Skip to main content
SpringerLink
Log in

Frühmanifestationen rheumatischer Gelenkerkrankungen an den Weichgewebestrukturen der Hand

Nachweis mit der MRT

Soft tissue manifestations of early rheumatic disease

Imaging with MRI

  • Handwurzel und Finger
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Zielsetzung

Analyse weichgeweblicher magnetresonanztomographischer (MRT-)Befundmuster früher Stadien rheumatischer Erkrankungen durch retrospektive Auswertung von MRT-Untersuchungen der Hand.

Material und Methoden

186 MRT-Untersuchungen bei Verdacht auf eine rheumatologische Erkrankung wurden in einem Konsensusreading durch 2 Radiologen analysiert und alle Befundmuster bzgl. Art und Lokalisation registriert. Die unter geblindeten und entblindeten Bedingungen gestellten Diagnosen wurden mit der abschließenden klinischen Diagnose korreliert.

Ergebnisse

Die häufigsten Diagnosen waren die rheumatoide Arthritis (RA, 45,7%) und Psoriasisarthritis (PsA, 15,6%). Die gemittelte Korrelation (r) von klinischem und MRT-Befund betrug 0,75 unter geblindeten bzw. 0,853 unter entblindeten Bedingungen (p <0,001). Folgende Befundmuster wurden nachgewiesen: Synovitiden (59,1%), Tendovaginitiden (91,4%), Daktylitiden (14,5%) und Spongiosaödeme (18,3%). Eine artdiagnostische Relevanz ergab sich für die Daktylitiden bei Verdacht auf PsA (r=0,934; Sensitivität 84,9%, Spezifität 82,4%).

Schlussfolgerung

Entzündliche Veränderungen der Hand können mit der MRT sicher nachgewiesen werden. Die artdiagnostische Zuordnung weichgeweblicher Befundmuster kann durch Berücksichtigung klinischer, laborchemischer und projektionsradiographischer Befunde signifikant verbessert werden (+13,7%).

Abstract

Purpose

The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis.

Material and methods

A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis.

Results

The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p <0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%).

Conclusion

Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1 a
Abb. 2a-d
Abb. 3a-h
Abb. 4a,b
Abb. 5a,b
Abb. 6a,b
Abb. 7
Abb. 8a,b

Literatur

  1. Argyropoulou MI, Glatzouni A, Voulgari PV et al. (2005) Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with infliximab. Joint Bone Spine 72: 557–561

    Article  PubMed  Google Scholar 

  2. Benton N, Stewart N, Crabbe J et al. (2004) MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis 63: 555–561

    Article  PubMed  Google Scholar 

  3. Bollow M, Braun J, Hamm B (1997) [Sacroiliitis: the key symptom of spondylathropathies. 1. The clinical aspects]. Rofo 166: 95–100

    PubMed  Google Scholar 

  4. Brahee DD, Pierre-Jerome C, Kettner NW (2003) Clinical and radiological manifestations of the rheumatoid wrist. A comprehensive review. J Manipulative Physiol Ther 26: 323–329

    Article  PubMed  Google Scholar 

  5. Gabriel SE (2001) The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 27: 269–281

    Article  PubMed  Google Scholar 

  6. Gaffney K, Cookson J, Blades S et al. (1998) Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging. Ann Rheum Dis 57: 152–157

    PubMed  Google Scholar 

  7. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF et al. (2005) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 52: 3381–3390

    Article  PubMed  Google Scholar 

  8. Luong AA, Salonen DC (2000) Imaging of the seronegative spondyloarthropathies. Curr Rheumatol Rep 2: 288–296

    PubMed  Google Scholar 

  9. McQueen FM, Stewart N, Crabbe J et al. (1999) Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 58: 156–163

    PubMed  Google Scholar 

  10. McQueen FM, Benton N, Perry D et al. (2003) 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 48: 1814–1827

    Article  PubMed  Google Scholar 

  11. Merkesdal S, Ruof J, Mittendorf T, Zeidler H (2004) Cost-effectiveness of TNF-alpha-blocking agents in the treatment of rheumatoid arthritis. Expert Opin Pharmacother 5: 1881–1886

    Article  PubMed  Google Scholar 

  12. Ostergaard M, Duer A, Moller U, Ejbjerg B (2004) Magnetic resonance imaging of peripheral joints in rheumatic diseases. Best Pract Res Clin Rheumatol 18: 861–879

    Article  PubMed  Google Scholar 

  13. Ostergaard M, Ejbjerg B, Szkudlarek M (2005) Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultrasonography, conventional radiography and computed tomography. Best Pract Res Clin Rheumatol 19: 91–116

    Article  PubMed  Google Scholar 

  14. Ruof J, Hulsemann JL, Mittendorf T et al. (2004) Comparison of estimated medical costs among patients who are defined as having rheumatoid arthritis using three different standards. Eur J Health Econ 5: 64–69

    Article  PubMed  Google Scholar 

  15. Savnik A, Malmskov H, Thomsen HS et al. (2001) MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T). Eur Radiol 11: 1030–1038

    Article  PubMed  Google Scholar 

  16. Savnik A, Malmskov H, Thomsen HS et al. (2002) MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 12: 1203–1210

    Article  PubMed  Google Scholar 

  17. Tehranzadeh J, Ashikyan O, Dascalos J (2004) Advanced imaging of early rheumatoid arthritis. Radiol Clin North Am 42: 89–107

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum Innenstadt der Ludwig-Maximilians-Universität, Pettenkoferstr. 8a, 80336 , München

    M. Treitl, A. Panteleon, M. Körner, C. Becker-Gaab, M. Reiser & S. Wirth

Authors
  1. M. Treitl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Panteleon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Körner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Becker-Gaab
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Wirth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Treitl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Treitl, M., Panteleon, A., Körner, M. et al. Frühmanifestationen rheumatischer Gelenkerkrankungen an den Weichgewebestrukturen der Hand. Radiologe 46, 677–688 (2006). https://doi.org/10.1007/s00117-006-1396-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-006-1396-1

Schlüsselwörter

Keywords

Search

Navigation