Vol.22 No.5

Original Article

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

Authors

Mami Tamai1,2 , Atsushi Kawakami1 , Masataka Uetani3 , Aya Fukushima3 , Kazuhiko Arima4 , Keita Fujikawa5 , Naoki Iwamoto1 , Toshiyuki Aramaki6 , Makoto Kamachi1 , Hideki Nakamura1 , Hiroaki Ida7 , Tomoki Origuchi8, Kiyoshi Aoyagi9, Katsumi Eguchi10

  • Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Center for Health and Community Medicine, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan
  • Department of Radiology and Radiation Research, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Department of Medical Gene Technology, Atomic Bomb Disease Institute, Nagasaki University School of Health Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Department of Rheumatology, Isahaya Healthy Insurance General Hospital, 24-1 Eisyohigashi-machi, Isahaya, 854-8501, Japan
  • Department of Rheumatology, Japanese Red Cross Nagasaki Genbaku Hospital, 3-15 Mori-machi, Nagasaki, 852-8511, Japan
  • Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University, 67 Asahi-machi, Kurume, 830-0011, Japan
  • Department of Rehabilitation Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Department of Public Health, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Sasebo City General Hospital, 9-3 Hirase-machi, Sasebo, 857-8511, Japan
Received:

25 July 2011

Accepted:

25 November 2011

Published online:

28 December 2011

Full Text

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Abstract

Objective To explore whether synovitis and bone lesions in the wrists and finger joints visualized by plain magnetic resonance imaging (MRI)-based findings correspond exactly or not to those judged by gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRIbased findings. Methods Magnetic resonance imaging of the wrists and finger joints of both hands were examined in 51 early-stage rheumatoid arthritis (RA) patients whose median disease duration from the onset of articular manifestations to entry was 5 months, by both plain (T1 and short-time inversion recovery images) and Gd-DTPA-enhanced MRI (postcontrast fat-suppressed T1-weighted images) simultaneously. We focused on 15 sites per hand, to examine the presence of synovitis and bone lesions (bone edema and bone erosion). Gd-DTPA-enhanced MRI-based findings were considered ‘‘true’’ lesions, and we evaluated the accuracy of plain MRI-based findings in comparison to Gd-DTPA-enhanced MRI-based findings. Results Synovitis, judged by plain MRI-based findings, appeared as false-positive at pretty frequency; thus, the specificity, positive predictive value and accuracy of the findings were low. The rate of enhancement (E-rate) in false-positive synovitis sites was significantly low compared with true-positive synovitis sites where Gd-DTPA enhancement appears. In contrast to synovitis, the falsepositivity of bone lesions, judged by plain MRI-based findings, was very low compared with Gd-DTPA-enhanced MRI-based findings. Conclusion Synovitis judged by plain MRI-based findings is sometimes considered false-positive especially in sites where synovitis is mild. However, plain MRI is effective in identifying bone lesions in the wrist and finger joints in early-stage RA.

Key words

Early-stage RA - Plain MRI - Gd-DTPA-enhanced MRI - Synovitis - Bone lesions