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.
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 MRI-based 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 (post-contrast 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 false-positivity of bone lesions, judged by plain MRI-based findings, was very low compared with Gd-DTPA-enhanced MRI-based findings.


CONCLUSIONS
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.
Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. tamaim@nagasaki-u.ac.jp
Mami
M
Tamai
Atsushi
A
Kawakami
Masataka
M
Uetani
Aya
A
Fukushima
Kazuhiko
K
Arima
Keita
K
Fujikawa
Naoki
N
Iwamoto
Toshiyuki
T
Aramaki
Makoto
M
Kamachi
Hideki
H
Nakamura
Hiroaki
H
Ida
Tomoki
T
Origuchi
Kiyoshi
K
Aoyagi
Katsumi
K
Eguchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media; D005260:Female; D005384:Finger Joint / Q000473:pathology*; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D011237:Predictive Value of Tests; D012217:Rheumatoid Factor / Q000097:blood; D013585:Synovitis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D014955:Wrist Joint / Q000473:pathology*; D055815:Young Adult
D015415:Biomarkers; D003287:Contrast Media; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor; D019786:Gadolinium DTPA