A simplified fluid-sensitive MRI protocol for the hands to detect inflammation without contrast administration: a large study of symptom-free subjects from the general population as a reference for normality
Skeletal Radiology, vol. 54, pp. 1429–1439
Abstract
OBJECTIVE: MRI of the hands is valuable for risk-stratification in patients with arthralgia at-risk for developing rheumatoid arthritis (RA). Contrast-enhanced MRI is considered standard for assessment of RA, but has practical disadvantages. It also shows inflammation-like features in the general population, especially at older age, which should be considered in image interpretation. The modified-Dixon (mDixon) technique is reliable compared to contrast-enhanced sequences. Moreover, this short protocol without contrast-enhancement is patient-friendly. Whether it also shows inflammation-like features in the general population is unknown. We studied this to support accurate use in the clinic. METHODS: Two hundred twenty symptom-free volunteers from different age-categories were recruited from the general population and underwent mDixon MRI of both hands. Two readers independently scored MRIs for synovitis, tenosynovitis, and bone marrow edema (BME) in the metacarpophalangeal-joints (MCP) and wrists according to the RAMRIS. Features were considered present if scored by both readers; frequencies > 5% were considered relevant in terms of specificity and determined per age-category (< 40/40- < 60/ ≥ 60-years). RESULTS: Higher age correlated with higher BME-scores (p-value < 0.005), but not with synovitis and tenosynovitis-scores. BME (grade 1) occurred in some bones in people aged ≥ 60, 14% had BME in the lunate, 7% in metacarpal-1, and 6% in the trapezium. Synovitis and tenosynovitis did not occur in > 5%, except for grade-1 synovitis in the right distal radio-ulnar-joint in people aged ≥ 60 (11%). CONCLUSION: On mDixon MRI, inflammatory features in the hands of the general population are rare. This facilitates image interpretation. To prevent overinterpretation, only several locations should be considered when evaluating people aged ≥ 60-years.
Authors 8
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Leiden University · Leiden University Medical Center · Erasmus MC
Affiliation as printed
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands. a.boeren@erasmusmc.nl
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. a.boeren@erasmusmc.nl
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Leiden University · Leiden University Medical Center · Erasmus MC
Affiliation as printed
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Bianca M. Boxma‐de Klerk Aachen Department of Clinical Epidemiology Department of Rheumatology, Leiden University Medical Centre
Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Clinical Epidemiology, Leiden University Medical Centre, Rotterdam, The Netherlands
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Affiliation as printed
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Affiliation as printed
Department of Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Centre, Rotterdam, The Netherlands
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Annette H M van der Helm–van Mil Aachen Department of Rheumatology, Leiden University Medical Centre
Leiden University · Leiden University Medical Center · Erasmus MC
Affiliation as printed
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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