title: Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset Bone Marrow Edema Is the Most Specific Finding for Rheumatoid Arthritis (RA) on Noncontrast Magnetic Resonance Imaging of the Hands and Wrists: A Comparison of Patients with RA and Healthy Controls Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. MRI and sonography of the shoulder. The role of ultrasonography in early detection and monitoring of shoulder erosions, and disease activity in rheumatoid arthritis patients; comparison with MRI examination. MR imaging findings in hands in early rheumatoid arthritis: comparison with those in systemic lupus erythematosus and primary Sjögren syndrome. Susceptibility-weighted MR imaging to improve the specificity of erosion detection: a prospective feasibility study in hand arthritis MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA) Magnetic Resonance Imaging of the Rheumatic Foot According to the RAMRIS System Is Reliable
abstract: OBJECTIVE To determine the role of ultrasound and magnetic resonance imaging ( MRI ) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis ( RA ) of the shoulder joint . METHODS Forty-three consecutive patients with known RA prospect ively underwent clinical examination , radiography , ultrasound , and MRI of the shoulder joints . Each patient was assigned a clinical /laboratory score consisting of 7 parameters , including measurements of shoulder mobility , the erythrocyte sedimentation rate , and C-reactive protein level .  Conventional radiography was st and ardized and performed in 2 planes . Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer . MRI at 1.5 T comprised transverse and oblique coronal T1- and T2 * -weighted fast spin-echo , gradient-echo ( GRE ) , and inversion-recovery sequences with a matrix size of up to 512 pixels . A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium . Erosions were assessed using all 3 imaging techniques on a 4-point scale . Soft-tissue involvement was evaluated according to the presence of synovitis , tenosynovitis , and bursitis on ultrasound and MRI . The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain . RESULTS In the study group , erosions of the humeroscapular joint were detected by conventional radiography in 26 patients , by ultrasound in 30 patients , and by MRI in 39 patients ; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI ( P < 0.0001 ) . Conventional radiography detected 12 erosions of the scapula and MRI detected 15 . Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI ( P = 0.0003 ) . Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI ( P = 0.0064 ) . Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI . The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI ( P < 0.05 ) . CONCLUSION Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint . Although conventional radiography can be used as the sole method of following up known joint destruction in RA , ultrasound and , preferably , MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results OBJECTIVES To evaluate the role of magnetic resonance imaging ( MRI ) of the wrist in detecting early joint damage in patients with rheumatoid arthritis ( RA ) . METHODS  MRI was performed on 42 patients with early RA ( median symptom duration of four months ) . Scans were scored separately by two musculoskeletal radiologists using a newly devised scoring system , which was vali date d. MRI findings were compared with plain radiography , clinical measures , and HLA-DRB*01/04 genotyping . RESULTS Interobserver reliability for the overall MRI score was high ( r = 0.81 ) as was intraobserver reliability ( r = 0.94 for observer 1 and 0.81 for observer 2 ) . There was more variation in scoring synovitis ( interobserver reliability : r = 0.74 ) . Erosions were detected in 45 % of scans ( 19 of 42 ) , compared with 15 % of plain radiographs . The most common site for erosions was the capitate ( 39 % ) , for synovitis the ulnar aspect of the radiocarpal joint , and for tendonitis , the extensor carpi ulnaris tendon . The total MRI score and MRI synovitis score correlated most significantly with C reactive protein ( r = 0.40 and 0.42 respectively , p<0.01 ) . The MRI erosion score was highly correlated with MRI bone marrow oedema ( r = 0.83 ) as well as the Ritchie score and disease activity score ( r = 0.32 , p<0.05 ) . HLA-DRB1 * 04 or * 01 ( shared epitope + ve ) was found in 76 % of patients ; 84 % of those with MRI erosions and 69 % of those without ( NS , p = 0.3 ) . CONCLUSIONS A high proportion of RA patients develop MRI erosions very early in their