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Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?

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An Erratum to this article was published on 23 June 2016



To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA).

Material and methods

In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference.


Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80–0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %).


T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA.

Key Points

Bone marrow oedema scores are equal on T2 and T1-Gd-chelate enhanced sequences.

Agreement between scores based on T2 and T1-Gd-chelate images was excellent.

Sensitivity and specificity for presence of bone marrow oedema were high.

A short protocol without T2 images suffices in rheumatoid arthritis patients.

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The scientific guarantor of this publication is Monique Reijnierse. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (, and the Dutch Arthritis Foundation, project TRACER (grant 04I-202). The research has also been funded by The European Community Seventh Framework Program FP7 Health-F2-2008-223404 (Masterswitch) as well as by a European grant from the Innovative Medicine Initiative: BTCURE. This work of A. van der Helm-van Mil is supported by a Vidi-grant of the Netherlands Organisation for Scientific Research. The work of A. Krabben is supported by a grant of the Dutch Arthritis Foundation. Wouter Stomp (the first author on the manuscript) has received speaking fees from GE Healthcare related to the use of their extremity MRI for a total amount of less than 2,000 euro. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects in this study. Patients in the early arthritis group are participating in the Leiden Early Arthritis Clinic, and multiple articles have been published about this cohort with ongoing inclusion, including one study on MRI results (Concordance between inflammation at physical examination and on MRI in patients with early arthritis. Krabben et al. Ann Rheum Dis Epub ahead of print 2013 Dec 12). Methodology: prospective cross-sectional study performed at one institution.

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Correspondence to Wouter Stomp.

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Stomp, W., Krabben, A., van der Heijde, D. et al. Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?. Eur Radiol 24, 2614–2622 (2014).

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