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Early Rheumatoid Arthritis: A Review of MRI and Sonographic Findings

¹ Department of Musculoskeletal Radiology, Centre Hospitalier Universitaire de Lille and Hôpital Roger Salengro, CHRU de Lille, Blvd. du Pr. J Leclercq, 59037 Lille, France.
² Department of Rheumatology, Centre Hospitalier Universitaire de Lille and Hôpital Roger Salengro, Lille, France.
³ Department of Anatomy, Centre Hospitalier Universitaire de Lille and Hôpital Roger Salengro, Lille, France.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —34-year-old woman with early rheumatoid arthritis and synovitis. Transverse fat-suppressed gadolinium-enhanced T1-weighted spin-echo MR images show bilateral synovitis (arrows) in wrist (A) and metatarsophalangeal joints (B). Note also bone marrow signal intensity changes (asterisks, B), which precede frank bone erosions, and flexor digitorum tenosynovitis (arrowhead, A).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —34-year-old woman with early rheumatoid arthritis and synovitis. Transverse fat-suppressed gadolinium-enhanced T1-weighted spin-echo MR images show bilateral synovitis (arrows) in wrist (A) and metatarsophalangeal joints (B). Note also bone marrow signal intensity changes (asterisks, B), which precede frank bone erosions, and flexor digitorum tenosynovitis (arrowhead, A).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —41-year-old man with early rheumatoid arthritis and synovitis. Dorsal longitudinal color sonogram of wrist reveals hypoechoic distention of both radiocarpal (single asterisk) and midcarpal (double asterisks) synovial recesses. High signal in synovium on power Doppler imaging indicates hyperemia. R = radius, L = lunate, C = capitate.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —29-year-old woman with early rheumatoid arthritis and tenosynovitis. R = radius, U = ulna, t = tendon. Transverse fat-suppressed gadolinium-enhanced T1-weighted spin-echo MR image shows significant enhancement (arrows) around extensor carpi ulnaris tendon that represents tenosynovitis. Note also mild enhancement in distal radioulnar joint, which is suggestive of synovitis.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —29-year-old woman with early rheumatoid arthritis and tenosynovitis. R = radius, U = ulna, t = tendon. Dorsal transverse sonogram of wrist shows hypoechoic thickening (asterisks) and hyperemia around extensor carpi ulnaris tendon on power Doppler imaging, representing tenosynovitis. Note also heterogeneous appearance of tendon on sonography.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —38-year-old woman with early rheumatoid arthritis and bone erosions. Transverse fat-suppressed gadolinium-enhanced 3D gradient-echo MR image reveals carpal bone erosions (capitate, triquetrum, pisiform) (arrows). Synovitis in carpal joints and flexor and extensor tenosynovitis are also evident. (Reprinted with permission from Boutry N, Larde A, Lapegue F, Solau-Gervais E, Flipo RM, Cotten A. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J Rheumatol 2003; 30:671–679 [4])

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —38-year-old woman with early rheumatoid arthritis and bone erosions. Transverse fat-suppressed gadolinium-enhanced 3D gradient-echo MR image shows bone erosion on radial aspect of third metacarpal bone (arrowhead). Note also presence of significant bilateral synovitis in second and third metacarpophalangeal joints and flexor digitorum tenosynovitis (arrows).

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —38-year-old woman with early rheumatoid arthritis and bone erosions. Transverse fat-suppressed gadolinium-enhanced 3D gradient-echo MR image exhibits bone erosion on lateral aspect of fifth metatarsal bone (arrowhead), which is associated with synovitis. Note also presence of inflammatory bursitis beneath fifth metatarsal bone (asterisk). (Reprinted with permission from Boutry N, Larde A, Lapegue F, Solau-Gervais E, Flipo RM, Cotten A. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J Rheumatol 2003; 30:671–679 [4])

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —47-year-old woman with rheumatoid arthritis and bone erosions. Transverse sonogram of wrist exhibits bone erosion of ulnar styloid process (arrow). Latter is related to hypoechoic thickening around extensor carpi ulnaris tendon, representing tenosynovitis (asterisks). U = ulna, t = tendon.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —47-year-old woman with rheumatoid arthritis and bone erosions. Coronal sonogram of forefoot shows bone erosion (arrow) on lateral aspect of fifth metatarsal bone (M5) associated with synovitis (asterisks).

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —47-year-old woman with rheumatoid arthritis and bone erosions. Coronal sonogram of hand shows hypervascular pannus filling bone erosion (arrows) on radial aspect of second metacarpal bone (M2) on power Doppler imaging. Note also hyperemia in articular space.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —33-year-old man with early rheumatoid arthritis and bone marrow edema. Coronal STIR T2-weighted MR image reveals bone marrow edema in second metacarpal bone (asterisk). Note also fluid in articular space.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —51-year-old man with early rheumatoid arthritis and bursitis. Transverse fat-suppressed gadolinium-enhanced 3D gradient-echo MR image shows submetatarsal (asterisk) and intermetatarsal (boxes) bursitis. Note also presence of bone erosion (arrow) associated with synovitis in third metatarsophalangeal joint.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —28-year-old man with early rheumatoid arthritis and bursitis. Longitudinal sonogram of web space reveals intermetatarsal bursitis (asterisks) as well-defined heterogeneous collection with synovial hyperemia on power Doppler imaging. (Courtesy of Morvan G, Paris, France)

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —Monitoring early rheumatoid arthritis activity. Schematic of quantitative evaluation of rate of synovial enhancement before (solid line) and after (dotted line) effective treatment. Data were derived from contrast-enhanced dynamic MRI scans. Synovial enhancement is defined as SIt – SI0 / t, where SIt is signal intensity obtained t seconds after contrast injection, SI0 is signal intensity obtained in first unenhanced image, and t is time taken to reach peak enhancement over initial linear phase (dotted area). After treatment, synovitis and therefore synovial enhancement are reduced.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —31-year-old man with psoriatic arthritis. Coronal fat-suppressed T2-weighted MR image shows edematous signal intensity changes (asterisks) in bone marrow of first phalanx. Note also similar findings along collateral ligaments (arrows) of adjacent proximal interphalangeal joint.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —31-year-old man with psoriatic arthritis. Longitudinal sonogram of foot using extended field of view reveals enthesitis of plantar fascia. Note significant hypoechoic thickening of fascia origin (double arrow); also note bone erosions and spurs (arrowheads). More distally, plantar fascia shows normal sonographic appearance (arrows). C = calcaneus.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —31-year-old man with psoriatic arthritis. Coronal color sonogram of hand shows enthesitis of radial collateral ligament as hypoechoic thickening of ligament with mild hyperemia on power Doppler imaging. For comparison, note normal fibrillar hyperechoic appearance of radial collateral ligament on normal side (arrows). P1 = proximal phalanx, P2 = middle phalanx.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —27-year-old woman with systemic lupus erythematosus. Transverse fat-suppressed gadolinium-enhanced T1-weighted spin-echo MR image shows bilateral synovitis in metacarpophalangeal joints and tenosynovitis (arrows) in flexor and extensor digitorum, as well as bone erosion on radial aspect of second metacarpal bone (arrowhead). MRI findings are similar to those of early rheumatoid arthritis.

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