disease , when plain radiography is frequently normal . MRI of the dominant wrist may identify those requiring early aggressive treatment Objective . To evaluate the sensitivity and specificity of magnetic resonance imaging ( MRI ) in detecting erosions , bone edema , and synovitis in the metacarpophalangeal and wrist joints for rheumatoid arthritis ( RA ) . Methods . MRI scans of bilateral h and s and wrists of 40 healthy subjects and 40 RA patients were performed using 0.2 T extremity-MRI and read blindly using a modified RA MRI ( RAMRIS ) system ( no contrast injection , imaging in 1 plane only ) . To determine interreader reliability , images of 10 r and omly selected subjects were read independently by a musculoskeletal radiologist . Results . A total of 3360 bones were evaluated . Patients with RA had significantly more erosions as well as higher scores for bone edema and synovitis than healthy subjects . Age had a significant effect on the number of erosions in both groups . However , when disease duration was factored in , age became insignificant in RA patients . Erosion number correlated with positive rheumatoid factor and higher C-reactive protein values . The intraclass correlation coefficient between the 2 readers was 0.76 for individual joints and 0.88 for total scores . When having a single erosion was used as a positive test for RA , the sensitivity of this test was 90 % , but the specificity was only 35 % . Presence of bone edema provided 65 % sensitivity and 82.5 % specificity . Eliminating the lunate from scoring for bone edema increased the specificity to 87.5 % while decreasing the sensitivity to 62.5 % . Conclusion . While MRI is a highly sensitive tool for identifying and tracking the progression of erosions , erosions detected by MRI with measures commonly used in a rheumatologist ’s office ( no contrast , imaging in 1 plane ) provide low specificity for RA . Bone marrow edema is the most specific MRI lesion for RA in this setting Objectives To determine the accuracy of ultrasonography ( US ) for bone erosion detection in different areas of rheumatoid arthritis ( RA ) metacarpophalangeal ( MCP ) joints with multislice CT as the reference method . Second , to establish the necessary bone volume loss on CT for US to reliably detect it as an erosion , and finally to compare two semiquantitative US-erosion scoring methods . Methods The 2nd–5th MCP joints of 49 patients with RA were examined by CT and US  , and evaluated for the presence of bone erosion in each MCP joint quadrant . On CT , erosion volume was scored according to the OMERACT-RAMRIS score ( bone volume loss in 10 % increments of original bone volume ) . US erosions were scored 0–3 according to the Szkudlarek and Scoring by UltraSound Structural erosion ( ScUSSe ) systems , respectively . Results Seven hundred and eighty-four MCP joint quadrants were examined . Erosions were detected by CT in 259 quadrants and by US in 142 quadrants . Sensitivity/specificity/accuracy of US was overall 44%/95%/78 % compared with 71%/95%/90 % in areas with good US accessibility ( radial 2nd MCP , ulnar 5th MCP and all dorsal/palmar aspects ) . US detected 95 % of erosions with bone volume loss > 20 % . In US accessible areas , 63 % of erosions with 1–10 % bone volume loss and 94 % of erosions with > 10 % bone loss were detected . The two US scoring systems agreed well on large erosions , whereas the smallest erosions ( Szkudlarek grade 1 , of which 86 % were confirmed by CT ) were not scored by ScUSSe . Conclusion In accessible areas , US was highly accurate for detection and semiquantitative assessment of RA bone erosion . Even the smallest erosions , only detected in one plane , were generally confirmed by CT OBJECTIVE Magnetic resonance imaging ( MRI ) is capable of revealing synovitis and tendinitis in early rheumatoid arthritis ( RA ) , as well as bone edema and erosion . These features are visible before radiographic joint damage occurs . We sought to examine whether MRI of one body region ( the wrist ) can be used to predict whole-body radiography scores reflecting joint damage at 6 years . METHODS We conducted a 6-year prospect i ve study of a cohort of patients who fulfilled the criteria for RA at presentation , using clinical parameters , radiographs , and MRI scans of the dominant wrist . Of the 42 patients enrolled at baseline , full MRI , radiographic , and clinical data were available for 31 at 6-year followup .  