. Importance of timing of post-contrast MRI in rheumatoid arthritis: what happens during the first 60 minutes after IV gadolinium-DTPA? Ann Rheum Dis 2001;60:1050–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Ostergaard M, Hansen M, Stoltenberg M, Lorenzen I. Quantitative assessment of the synovial membrane in the rheumatoid wrist: an easily obtained MRI score reflects the synovial volume. Br J Rheumatol 1996;35:965–71.PubMedCrossRefGoogle Scholar
  25. 25.
    Rhodes LA, Grainger AJ, Keenan AM, Thomas C, Emery P, Conaghan PG. The validation of simple scoring methods for evaluating compartment-specific synovitis detected by MRI in knee osteoarthritis. Rheumatology (Oxford) 2005;44:1569–73.CrossRefGoogle Scholar
  26. 26.
    Klarlund M, Ostergaard M, Lorenzen I. Finger joint synovitis in rheumatoid arthritis: quantitative assessment by magnetic resonance imaging. Rheumatology (Oxford) 1999;38(1):66–72.CrossRefGoogle Scholar
  27. 27.
    Savnik A, Malmskov H, Thomsen HS, Graff LB, Nielsen H, Danneskiold-Samsoe B, et al. MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 2002;12:1203–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Ostergaard M, Stoltenberg M, Lovgreen-Nielsen P, Volck B, Jensen CH, Lorenzen I. Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis: comparison with the macroscopic and microscopic appearance of the synovium. Arthritis Rheum 1997;40:1856–67.PubMedCrossRefGoogle Scholar
  29. 29.
    Ostergaard M, Stoltenberg M, Lovgreen-Nielsen P, Volck B, Sonne-Holm S, Lorenzen I. Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 1998;16:743–54.PubMedCrossRefGoogle Scholar
  30. 30.
    Huh YM, Suh JS, Jeong EK, Lee SK, Lee JS, Choi BW, et al. Role of the inflamed synovial volume of the wrist in defining remission of rheumatoid arthritis with gadolinium-enhanced 3D-SPGR MR imaging. J Magn Reson Imaging 1999;10:202–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Palmer WE, Rosenthal DI, Schoenberg OI, et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1995;196:647–55.PubMedGoogle Scholar
  32. 32.
    McQueen FM, Benton N, Crabbe J, Robinson E, Yeoman S, McLean L, et al. What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first two years of disease. Ann Rheum Dis 2001;60:859–68.PubMedGoogle Scholar
  33. 33.
    Tamai K, Yamato M, Yamaguchi T, Ohno W. Dynamic magnetic resonance imaging for the evaluation of synovitis in patients with rheumatoid arthritis. Arthritis Rheum 1994;37(8):1151–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Huang J, Stewart N, Crabbe J, Robinson E, McLean L, Yeoman S, et al. A 1-year follow-up study of dynamic magnetic resonance imaging in early rheumatoid arthritis reveals synovitis to be increased in shared epitope-positive patients and predictive of erosions at 1 year. Rheumatology (Oxford) 2000;39:407–16.CrossRefGoogle Scholar
  35. 35.
    Savnik A, Malmskov H, Thomsen HS, Graff LB, Nielsen H, Danneskiold-Samsoe B, et al. Magnetic resonance imaging of the wrist and finger joints in patients with inflammatory joint diseases. J Rheumatol 2001;28:2193–200.PubMedGoogle Scholar
  36. 36.
    Gaffney K, Cookson J, Blake D, Coumbe A, Blades S. Quantification of rheumatoid synovitis by magnetic resonance imaging. Arthritis Rheum 1995;38:1610–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Reece RJ, Kraan MC, Radjenovic A, et al. Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging. Arthritis Rheum 2002;46:366–72.PubMedCrossRefGoogle Scholar
  38. 38.
    Kraan MC, Reece RJ, Barg EC, Smeets TJ, Farnell J, Rosenburg R, et al. Modulation of inflammation and metalloproteinase expression in synovial tissue by leflunomide and methotrexate in patients with active rheumatoid arthritis. Findings in a prospective, randomized, double-blind, parallel-design clinical trial in thirty-nine patients at two centers. Arthritis Rheum 2000;43:1820–30.PubMedCrossRefGoogle Scholar
  39. 39.
