Page 100 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints
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                                Chapter 6
Objective: To evaluate 0.2T extremity MRI for detecting synovitis, bone erosions, and bone marrow oedema (BME) in patients with early inflammatory hand arthralgia, by comparison with 1.5T conventional MRI and ultrasound.
Methods: 40 patients with arthralgia or early arthritis in wrist or hand had contrast-enhanced MRI of wrist and MCP joints on 0.2T extremity MRI and 1.5T conventional MRI. The MRI examinations were evaluated for synovitis, erosions and BME using RAMRIS. 26 of those patients also had two ultrasound (US) examinations, once by using standardized views and once with free viewing. Both ultrasound examinations evaluated the MCP joints for synovitis and erosions and the wrist for synovitis.
Results: Agreement between the MRI scanners for detection of synovitis was good (κ=0.65), erosions moderate (κ=0.48), and BME poor (κ=0.19). 0.2T MRI detected less erosions than 1.5T MRI (82 vs 96) and less BME (8 vs 42). There was poor agreement between the different US scoring methods for synovitis (κ=0.13) and between the US and MRI method (κ=0.24-0.32). The standardized US method identified less joints with synovitis than 0.2T MRI (23 vs 46) but was very specific (93%). Almost no (6 and 0) erosions were found with the two different US methods.
Conclusions: In patients with hand arthralgia and early arthritis, contrast enhanced 0.2T MRI is good in detecting synovitis, slightly less sensitive for erosion detection than 1.5T, and more sensitive than US for both synovitis and erosions. However, most BME lesions were missed with 0.2T MRI, suggesting that higher field-strength scanners should be used for BME detection.

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