MRI scans were scored by 2 radiologists , using a vali date d scoring system . Radiographs of the h and s and feet were grade d using the modified Sharp scoring method . MRI and radiography scores obtained at baseline and 6 years were compared , and baseline MRI scores were examined for their ability to predict radiographic outcome at 6 years . RESULTS At 6 years , the total Sharp score correlated significantly with the total MRI score and the MRI erosion score ( r = 0.81 , P < 0.0001 and r = 0.79 , P < 0.0001 , respectively ) . The 6-year Sharp score also correlated with the baseline total MRI and MRI erosion scores ( r = 0.56 , P < 0.0001 and r = 0.33 , P = 0.03 , respectively ) . MRI synovitis and bone edema scores remained constant for the group as a whole over 6 years , but bone erosion scores progressed ( P = 0.0001 ) , consistent with radiographic deterioration . Erosions on 6-year MRI scans were frequently preceded by MRI bone edema at baseline ( odds ratio 6.5 , 95 % confidence interval 2.78 - 18.1 ) . Regression models indicated that the baseline MRI bone edema score was predictive of the 6-year total Sharp score ( P = 0.01 ) , as was the C-reactive protein ( CRP ) level ( P = 0.0002 ) . Neither shared epitope status nor swollen or tender joint counts predicted radiographic outcome in this cohort . A model incorporating baseline MRI scores for erosion , bone edema , synovitis , and tendinitis plus the CRP level and the erythrocyte sedimentation rate explained 59 % of the variance in the 6-year total Sharp score ( R(2 ) = 0.59 , adjusted R(2 ) = 0.44 ) . CONCLUSION MRI scans performed at the first presentation of RA can be used to help predict future radiographic damage , allowing disease-modifying therapy to be targeted to patients with aggressive disease OBJECTIVE To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis ( RA ) . METHODS Forty patients with early , untreated RA underwent gadolinium-enhanced magnetic resonance imaging ( MRI ) of the second through fifth metacarpophalangeal joints of the dominant h and at presentation , 3 months , and 12 months . In the first phase ( 0 - 3 months ) , patients were r and omized to receive either methotrexate alone ( MTX ) or MTX and intraarticular corticosteroids ( MTX + IAST ) into all joints with clinical ly active RA . The MTX-alone group received no further corticosteroids until the second phase ( 3 - 12 months ) , when both groups received st and ard therapy . RESULTS In the first phase , MTX + IAST reduced synovitis scores more than MTX alone . There were significantly fewer joints with new erosions on MRI in the former group compared with the latter . During the second phase , the synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI . In both phases , there was a close correlation between the degree of synovitis and the number of new erosions , with the area under the curve for MRI synovitis the only significant predictor of bone damage progression . In individual joints , there was a threshold effect on new bone damage related to the level of synovitis ; no erosions occurred in joints without synovitis . CONCLUSION In early RA , synovitis appears to be the primary abnormality , and bone damage occurs in proportion to the level of synovitis but not in its absence . In the treatment of patients with RA , outcome measures and therapies should focus on synovitis We prospect ively evaluated the diagnostic value of sonography and magnetic resonance imaging ( MRI ) in 24 shoulders in 23 patients with suspected rotator cuff tears using arthrography as gold st and ard . Sonography demonstrated 14 of 15 , MRI 10 of 15 rotator cuff tears , respectively . Sonography diagnosed seven of nine intact rotator cuffs correctly , MRI eight of nine . In a retrospective study we review ed the diagnostic value of sonography and MRI in other pathologies of the shoulder including intra-articular pathology , humeral head and acromioclavicular joint pathology , and calcification . We conclude that with regard to cost and patient compliance , sonography should be the first radiologic examination in suspected rotator cuff tears if performed by an experienced sonographer . MRI is superior in depicting additional pathology and is less operator dependent . It may thus become the method of choice for the evaluation of the rotator cuff and related pathology in the future OBJECTIVES To determine the accuracy of ultrasound in early detection of bone erosions and monitoring disease activity in rheumatoid arthritis ( RA ) patients using magnetic resonance imaging ( MRI ) as a gold st and ard technique . MATERIAL AND METHODS This prospect i ve study was carried out on 50 patients with known RA and 15 healthy controls .  