Quantifying bone marrow edema in the rheumatoid cervical spine using magnetic resonance imaging.
OBJECTIVE
To determine the reliability and feasibility of a new magnetic resonance imaging (MRI) score to quantify bone marrow edema (BME), synovitis, and erosions in the cervical spine of patients with rheumatoid arthritis (RA); and to investigate the correlations among neck pain, clinical markers of RA disease activity, and MRI features of disease activity in the cervical spine.


METHODS
Thirty patients with RA (50% with neck pain) and a Disease Activity Score 28-joint count > 3.2 had an MRI scan of their cervical spine. STIR, VIBE, and T1-weighted postcontrast sequences were used to quantify BME. MRI scans were scored for total BME, synovitis, and erosions using a new scoring method developed by the authors and assessed for reliability and feasibility. Associations between neck pain and clinical markers of disease activity were investigated.


RESULTS
BME was present in 14/30 patients; 9/14 (64%) had atlantoaxial BME, 10/14 (71%) had subaxial BME, and 5/14 (36%) had both. Interobserver reliability for total cervical BME score was moderate [intraclass correlation coefficient (ICC) = 0.51]. ICC improved to 0.67 if only the vertebral bodies and dens were considered. There was no correlation between neck pain or clinical measures of RA disease activity and the presence of any MRI features including BME, synovitis, or erosions.


CONCLUSIONS
Current RA disease activity scores do not identify activity in the cervical spine. An MRI score that quantifies BME, synovitis, and erosions in the cervical spine may provide useful information regarding inflammation and damage. This could alert clinicians to the presence of significant pathology and influence management.
Suppiah
Ravi
R
Department of Rheumatology and Department of Radiology, Auckland District Health Board, Auckland, United Kingdom. ravi.suppiah@gmail.com
Doyle
Anthony
A
Rai
Raylynne
R
Dalbeth
Nicola
N
Lobo
Maria
M
Braun
Jürgen
J
McQueen
Fiona M
FM
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000209:etiology; D002574:Cervical Vertebrae / Q000473:pathology*; D004487:Edema / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013585:Synovitis / Q000209:etiology / Q000473:pathology