MRI of Large Intraosseous Lesions in Patients with Inflammatory Arthritis
Jamshid Tehranzadeh1,
Oganes Ashikyan1,
Jane Dascalos2 and
Carolyn Dennehey3
1 Department of Radiological Sciences, University of California, Irvine, 101 The
City Dr. S, Route 140, Orange, CA 92868
2 Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, CA
93102.
3 Department of Internal Medicine, University of California, Irvine, Orange, CA
92868.
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Fig. 1A. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Lateral
(A), oblique (B), and anteroposterior (C) radiographs of
right wrist show normal findings.
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Fig. 1B. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Lateral
(A), oblique (B), and anteroposterior (C) radiographs of
right wrist show normal findings.
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Fig. 1C. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Lateral
(A), oblique (B), and anteroposterior (C) radiographs of
right wrist show normal findings.
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Fig. 1D. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Sagittal
spin-echo T1-weighted (TR/TE, 400/10) (D), sagittal spin-echo
fat-saturated gadolinium-enhanced T1-weighted (400/9.3, obtained 9 min after
injection) (E), and sagittal spin-echo T2-weighted with fat saturation
(2,500/80) (F) images show 1.0 x 0.5 x 0.4 cm lesion in
distal radius with low signal intensity on T1-weighted images (D).
Lesion enhances with contrast administration on T1-weighted fat-saturated
image (E) and has bright signal on T2-weighted image (F). There
is no cortical break, and lesion is remote from nearest joint. Note bone
marrow edema of lunate bone.
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Fig. 1E. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Sagittal
spin-echo T1-weighted (TR/TE, 400/10) (D), sagittal spin-echo
fat-saturated gadolinium-enhanced T1-weighted (400/9.3, obtained 9 min after
injection) (E), and sagittal spin-echo T2-weighted with fat saturation
(2,500/80) (F) images show 1.0 x 0.5 x 0.4 cm lesion in
distal radius with low signal intensity on T1-weighted images (D).
Lesion enhances with contrast administration on T1-weighted fat-saturated
image (E) and has bright signal on T2-weighted image (F). There
is no cortical break, and lesion is remote from nearest joint. Note bone
marrow edema of lunate bone.
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Fig. 1F. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Sagittal
spin-echo T1-weighted (TR/TE, 400/10) (D), sagittal spin-echo
fat-saturated gadolinium-enhanced T1-weighted (400/9.3, obtained 9 min after
injection) (E), and sagittal spin-echo T2-weighted with fat saturation
(2,500/80) (F) images show 1.0 x 0.5 x 0.4 cm lesion in
distal radius with low signal intensity on T1-weighted images (D).
Lesion enhances with contrast administration on T1-weighted fat-saturated
image (E) and has bright signal on T2-weighted image (F). There
is no cortical break, and lesion is remote from nearest joint. Note bone
marrow edema of lunate bone.
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Fig. 1G. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Coronal
spin-echo T1-weighted (400/10) (G) and coronal spin-echo
gadolinium-enhanced fat-saturated T1-weighted (584/9.3, obtained immediately
after injection) (H) images show lesion (arrow) in proximal
corner in distal radius. Lesion has low signal intensity on T1-weighted image
(G) and enhances with gadolinium contrast material (H).
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Fig. 1H. —48-year-old woman with rheumatoid arthritis since childhood
and intraosseous lesion of distal radius. Radiographs failed to show
intraosseous lesion of distal radius even 25 months after MRI. Coronal
spin-echo T1-weighted (400/10) (G) and coronal spin-echo
gadolinium-enhanced fat-saturated T1-weighted (584/9.3, obtained immediately
after injection) (H) images show lesion (arrow) in proximal
corner in distal radius. Lesion has low signal intensity on T1-weighted image
(G) and enhances with gadolinium contrast material (H).
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Fig. 2A. —47-year-old man with psoriatic arthritis for 6 months and
intraosseous erosion of distal radius. Lateral radiograph of right wrist shows
juxtaarticular osteopenia with no erosion.
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Fig. 2B. —47-year-old man with psoriatic arthritis for 6 months and
intraosseous erosion of distal radius. Anteroposterior radiograph of right
wrist shows juxtaarticular osteopenia with small cystic changes of carpal
bones. Large lesion of distal radius was not visualized.
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Fig. 2C. —47-year-old man with psoriatic arthritis for 6 months and
intraosseous erosion of distal radius. Sagittal spin-echo T1-weighted (TR/TE,
400/10) (C), sagittal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (400/9.3, obtained 5 min after injection) (D), and sagittal
spin-echo fat-saturated T2-weighted (2,000/80) (E) images show
punched-out erosion of anterior articular cortex of distal radius, which has
low signal intensity on T1-weighted image (arrow) (C). Lesion
enhances with contrast administration on T1-weighted fat-saturated image
(D), has high signal on T2-weighted image (E), measures 1.0
x 0.3 x 0.7 cm, and is breaking through cortex into distal
radiocarpal joint.
