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Rheumatoid Arthritis of the Hand and Wrist: Comparison of Three Imaging Techniques

Bachir Taouli1,2, Souhil Zaim1, Charles G. Peterfy1, John A. Lynch1, Alexander Stork1, Ali Guermazi1, Bo Fan1, Kenneth H. Fye3 and Harry K. Genant1

1 Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA 94143-0628.
2 Department of Radiology, NYU Medical Center, 560 First Ave., TCH-HW202, New York, NY 10016-6497.
3 Division of Rheumatology, University of California, San Francisco, 400 Parnassus Ave., ACC 587, Box 0326, San Francisco, CA 94143-0326.



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  		Fig. 1A. —42-year-old woman with rheumatoid arthritis. Posteroanterior radiograph reveals multiple erosions of carpal bones (arrows).

 


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  		Fig. 1B. —42-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted spin-echo conventional high-field-strength MR image reveals multiple erosions of carpal bones (arrows). Triquetral erosion (arrowhead) is not visible on radiograph because of pisiform superposition.

 


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  		Fig. 1C. —42-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted gradient-recalled echo low-field-strength dedicated extremity MR image reveals multiple erosions of carpal bones (arrows), seen on two adjacent slices because of different slice location (not shown).

 


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  		Fig. 1D. —42-year-old woman with rheumatoid arthritis. Adjacent unenhanced coronal T1-weighted gradient-recalled echo low-field-strength dedicated extremity MR image reveals triquetral erosion (arrow) not visible on radiography because of pisiform superposition.

 


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  		Fig. 2A. —71-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted spin-echo conventional high-field-strength MR image shows multiple erosions and synovitis of left second to fifth metacarpophalangeal joints (arrows).

 


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  		Fig. 2B. —71-year-old woman with rheumatoid arthritis. Unenhanced coronal T2*-weighted fast gradient-echo conventional high-field-strength MR image in steady state with fat saturation shows multiple erosions and synovitis of left second to fourth metacarpophalangeal joints (arrows).

 


View larger version (139K):

[in a new window]
  		Fig. 2C. —71-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted gradient-recalled echo low-field-strength dedicated extremity MR image shows multiple erosions and synovitis of left second to fifth metacarpophalangeal joints (arrows).

 


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  		Fig. 2D. —71-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted gradient-recalled echo low-field-strength dedicated extremity MR image shows multiple erosions and synovitis of left second to fourth metacarpophalangeal joints (arrows).

 


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  		Fig. 3A. —52-year-old man with rheumatoid arthritis. Posteroanterior radiograph reveals severe joint-space narrowing of carpus and radiocarpal joints, with grade 4 joint ankylosis (arrows) between capitate, scaphoid, lunate, and triquetrum bones.

 


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  		Fig. 3B. —52-year-old man with rheumatoid arthritis. Unenhanced coronal T1-weighted spin-echo conventional high-field-strength MR image reveals severe joint-space narrowing of carpus and radiocarpal joints, with grade 4 joint ankylosis (arrow) between capitate, scaphoid, lunate, and triquetrum bones.

 


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  		Fig. 3C. —52-year-old man with rheumatoid arthritis. Unenhanced coronal T2*-weighted fast gradient-echo conventional high-field-strength MR image in steady state with fat saturation reveals severe joint-space narrowing of carpus and radiocarpal joints, with grade 4 joint ankylosis (arrow) between capitate, scaphoid, lunate, and triquetrum bones.

 


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  		Fig. 3D. —52-year-old man with rheumatoid arthritis. Unenhanced coronal T1-weighted gradient-recalled echo low-field-strength dedicated extremity MR image also reveals severe joint-space narrowing of carpus and radiocarpal joints, with grade 4 joint ankylosis (arrows) between capitate, scaphoid, lunate, and triquetrum bones.

 


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  		Fig. 4A. —42-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted spin-echo conventional high-field-strength MR image reveals synovitis (arrows) at ulnar side of wrist and first carpometacarpal joint in low signal.

 


View larger version (141K):

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  		Fig. 4B. —42-year-old woman with rheumatoid arthritis. Unenhanced coronal T2*-weighted fast gradient-echo conventional high-field-strength MR image in steady state with fat saturation reveals synovitis (arrows) at ulnar side of wrist and first carpometacarpal joint in high signal.

 


View larger version (96K):

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  		Fig. 4C. —42-year-old woman with rheumatoid arthritis. Unenhanced coronal T1-weighted gradient-recalled echo low-field-strength dedicated extremity MR image reveals synovitis (arrows) at ulnar side of wrist and first carpometacarpal joint in low signal.

 


View larger version (138K):

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  		Fig. 4D. —42-year-old woman with rheumatoid arthritis. Unenhanced coronal T2-weighted short time inversion recovery low-field-strength dedicated extremity MR image reveals synovitis (arrows) at ulnar side of wrist and first carpometacarpal joint in high signal.

 

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