Skip to main content
SpringerLink
Log in

Influence of field strength, coil type and image resolution on assessment of synovitis by unenhanced MRI – a comparison with contrast-enhanced MRI

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To explore if the reliability of synovitis assessment by unenhanced MRI is influenced by different MRI field-strengths, coil types and image resolutions in RA patients.

Methods

Forty-one RA patients and 12 healthy controls underwent hand MRI (wrist and 2nd--5th metacarpophalangeal joints) at 4 different field-strengths (0.23 T/0.6 T/1.5 T/3.0 T) on the same day. Seven protocols using a STIR sequence with different field-strengths, coils (flex coils/dedicated phased-array extremity coils) and resolution were applied and scored blindly for synovitis (OMERACT-RAMRIS method). A 1.5 T post-contrast T1-weighted sequence was used as gold standard reference.

Results

Fair-good agreement (ICC=0.38--0.72) between the standard reference and the different STIR protocols (best agreement with extremity coil and small voxel size at 1.5 T). The accuracy for presence/absence of synovitis was very high per person (0.80--1.0), and moderate-high per joint (0.63--0.85), whereas exact agreements on scores were moderate (0.50--0.66). The intrareader agreement (15 patients and 3 controls) on presence/absence of synovitis was very high (0.87--1.0).

Conclusions

Unenhanced MRI using STIR sequence is only moderately reliable for assessing hand synovitis in RA, when contrast-enhanced MRI is considered the gold standard reference. Contrast injection, field strength and coil type influence synovitis assessment, and should be considered before performing MRI in clinical trials and practice.

Key Points

• STIR is only moderately reliable for synovitis assessment, compared with post–contrast-T1-w.

• Contrast injection, field strength, and coil type influence synovitis assessment.

• Contrast injection is recommended for reliable and reproducible hand synovitis assessment.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ostergaard M, Pedersen SJ, Dohn UM (2008) Imaging in rheumatoid arthritis–status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 22:1019–1044

    Article  PubMed  Google Scholar 

  2. Whitten CG, Moore TE, Yuh WT, Kathol MH, Renfrew DL, Walker CW (1992) The use of intravenous gadopentetate dimeglumine in magnetic resonance imaging of synovial lesions. Skelet Radiol 21:215–218

    Article  CAS  Google Scholar 

  3. Peterfy C, Edmonds J, Lassere M, Conaghan P, Ostergaard M, McQueen F et al (2003) OMERACT rheumatoid arthritis MRI studies module. J Rheumatol 30:1364–1365

    PubMed  Google Scholar 

  4. McQueen FM (2009) The MRI view of synovitis and tenosynovitis in inflammatory arthritis: implications for diagnosis and management. Ann N Y Acad Sci 1154:21–34

    Article  PubMed  Google Scholar 

  5. Thomsen HS (2013) Non-renal adverse reactions to contrast media: separating fact from myth. Acta Radiol 54:835–836

    Article  PubMed  Google Scholar 

  6. Semelka RC, Hernandes Mde A, Stallings CG, Castillo M (2013) Objective evaluation of acute adverse events and image quality of gadolinium-based contrast agents (gadobutrol and gadobenate dimeglumine) by blinded evaluation. Pilot study. Magn Reson Imaging 31:96–101

    Article  CAS  PubMed  Google Scholar 

  7. Thomsen HS (2011) Contrast media safety-an update. Eur J Radiol 80:77–82

    Article  PubMed  Google Scholar 

  8. Suzuki T, Ito S, Handa S, Kose K, Okamoto Y, Minami M et al (2009) A new low-field extremity magnetic resonance imaging and proposed compact MRI score: evaluation of anti-tumor necrosis factor biologics on rheumatoid arthritis. Mod Rheumatol 19:358–365

    Article  PubMed Central  PubMed  Google Scholar 

  9. Taouli B, Zaim S, Peterfy CG, Lynch JA, Stork A, Guermazi A et al (2004) Rheumatoid arthritis of the hand and wrist: comparison of three imaging techniques. AJR Am J Roentgenol 182:937–943

    Article  PubMed  Google Scholar 

  10. Ostergaard M, Conaghan PG, O'Connor P, Szkudlarek M, Klarlund M, Emery 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. Ostergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B 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 

  12. Bird P, Ejbjerg B, McQueen F, Ostergaard M, Lassere M, Edmonds J (2003) OMERACT rheumatoid arthritis magnetic resonance imaging studies. Exercise 5: an international multicenter reliability study using computerized MRI erosion volume measurements. J Rheumatol 30:1380–1384

    PubMed  Google Scholar 

  13. Ejbjerg B, McQueen F, Lassere M, Haavardsholm E, Conaghan P, O'Connor P et al (2005) The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint. Ann Rheum Dis 64:i23–i47

    Article  PubMed Central  PubMed  Google Scholar 

  14. Krabbe S, Eshed I, Pedersen SJ, Boyesen P, Moller JM, Therkildsen F et al (2014) Bone marrow oedema assessment by magnetic resonance imaging in rheumatoid arthritis wrist and metacarpophalangeal joints: the importance of field strength, coil type and image resolution. Rheumatology (Oxford) 53:1446–1451