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Fig. 2D. —47-year-old man with psoriatic arthritis for 6 months and
intraosseous erosion of distal radius. Sagittal spin-echo T1-weighted (TR/TE,
400/10) (C), sagittal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (400/9.3, obtained 5 min after injection) (D), and sagittal
spin-echo fat-saturated T2-weighted (2,000/80) (E) images show
punched-out erosion of anterior articular cortex of distal radius, which has
low signal intensity on T1-weighted image (arrow) (C). Lesion
enhances with contrast administration on T1-weighted fat-saturated image
(D), has high signal on T2-weighted image (E), measures 1.0
x 0.3 x 0.7 cm, and is breaking through cortex into distal
radiocarpal joint.
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Fig. 2E. —47-year-old man with psoriatic arthritis for 6 months and
intraosseous erosion of distal radius. Sagittal spin-echo T1-weighted (TR/TE,
400/10) (C), sagittal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (400/9.3, obtained 5 min after injection) (D), and sagittal
spin-echo fat-saturated T2-weighted (2,000/80) (E) images show
punched-out erosion of anterior articular cortex of distal radius, which has
low signal intensity on T1-weighted image (arrow) (C). Lesion
enhances with contrast administration on T1-weighted fat-saturated image
(D), has high signal on T2-weighted image (E), measures 1.0
x 0.3 x 0.7 cm, and is breaking through cortex into distal
radiocarpal joint.
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Fig. 2F. —47-year-old man with psoriatic arthritis for 6 months and
intraosseous erosion of distal radius. Coronal spin-echo gadolinium-enhanced
fat-saturated T1-weighted image (384/9.3, obtained immediately after
injection) shows intraosseous lesion (arrow) at distal epiphysis of
radius. Note marked synovial enhancement of wrist joint.
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Fig. 3A. —51-year-old woman with inflammatory arthritis for 8 months
and intraosseous lesion of capitate bone. Sagittal spin-echo T1-weighted
(TR/TE, 400/10) (A), sagittal spin-echo gadolinium-enhanced
fat-saturated T1-weighted (525/9.3, obtained 5 min after injection)
(B), and sagittal spin-echo T2-weighted (2,500/80) (C) images
show 1.3 x 0.7 x 1.2 cm lesion in capitate bone. Lesion has low
signal on T1-weighted image (A), enhances with contrast administration
(B), and has high signal on T2-weighted image (C).
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Fig. 3B. —51-year-old woman with inflammatory arthritis for 8 months
and intraosseous lesion of capitate bone. Sagittal spin-echo T1-weighted
(TR/TE, 400/10) (A), sagittal spin-echo gadolinium-enhanced
fat-saturated T1-weighted (525/9.3, obtained 5 min after injection)
(B), and sagittal spin-echo T2-weighted (2,500/80) (C) images
show 1.3 x 0.7 x 1.2 cm lesion in capitate bone. Lesion has low
signal on T1-weighted image (A), enhances with contrast administration
(B), and has high signal on T2-weighted image (C).
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Fig. 3C. —51-year-old woman with inflammatory arthritis for 8 months
and intraosseous lesion of capitate bone. Sagittal spin-echo T1-weighted
(TR/TE, 400/10) (A), sagittal spin-echo gadolinium-enhanced
fat-saturated T1-weighted (525/9.3, obtained 5 min after injection)
(B), and sagittal spin-echo T2-weighted (2,500/80) (C) images
show 1.3 x 0.7 x 1.2 cm lesion in capitate bone. Lesion has low
signal on T1-weighted image (A), enhances with contrast administration
(B), and has high signal on T2-weighted image (C).
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Fig. 3D. —51-year-old woman with inflammatory arthritis for 8 months
and intraosseous lesion of capitate bone. Coronal spin-echo T1-weighted
(400/10) (D), coronal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (578/9, obtained immediately after injection) (E), and
coronal spin-echo fat-saturated T2-weighted (2,200/80) (F) images show
same lesion as seen in A–C. Lesion has low signal on T1-weighted
image (D), enhances with contrast administration (E), has high
signal on T2-weighted image (F), and shows break in cortex with
intraarticular extension. Note tenosynovitis of extensor carpi ulnaris
muscle.