Conventional radiography was st and ardized and performed in two planes . Ultrasound ( US ) and MRI was performed to evaluate the presence of synovitis , tenosynovitis , and bursitis as well as erosions on ultrasound and MRI .  The results in the study group were compared with those obtained in a control group . RESULT In the study group , the most frequent US finding of shoulder joint was Tenosynovitis of the long head of the biceps tendon . Tenosynovitis was observed in the long head of biceps tendon in 20 joints ( 40 % ) . Erosions of the humeroscapular joint were detected by conventional radiography in 15 ( 30 % ) , by US in 41 ( 82 % ) , and by MRI in 46 ( 92 % ) of the shoulders examined , no statistically significant difference is noted between US and MRI in overall detection of erosion ( P = .333 ) . CONCLUSION US is a helpful imaging method and in comparison with MRI in assessing the shoulder joint and , preferably with MRI , are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results PURPOSE To evaluate prospect ively the use of magnetic resonance ( MR ) imaging for differentiating true rheumatoid arthritis ( RA ) from systemic lupus erythematosus ( SLE ) or primary Sjögren syndrome in patients who have inflammatory polyarthralgia of the h and s but no radiographic evidence of RA . MATERIAL S AND METHODS This study had institutional review board approval , and patient informed consent was obtained . Twenty-eight patients ( 16 female and 12 male patients ; mean age , 42 years ) with early RA and 19 patients ( 18 female and one male patient ; mean age , 46 years ) with SLE ( n = 14 ) or primary Sjögren syndrome ( n = 5 ) underwent MR imaging of both h and s.  All patients had inflammatory polyarthralgia of the h and s and no evidence of erosive changes on radiographs . Coronal T2-weighted short inversion time inversion-recovery , transverse T1-weighted spin-echo , transverse fat-suppressed gadolinium-enhanced T1-weighted spin-echo , and transverse gadolinium-enhanced three-dimensional gradient-echo MR images were obtained . The following MR imaging variables were assessed in the wrist and nonthumb metacarpophalangeal joints : synovitis , bone lesions ( erosion , defect , and edema ) , and tenosynovitis . Synovitis and bone lesions were scored with the OMERACT RA-MRI scoring system . Findings in patients with RA and those without RA were compared by means of Mann-Whitney , chi2 , and Fisher exact tests . RESULTS The only significant difference between the two groups in terms of individual scores for synovitis , bone lesions , and tenosynovitis was the more frequent presence of tenosynovitis of the right fourth extensor tendon in patients without RA ( P = .04 ) . There were no significant differences between patients with RA and those without RA in terms of global scores for synovitis , bone lesions , and tenosynovitis . However , bone marrow edema in the metacarpophalangeal joints was seen more frequently in patients with RA ( P < .001 ) . CONCLUSION It may be impossible to distinguish between patients with early RA and those without RA ( ie , those with SLE or primary Sjögren syndrome ) by means of MR imaging Objective To evaluate the diagnostic potential of susceptibility-weighted imaging ( SWI ) for the detection of erosions of the h and , compared to T1-weighted ( T1w ) magnetic resonance imaging ( MRI ) . Computed tomography ( CT ) was used as a reference st and ard . Material s and methods We prospect ively investigated 37 patients with suspected arthritic activity of the h and . All patients underwent T1w , SWI , and CT on the same day . Patients were r and omized to MRI or CT  first . CT , T1w , SWI , and T1w/SWI were scored for erosions according to OMERACT RAMRIS guidelines . Specificity , sensitivity , and diagnostic accuracy were separately calculated for T1w , SWI , and T1w/SWI on a per-patient and per-bone basis using CT as reference . The one-tailed McNemar test was performed to test the number of erosion-positive patients in T1w , SWI , and T1w/SWI for non-inferiority . Measured erosion sizes were compared using Pearson ’s test . Results CT was positive for erosions in 16 patients and 55 bones . SWI and T1w/SWI had superior diagnostic accuracy ( 91.2 and 93.8 % ) compared to T1w ( 87.8 % ) driven by a higher specificity ( 93.8 and 96.5 % ) compared to T1w ( 88.8 % ) . On the patient level , SWI and T1w/SWI showed non-inferiority ( p = 0.11 and p = 0.38 ) but not T1w alone ( p < 0.0001 ) . The lesion size on CT correlated better with SWI ( Pearson ’s r = 0.92 ) compared