title: Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate and characterize magnetic resonance imaging (MRI) findings in the metacarpophalangeal (MCP) joints of rheumatoid arthritis (RA) patients macroscopically, using miniarthroscopy (MA; needle arthroscopy).
  
  
  METHODS
  The second MCP joint of the dominant hand of 22 RA patients (13 with various RA activities/stages; 9 with early RA [< or = 1.5 years' duration]) was examined by MRI followed by MA. Findings were evaluated by standardized semiquantitative measures of synovial and bony pathologic changes of the MCP joint, and were compared with the clinical and conventional radiologic findings.
  
  
  RESULTS
  Erosions and pre-erosions were detected in 17 of 22 patients by MRI; 2 of the other 5 patients (all early RA) displayed bony changes on MA. All 10 joints with pre-erosions on MRI (grade I bony alterations on MRI) exhibited significant cartilaginous and bony pathology on MA. Synovial membrane pathology was detected in all but 1 patient by MRI and in all patients by MA, although findings of plain radiography were normal in 6 of the 22 patients and another 9 patients had a Larsen score of 1. Semiquantitative analysis of synovial findings of MRI revealed gadolinium diethylenetriaminepentaacetic acid enhancement as a significant marker of macroscopically varied synovial vascularity and hyperemia, both of which strongly correlated with clinical activity (as measured by the Disease Activity Score). The extent of synovitis/synovial proliferation shown by MA and MRI were significantly correlated with each other, but not with any other activity or damage parameter analyzed.
  
  
  CONCLUSIONS
  In RA, both MRI and MA findings support early detection and staging of synovial changes. Ongoing longitudinal studies are aimed at evaluating the value of synovial proliferation as visualized by both methods.
authors.affiliation: Center for Rheumatology, Department of Nephrology and Rheumatology, Heinrich-Heine University of Düsseldorf, Germany. ostendorf@rheumanet.org
authors.forename: B
authors.initials: B
authors.lastname: Ostendorf
authors.forename: R
authors.initials: R
authors.lastname: Peters
authors.forename: P
authors.initials: P
authors.lastname: Dann
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: A
authors.initials: A
authors.lastname: Scherer
authors.forename: F
authors.initials: F
authors.lastname: Wedekind
authors.forename: J
authors.initials: J
authors.lastname: Friemann
authors.forename: K P
authors.initials: KP
authors.lastname: Schulitz
authors.forename: U
authors.initials: U
authors.lastname: Mödder
authors.forename: M
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D001182:Arthroscopy / Q000379:methods*; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D011859:Radiography; D015203:Reproducibility of Results; D013583:Synovial Membrane / Q000473:pathology; D013585:Synovitis / Q000473:pathology