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Fig. 3E. —51-year-old woman with inflammatory arthritis for 8 months
and intraosseous lesion of capitate bone. Coronal spin-echo T1-weighted
(400/10) (D), coronal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (578/9, obtained immediately after injection) (E), and
coronal spin-echo fat-saturated T2-weighted (2,200/80) (F) images show
same lesion as seen in A–C. Lesion has low signal on T1-weighted
image (D), enhances with contrast administration (E), has high
signal on T2-weighted image (F), and shows break in cortex with
intraarticular extension. Note tenosynovitis of extensor carpi ulnaris
muscle.
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Fig. 3F. —51-year-old woman with inflammatory arthritis for 8 months
and intraosseous lesion of capitate bone. Coronal spin-echo T1-weighted
(400/10) (D), coronal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (578/9, obtained immediately after injection) (E), and
coronal spin-echo fat-saturated T2-weighted (2,200/80) (F) images show
same lesion as seen in A–C. Lesion has low signal on T1-weighted
image (D), enhances with contrast administration (E), has high
signal on T2-weighted image (F), and shows break in cortex with
intraarticular extension. Note tenosynovitis of extensor carpi ulnaris
muscle.
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Fig. 4A. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Lateral oblique
radiograph of right hand shows findings negative for erosion. Note deformity
of fifth metacarpal bone due to old healed fracture.
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Fig. 4B. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Anteroposterior
radiograph of right hand was unremarkable for erosion.
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Fig. 4C. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Sagittal spin-echo
T1-weighted (TR/TE, 414/10) (C), sagittal spin-echo gadolinium-enhanced
fat-saturated T1-weighted (630/9.3, obtained 5 min after injection)
(D), and sagittal spin-echo fat-saturated T2-weighted (2,799/80)
(E) images show 1.0 x 0.5 x 0.7 cm lesion in proximal
aspect of distal phalanx of fifth digit. Lesion has low signal intensity on
T1-weighted image (C), enhances with contrast administration
(D), and has high signal intensity on T2-weighted image (E).
Note synovitis of proximal interphalangeal joint.
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Fig. 4D. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Sagittal spin-echo
T1-weighted (TR/TE, 414/10) (C), sagittal spin-echo gadolinium-enhanced
fat-saturated T1-weighted (630/9.3, obtained 5 min after injection)
(D), and sagittal spin-echo fat-saturated T2-weighted (2,799/80)
(E) images show 1.0 x 0.5 x 0.7 cm lesion in proximal
aspect of distal phalanx of fifth digit. Lesion has low signal intensity on
T1-weighted image (C), enhances with contrast administration
(D), and has high signal intensity on T2-weighted image (E).
Note synovitis of proximal interphalangeal joint.
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Fig. 4E. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Sagittal spin-echo
T1-weighted (TR/TE, 414/10) (C), sagittal spin-echo gadolinium-enhanced
fat-saturated T1-weighted (630/9.3, obtained 5 min after injection)
(D), and sagittal spin-echo fat-saturated T2-weighted (2,799/80)
(E) images show 1.0 x 0.5 x 0.7 cm lesion in proximal
aspect of distal phalanx of fifth digit. Lesion has low signal intensity on
T1-weighted image (C), enhances with contrast administration
(D), and has high signal intensity on T2-weighted image (E).
Note synovitis of proximal interphalangeal joint.
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Fig. 4F. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Coronal spin-echo
T1-weighted (400/10) image shows lesion in proximal aspect of distal phalanx
of fifth digit. Note absence of synovitis at distal interphalangeal joint of
fifth digit and presence of synovitis in proximal interphalangeal joints of
third and fourth fingers.
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Fig. 4G. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Coronal spin-echo
gadolinium-enhanced fat-saturated T1-weighted image (735/9.3, obtained
immediately after injection) (G) and coronal spin-echo fat saturated
T2-weighted (2,500/80) (H) image show lesion in proximal aspect of
distal phalanx of fifth digit. Note absence of synovitis at distal
interphalangeal joint of fifth digit and presence of synovitis in proximal
interphalangeal joints of third and fourth fingers.
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Fig. 4H. —41-year-old man with seronegative rheumatoid arthritis and
intraosseous lesion of distal phalanx of fifth finger. Coronal spin-echo
gadolinium-enhanced fat-saturated T1-weighted image (735/9.3, obtained
immediately after injection) (G) and coronal spin-echo fat saturated
T2-weighted (2,500/80) (H) image show lesion in proximal aspect of
distal phalanx of fifth digit. Note absence of synovitis at distal
interphalangeal joint of fifth digit and presence of synovitis in proximal
interphalangeal joints of third and fourth fingers.
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Fig. 5A. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Lateral radiograph of left wrist was unremarkable for
erosion.
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Fig. 5B. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Anteroposterior slightly oblique radiograph of left wrist
shows juxtaarticular osteopenia and no large erosion. Note possible small
cystic change of ulnar styloid and distal first metacarpal bone.
