Skip to main content

Advertisement

Log in

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

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 23 June 2016

Abstract

Purpose

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.

Results

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 %).

Conclusion

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.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. McQueen FM (2012) Bone marrow edema and osteitis in rheumatoid arthritis: the imaging perspective. Arthritis Res Ther 14:224

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bugatti S, Manzo A, Caporali R, Montecucco C (2012) Inflammatory lesions in the bone marrow of rheumatoid arthritis patients: a morphological perspective. Arthritis Res Ther 14:229

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hetland ML, Ejbjerg B, Hørslev-Petersen K et al (2009) MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA). Ann Rheum Dis 68:384–390

    Article  CAS  PubMed  Google Scholar 

  4. Bøyesen P, Haavardsholm EA, Ostergaard M et al (2011) MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression. Ann Rheum Dis 70:428–433

    Article  PubMed  Google Scholar 

  5. 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 

  6. Østergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386

    PubMed  Google Scholar 

  7. Henkelman RM, Hardy PA, Bishop JE et al (1992) Why fat is bright in RARE and fast spin-echo imaging. J Magn Reson Imaging 2:533–540

    Article  CAS  PubMed  Google Scholar 

  8. Schmid MR, Hodler J, Vienne P et al (2002) Bone marrow abnormalities of foot and ankle: STIR versus T1-weighted contrast-enhanced fat-suppressed spin-echo MR imaging. Radiology 224:463–469

    Article  PubMed  Google Scholar 

  9. Mayerhoefer ME, Breitenseher MJ, Kramer J et al (2005) STIR vs. T1-weighted fat-suppressed gadolinium-enhanced MRI of bone marrow edema of the knee: computer-assisted quantitative comparison and influence of injected contrast media volume and acquisition parameters. J Magn Reson Imaging 22:788–793

    Article  PubMed  Google Scholar 

  10. Ostergaard M, Conaghan PG, O’Connor P et al (2009) Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection – does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol 36:1806–1810

    Article  PubMed  Google Scholar 

  11. Tamai M, Kawakami A, Uetani M et al (2012) 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. Mod Rheumatol 22:654–658

    Article  PubMed  Google Scholar 

  12. Tehranzadeh J, Ashikyan O, Anavim A, Tramma S (2006) Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skelet Radiol 35:814–822

    Article  Google Scholar 

  13. De Rooy DPC, van der Linden MPM, Knevel R et al (2011) Predicting arthritis outcomes–what can be learned from the Leiden Early Arthritis Clinic? Rheumatology (Oxford) 50:93–100

    Article  Google Scholar 

  14. Jimenez-Boj E, Nöbauer-Huhmann I, Hanslik-Schnabel B et al (2007) Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 56:1118–1124

    Article  PubMed  Google Scholar 

  15. Dalbeth N, Smith T, Gray S et al (2009) Cellular characterisation of magnetic resonance imaging bone oedema in rheumatoid arthritis; implications for pathogenesis of erosive disease. Ann Rheum Dis 68:279–282

    Article  CAS  PubMed  Google Scholar 

  16. Hodgson R, Grainger A, O’Connor P et al (2008) Dynamic contrast enhanced MRI of bone marrow oedema in rheumatoid arthritis. Ann Rheum Dis 67:270–272

    Article  CAS  PubMed  Google Scholar 

  17. Van der Heijde DM, van’t Hof M, van Riel PL, van de Putte LB (1993) Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol 20:579–581

    PubMed  Google Scholar 

Download references

Acknowledgements

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 (www.ctmm.nl), 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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wouter Stomp.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s00330-014-3272-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3272-0

Keywords

Navigation