to T1w ( r = 0.69 ) . Conclusions Adding SWI to a st and ard MRI protocol has the potential to improve erosion detection in h and s by increasing specificity . SWI depicts bony erosions more accurately compared to st and ard MRI techniques Objective : To identify predictors of radiographic progression in a 2-year r and omised , double-blind , clinical study ( CIMESTRA ) of patients with early rheumatoid arthritis ( RA ) . Methods : Patients with early RA ( n = 130 ) were treated with methotrexate , intra-articular betamethasone and ciclosporin/placebo-ciclosporin . Baseline magnetic resonance imaging ( MRI ) of the wrist ( wrist-only group , n = 130 ) or  MRI  of  wrist and metacarpophalangeal ( MCP ) joints ( wrist+MCP group , n = 89 ) ( OMERACT RAMRIS ) ,  x-ray examination  of h and s , wrists and forefeet ( Sharp/van der Heijde Score ( TSS ) ) , Disease Activity Score ( DAS28 ) , anti-cyclic citrullinated peptide antibodies ( anti-CCP ) , HLA-DRB1-shared epitope ( SE ) and smoking status were assessed . Multiple regression analysis was performed with delta-TSS ( 0–2 years ) as dependent variable and baseline DAS28 , TSS , MRI bone oedema score , MRI synovitis score , MRI erosion score , anti-CCP , smoking , SE , age and gender as explanatory variables . Results : Baseline values : median DAS28 5.6 ( range 2.4–8.0 ) ; anti-CCP positive 61 % ; radiographic erosions 56 % . At 2 years : DAS28 2.0 ( 0.5–5.7 ) , in DAS remission : 56 % , radiographic progression 26 % ( wrist+MCP group , similar for wrist-only group ) . MRI bone oedema score was the only independent predictor of delta-TSS ( wrist+MCP group : coefficient = 0.75 ( 95 % CI 0.55 to 0.94 ) , p<0.001 ; wrist-only group : coefficient = 0.59 ( 95 % CI 0.40 to 0.77 ) , p<0.001 ) . Bone oedema score explained 41 % of the variation in the progression of TSS ( wrist+MCP group ) , 25 % in wrist-only group ( Pearson ’s r = 0.64 and r = 0.50 , respectively ) . Results were confirmed by sensitivity analyses . Conclusion : In a r and omised controlled trial aim ing at remission in patients with early RA , baseline RAMRIS MRI bone oedema score of MCP and wrist joints ( and of wrist only ) was the strongest independent predictor of radiographic progression in h and s , wrists and forefeet after 2 years . MRI synovitis score , MRI erosion score , DAS28 , anti-CCP , SE , smoking , age and gender were not independent risk factors . Trial registration number : NCT00209859 Objective . In rheumatology , magnetic resonance imaging ( MRI ) is predominantly applied in the assessment and outcome measurement of rheumatoid arthritis ( RA ) in h and s and wrists , leading to the development of the RAMRIS ( RA-MRI-Scoring ) system . It was initiated by the Outcome Measures in Rheumatoid Arthritis Clinical Trials ( OMERACT ) . The RAMRIS system has not been applied widely in the measurement of feet . We investigated the interreader and intrareader agreement of the RAMRIS scoring system in the assessment of feet in RA . Methods . Twenty-nine patients with RA who had radiological damage and /or arthritis underwent MRI .  Two experienced readers independently read both complete sets . One reader read 6 r and om sets after the initial session , in order to assess the intrareader agreement . For evaluation of the intrareader and interreader reliability , quadratic-weighted κ scores were calculated per joint and lesion . Results . For the forefeet , interreader scores were excellent , ranging from 0.77 ( bone edema ) to 0.95 ( bone erosion ) . Hindfoot interreader agreement scores were highest for erosion ( 0.90 ) and synovitis global score ( 0.88 ) , but edema and synovial thickness agreement were also acceptable ( 0.83 and 0.86 ) . Intrareader scores were on the whole slightly lower , but excellent . Conclusion . Reliability ( interreader and intrareader agreement ) in the assessment of the rheumatoid foot according to the RAMRIS method is excellent
target: It can be classified according to their configuration , shape , content , and can be described specifically with an anatomical term . “
background: Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage .
  The correct differentiation between a true erosion and other entities — then often called “ pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease .
  The aims of this systematic review were as follows : to create a definition and delineation of the term “ pseudoerosion ” , to point out morphological pitfalls in the interpretation of images , and to report on difficulties arising from choosing different imaging modalities .