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Fig. 5C. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Sagittal spin-echo T1-weighted (TR/TE, 414/10) (C),
sagittal spin-echo gadolinium-enhanced fat-saturated T1-weighted (400/9.3,
obtained 5 min after injection) (D), and sagittal spin-echo
fat-saturated T2-weighted (2,500/80) (E) images show 1.6 x 1.2
x 1.4 cm lesion in proximal second metacarpal bone with cortical
disruption into carpometacarpal joint. Lesion has low signal intensity on
T1-weighted image (C), enhances with contrast administration
(D), and has high signal intensity on T2-weighted image (E).
Note smaller lesion in trapezoid bone and adjacent soft-tissue inflammation
and synovitis.
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Fig. 5D. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Sagittal spin-echo T1-weighted (TR/TE, 414/10) (C),
sagittal spin-echo gadolinium-enhanced fat-saturated T1-weighted (400/9.3,
obtained 5 min after injection) (D), and sagittal spin-echo
fat-saturated T2-weighted (2,500/80) (E) images show 1.6 x 1.2
x 1.4 cm lesion in proximal second metacarpal bone with cortical
disruption into carpometacarpal joint. Lesion has low signal intensity on
T1-weighted image (C), enhances with contrast administration
(D), and has high signal intensity on T2-weighted image (E).
Note smaller lesion in trapezoid bone and adjacent soft-tissue inflammation
and synovitis.
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Fig. 5E. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Sagittal spin-echo T1-weighted (TR/TE, 414/10) (C),
sagittal spin-echo gadolinium-enhanced fat-saturated T1-weighted (400/9.3,
obtained 5 min after injection) (D), and sagittal spin-echo
fat-saturated T2-weighted (2,500/80) (E) images show 1.6 x 1.2
x 1.4 cm lesion in proximal second metacarpal bone with cortical
disruption into carpometacarpal joint. Lesion has low signal intensity on
T1-weighted image (C), enhances with contrast administration
(D), and has high signal intensity on T2-weighted image (E).
Note smaller lesion in trapezoid bone and adjacent soft-tissue inflammation
and synovitis.
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Fig. 5F. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Coronal spin-echo T1-weighted (400/10) (F), coronal
spin-echo gadolinium-enhanced fat-saturated T1-weighted (584/9, obtained
immediately after injection) (G), and coronal spin-echo fat saturated
T2-weighted (2,500/80) (H) images show same lesions as in
A–E with low signal intensity on T1-weighted image (F),
enhancement with contrast administration (G), and high signal intensity
on T2-weighted image (H). Note edema of capitate and hamate bones and
bases of third and fourth metacarpal bones with marked synovitis of wrist
joint.
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Fig. 5G. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Coronal spin-echo T1-weighted (400/10) (F), coronal
spin-echo gadolinium-enhanced fat-saturated T1-weighted (584/9, obtained
immediately after injection) (G), and coronal spin-echo fat saturated
T2-weighted (2,500/80) (H) images show same lesions as in
A–E with low signal intensity on T1-weighted image (F),
enhancement with contrast administration (G), and high signal intensity
on T2-weighted image (H). Note edema of capitate and hamate bones and
bases of third and fourth metacarpal bones with marked synovitis of wrist
joint.
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Fig. 5H. —46-year-old woman with systemic lupus erythematosus of 7
months' duration and intraosseous lesions at base of second metacarpal and
trapezoid bones. Coronal spin-echo T1-weighted (400/10) (F), coronal
spin-echo gadolinium-enhanced fat-saturated T1-weighted (584/9, obtained
immediately after injection) (G), and coronal spin-echo fat saturated
T2-weighted (2,500/80) (H) images show same lesions as in
A–E with low signal intensity on T1-weighted image (F),
enhancement with contrast administration (G), and high signal intensity
on T2-weighted image (H). Note edema of capitate and hamate bones and
bases of third and fourth metacarpal bones with marked synovitis of wrist
joint.
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Fig. 6A. —41-year-old woman with seronegative rheumatoid arthritis with
large erosion of third metacarpal head. Coronal spin-echo T1-weighted (TR/TE,
400/10) (A) and coronal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (578/9.3, obtained immediately after injection) (B) images
show large erosion (arrow, A) of third metacarpal head
measuring 1.3 cm.
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Fig. 6B. —41-year-old woman with seronegative rheumatoid arthritis with
large erosion of third metacarpal head. Coronal spin-echo T1-weighted (TR/TE,
400/10) (A) and coronal spin-echo gadolinium-enhanced fat-saturated
T1-weighted (578/9.3, obtained immediately after injection) (B) images
show large erosion (arrow, A) of third metacarpal head
measuring 1.3 cm.
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