    Klarlund M, Ostergaard M, Rostrup E, Skjodt H, Lorenzen I. Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls. Scand J Rheumatol 2000;29(2):108–15.PubMedCrossRefGoogle Scholar
  40. 40.
    Ostergaard M, Klarlund M, Lassere M, Conaghan P, Peterfy C, McQueen F, et al. Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints-an international multicenter study. J Rheumatol 2001;28:1143–50.PubMedGoogle Scholar
  41. 41.
    Conaghan P, Lassere M, Ostergaard M, Peterfy C, McQueen F, O’Connor P, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 4: an international multicenter longitudinal study using the RA-MRI Score. J Rheumatol 2003;30:1376–9.PubMedGoogle Scholar
  42. 42.
    Lassere M, McQueen F, Ostergaard M, Conaghan P, Shnier R, Peterfy C, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score. J Rheumatol 2003;30:1366–75.PubMedGoogle Scholar
  43. 43.
    Bird P, Conaghan P, Ejbjerg B, O’Connor P, Peterfy C, McQueen F, et al. The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis 2005;64(Suppl 1):i8–10.PubMedCrossRefGoogle Scholar
  44. 44.
    McQueen F, Lassere M, Edmonds J, Conaghan P, Peterfy C, Bird P, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Summary of OMERACT 6 MR imaging module. J Rheumatol 2003;30:1387–92.PubMedGoogle Scholar
  45. 45.
    Haavardsholm EA, Ostergaard M, Ejbjerg BJ, Kvan NP, Uhlig TA, Lilleas FG, et al. Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting. Arthritis Rheum 2005;52:3860–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Savnik A, Malmskov H, Thomsen HS, Bretlau T, Graff LB, Nielsen H, et al. MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T). Eur Radiol 2001;11:1030–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Ejbjerg BJ, Narvestad E, Jacobsen S, Thomsen HS, Ostergaard M. 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. Ann Rheum Dis 2005;64:1280–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Lindegaard H, Vallo J, Horslev-Petersen K, Junker P, Ostergaard M. Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset. Ann Rheum Dis 2001;60:770–6.PubMedCrossRefGoogle Scholar
  49. 49.
    McQueen FM, Benton N, Perry D, Crabbe J, Robinson E, Yeoman S, et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003;48:1814–27.PubMedCrossRefGoogle Scholar
  50. 50.
    McGonagle D, Gibbon W, O’Connor P, Green M, Pease C, Emery P. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 1998;41:694–700.PubMedCrossRefGoogle Scholar
  51. 51.
    Tan AL, Grainger AJ, Tanner SF, Shelly DM, Pease C, Emery P, et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 2005;52:2355–65.PubMedCrossRefGoogle Scholar
  52. 52.
    Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32:2485–7.PubMedGoogle Scholar
  53. 53.
    Newman JS, Adler RS, Bude RO, Rubin JM. Detection of soft-tissue hyperemia: value of power Doppler sonography. AJR Am J Roentgenol 1994;163:385–9.PubMedGoogle Scholar
  54. 54.
    Walther M, Harms H, Krenn V, Radke S, Faehndrich TP, Gohlke F. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 2001;44:331–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Rubin JM. Musculoskeletal power doppler. Eur Radiol 1999;9(Suppl 3):S403–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Magarelli N, Guglielmi G, Di Matteo L, Tartaro A, Mattei PA, Bonomo L. Diagnostic utility of an echo-contrast agent in patients with synovitis using power Doppler ultrasound: a preliminary study with comparison to contrast-enhanced MRI. Eur Radiol 2001;11:1039–46.PubMedCrossRefGoogle Scholar
  57. 57.
    Fiocco U, Ferro F, Cozzi L, Vezzù, Sfriso P, Checchetto C, et al. Contrast medium in power Doppler ultrasound for assessment of synovial vascularity: comparison with arthroscopy. J Rheumatol 2003;30:2170–6.PubMedGoogle Scholar
  58. 58.
    Teh J, Stevens K, Williamson L, Leung J, McNally EG. Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol 2003;76:875–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Terslev L, Torp-Pedersen S, Savnik A, van der Recke P, Danneskiold-Samsoe B, Bliddal H, et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum 2003;48:2434–41.PubMedCrossRefGoogle Scholar
  60. 60.
