Abstract
BackgroundKnowledge of the synovial and tenosynovial appearance of the clinically non-arthritic symptomatic juvenile wrist using contrast-enhanced magnetic resonance imaging (MRI) is sparse.ObjectivesTo analyze contrast-enhanced MRI findings of the clinically non-inflamed symptomatic pediatric wrist, focusing on the enhancing synovial and tenosynovial membrane. To evaluate the coexistent presence of (teno)synovial enhancement, joint fluid, bony depressions and medullary changes suggestive of bone marrow edema.Materials and methodsWe included 20 children (15 girls; age range: 7.5–17.6 years) who underwent contrast-enhanced MRI of the wrist, based on initial clinical indication, and eventually turned out to be unaffected by arthritic or orthopedic disorders. Various imaging characteristics of the synovium, tenosynovium, joint fluid, bone tissue and bone marrow were evaluated using existing MRI scoring systems.ResultsIn 3/20 (15%) children, mild or moderate-severe synovial enhancement was observed and 2/20 (10%) children showed mild tenosynovial enhancement/thickening. Joint fluid (11/20 children; 55%), bony depressions (20/20 children; 100%) and medullary changes suggestive of bone marrow edema (6/20; 30%) were found in a substantial percentage of children. The most frequently observed combination of coexisting imaging characteristics was bony depressions with ≥2 mm joint fluid, which was found in 7/20 (35%) children. Simultaneous presence of synovial and tenosynovial enhancement/thickening, bony depressions and medullary changes suggestive of bone marrow edema was observed in one child.ConclusionSeveral juvenile idiopathic arthritis-relevant MRI characteristics can be observed in the clinically non-inflamed symptomatic pediatric wrist.
Highlights
Important steps contributing to a magnetic resonance imaging (MRI) atlas of the healthy pediatric wrist have been made [1,2,3,4]
It is shown that bony depressions and joint fluid can be found in the wrist joint in a substantial percentage of healthy children [1, 2]
Signal changes suggestive of bone marrow edema, which is associated with rheumatoid arthritis activity in adults [11, 12], have been detected in the wrist and knee joint of healthy children and might be related to the physiological process of maturation [1, 2, 9]
Summary
Important steps contributing to a magnetic resonance imaging (MRI) atlas of the healthy pediatric wrist have been made [1,2,3,4]. Signal changes suggestive of bone marrow edema, which is associated with rheumatoid arthritis activity in adults [11, 12], have been detected in the wrist and knee joint of healthy children and might be related to the physiological process of maturation [1, 2, 9]. Knowledge of the synovial and tenosynovial appearance of the clinically non-arthritic symptomatic juvenile wrist using contrast-enhanced magnetic resonance imaging (MRI) is sparse. To evaluate the coexistent presence of (teno)synovial enhancement, joint fluid, bony depressions and medullary changes suggestive of bone marrow edema. Simultaneous presence of synovial and tenosynovial enhancement/thickening, bony depressions and medullary changes suggestive of bone marrow edema was observed in one child
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