    Article  Google Scholar 

  15. Lassere M, McQueen F, Ostergaard M, Conaghan P, Shnier R, Peterfy C et al (2003) OMERACT rheumatoid arthritis magnetic resonance imaging studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score. J Rheumatol 30:1366–1375

    PubMed  Google Scholar 

  16. Haavardsholm EA, Ostergaard M, Ejbjerg BJ, Kvan NP, Uhlig TA, Lilleas FG et al (2005) Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting. Arthritis Rheum 52:3860–3867

    Article  PubMed  Google Scholar 

  17. Tamai M, Kawakami A, Uetani M, Fukushima A, Arima K, Fujikawa K 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 

  18. Morrison WB (2005) Indirect MR arthrography: concepts and controversies. Semin Musculoskelet Radiol 9:125–134

    Article  PubMed  Google Scholar 

  19. Boles CA, Ward WG Sr (2000) Loose fragments and other debris: miscellaneous synovial and marrow disorders. Magn Reson Imaging Clin N Am 8:371–390

    CAS  PubMed  Google Scholar 

  20. Dewan AK, Chhabra AB, Khanna AJ, Anderson MW, Brunton LM (2013) Magnetic resonance imaging of the hand and wrist: techniques and spectrum of disease: AAOS exhibit selection. J Bone Joint Surg Am 95:e68

    PubMed  Google Scholar 

  21. Ejbjerg B, Narvestad E, Rostrup E, Szkudlarek M, Jacobsen S, Thomsen HS et al (2004) 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 50:1097–1106

    Article  PubMed  Google Scholar 

  22. Kneeland JB (1995) Technical considerations for MR imaging of the hand and wrist. Magn Reson Imaging Clin N Am 3:191–196

    CAS  PubMed  Google Scholar 

  23. Naraghi AM, White LM, Patel C, Tomlinson G, Keystone EC (2009) Comparison of 1.0-T extremity MR and 1.5-T conventional high-field-strength MR in patients with rheumatoid arthritis. Radiology 251:829–837

    Article  PubMed  Google Scholar 

  24. Ejbjerg BJ, Narvestad E, Jacobsen S, Thomsen HS, Ostergaard M (2005) 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 64:1280–1287

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Axelsen MB, Stoltenberg M, Poggenborg RP, Kubassova O, Boesen M, Bliddal H et al (2012) Dynamic gadolinium-enhanced magnetic resonance imaging allows accurate assessment of the synovial inflammatory activity in rheumatoid arthritis knee joints: a comparison with synovial histology. Scand J Rheumatol 41:89–94

    Article  CAS  PubMed  Google Scholar 

  26. Boesen M, Kubassova O, Bouert R, Axelsen MB, Ostergaard M, Cimmino MA et al (2012) Correlation between computer-aided dynamic gadolinium-enhanced MRI assessment of inflammation and semi-quantitative synovitis and bone marrow oedema scores of the wrist in patients with rheumatoid arthritis--a cohort stud. Rheumatology (Oxford) 51:134–143

    Article  Google Scholar 

  27. Barth MM, Smith MP, Pedrosa I, Lenkinski RE, Rofsky NM (2007) Body MR imaging at 3.0 T: understanding the opportunities and challenges. Radiographics 27:1445–1462, discussion 1462-4

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is Mikkel Ostergaard. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Rheumatology (Oxford). 2014 Mar 21.: Krabbe S, Eshed I, Pedersen SJ, Bøyesen P, Møller JM, Therkildsen F, Axelsen MB, Madsen OR, Ostergaard M."Bone marrow oedema assessment by magnetic resonance imaging in rheumatoid arthritis wrist and metacarpophalangeal joints: the importance of field strength, coil type and image resolution." Methodology: prospective, diagnostic or prognostic study, multicenter study.

Author information

Authors and Affiliations

  1. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark

    Simon Krabbe, Mikkel Østergaard, Mette Axelsen & Susanne Juhl Pedersen

  2. Department of Diagnostic Imaging, The Sheba Medical Center, Tel Hashomer, 52621, Israel

    Iris Eshed

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Iris Eshed

  4. Department of Rheumatology/C, Copenhagen University Hospital Gentofte, Copenhagen, Denmark

    Mikkel Østergaard & Ole Rintek Madsen

  5. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

    Pernille Bøyesen

  6. Department of Radiology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark

    Jakob M. Møller

  7. Metropolitan University College, Copenhagen, Denmark

    Flemming Therkildsen

Authors
  1. Iris Eshed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simon Krabbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikkel Østergaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pernille Bøyesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jakob M. Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Flemming Therkildsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ole Rintek Madsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mette Axelsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Susanne Juhl Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iris Eshed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eshed, I., Krabbe, S., Østergaard, M. et al. Influence of field strength, coil type and image resolution on assessment of synovitis by unenhanced MRI – a comparison with contrast-enhanced MRI. Eur Radiol 25, 1059–1067 (2015). https://doi.org/10.1007/s00330-014-3470-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3470-9

Keywords

Search

Navigation