    Fiocco U, Cozzi L, Rubaltelli L, Rigon C, De Candia A, Tregnaghi A, et al. Long-term sonographic follow-up of rheumatoid and psoriatic proliferative knee joint synovitis. Br J Rheumatol 1996;35:155–63.PubMedCrossRefGoogle Scholar
  61. 61.
    Schmidt WA, Volker L, Zacher J, Schlafke M, Ruhnke M, Gromnica-Ihle E. Colour Doppler ultrasonography to detect pannus in knee joint synovitis. Clin Exp Rheumatol 2000;18:439–44.PubMedGoogle Scholar
  62. 62.
    Walther M, Harms H, Krenn V, Radke S, Kirschner S, Gohlke F. Synovial tissue of the hip at power Doppler US: correlation between vascularity and power Doppler US signal. Radiology 2002;225:225–31.PubMedGoogle Scholar
  63. 63.
    Ostendorf B, Peters R, Dann P, Becker A, Scherer A, Wedekind F, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001;44(11):2492–502.PubMedCrossRefGoogle Scholar
  64. 64.
    Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Ostergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 2004;50:2103–12.PubMedCrossRefGoogle Scholar
  65. 65.
    Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001;44:2018–23.PubMedCrossRefGoogle Scholar
  66. 66.
    Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ, et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999;42:1232–45.PubMedCrossRefGoogle Scholar
  67. 67.
    Terslev L, Torp-Pedersen S, Qvistgaard E, Danneskiold-Samsoe B, Bliddal H. Estimation of inflammation by Doppler ultrasound: quantitative changes after intra-articular treatment in rheumatoid arthritis. Ann Rheum Dis 2003;62:1049–53.PubMedCrossRefGoogle Scholar
  68. 68.
    Terslev L, Torp-Pedersen S, Qvistgaard E, Bliddal H. Spectral Doppler and resistive index. A promising tool in ultrasonographic evaluation of inflammation in rheumatoid arthritis. Acta Radiol 2003;44:645–52.PubMedCrossRefGoogle Scholar
  69. 69.
    Stone M, Bergin D, Whelan B, Maher M, Murray J, McCarthy C. Power Doppler ultrasound assessment of rheumatoid hand synovitis. J Rheumatol 2001;28:1979–82.PubMedGoogle Scholar
  70. 70.
    Ribbens C, Andre B, Marcelis S, Kaye O, Mathy L, Bonnet V, et al. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 2003;229:562–9.PubMedGoogle Scholar
  71. 71.
    Hau M, Kneitz C, Tony HP, Keberle M, Jahns R, Jenett M. High resolution ultrasound detects a decrease in pannus vascularisation of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor alpha receptor (etanercept). Ann Rheum Dis 2002;61(1):55–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Terslev L, Torp-Pedersen S, Qvistgaard E, Kristofferson H, Rogind H, Danneskiold-Samsoe B, et al. Effects of treatment with etanercept (Enbrel, TNRF:Fc) on rheumatoid arthritis evaluated by Doppler ultrasonography. Ann Rheum Dis 2003;62:178–81.PubMedCrossRefGoogle Scholar
  73. 73.
    Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48:955–62.PubMedCrossRefGoogle Scholar
  74. 74.
    Taylor PC, Steuer A, Gruber J, Cosgrove DO, Blomley MJK, Marsters PA, et al. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum 2004;50:1107–16.PubMedCrossRefGoogle Scholar
  75. 75.
    Conaghan PG, O’Connor P, McGonagle D, Astin P, Wakefied, Gibbon, et al. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 2003;48:64–71.PubMedCrossRefGoogle Scholar
  76. 76.
    Frediani B, Falsetti P, Storri L, Allegri A, Bisogno S, Baldi F, et al. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol 2002;21:294–8.PubMedCrossRefGoogle Scholar
  77. 77.
    Ostergaard M, Ejbjerg B, Szkudlarek M. Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultrasonography, conventional radiography and computed tomography. Best Pract Res Clin Rheumatol 2005;19:91–116.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2006

Authors and Affiliations

  • J. M. Farrant
    • 1
  • P. J. O’Connor
    • 1
  • A. J. Grainger
    • 1
    • 2
    Email author
  1. 1.Department of RadiologyLeeds Teaching HospitalsLeedsUK
  2. 2.Radiology DepartmentChapel Allerton HospitalLeedsUK

Personalised recommendations