Extremity magnetic resonance imaging in rheumatoid arthritis: Updated literature review.

Abstract

Introduction In April 2006, a white paper on extremity magnetic resonance imaging (MRI) in rheumatoid arthritis (RA) was published, based on a review of the literature by a task force commissioned by the American College of Rheumatology (ACR) (1). The document was well received for its scientific rigor and overview of the literature at that time. However, the report had unexpected consequences as certain insurers began to restrict coverage for extremity MRI, which was not the intent of the original scientific review. Over the last 4 years, research into the value of extremity MRI and its role compared with conventional radiography and high-field MRI has been ongoing. In May 2009, the International Society of Extremity MRI in Rheumatology (ISEMIR) forwarded to the ACR publications they believed to be important in the field, requesting that the ACR review these new data and update the white paper with inclusion of the new information. The ACR Executive Committee and ACR Board of Directors thought that it was important to respond to this group, but due to the many efforts the ACR had ongoing, it was decided not to reconvene the original formal task force. Three members of the initial task force were asked to participate in this literature review: Atul Deodhar (an academic clinical rheumatologist with research interest in imaging modalities), to provide clinical perspective; Hollis Potter (a musculoskeletal radiologist with extensive experience in MRI), to provide technical expertise; and Stanley Cohen (a clinical rheumatologist in private practice with research interests in RA treatment). Paul Emery, who was not a member of the original task force, was asked to participate due to his expertise in MRI in RA as well as his involvement in the ISEMIR. Subsequent to the initial development of the manuscript, Philip Conaghan and Mikkel Ostergaard were invited to contribute to the review based on their expertise in the field and the desire of the working group as well as the ACR Board of Directors to broaden the perspective on this subject. This group reviewed the publications forwarded, as well as conducted a literature review of additional articles in Medline and PubMed involving MRI in RA published since 2006. This was not a formal evidence-based review such as the nowpopular RAND-based methodology, but simply a literature review addressing the same questions raised in 2006 to determine if the conclusions reached at that time should be modified. These publications can be broadly divided into 3 groups. The first group of publications deals with technical aspects, such as comparing low-field extremity units to high-field units, comparing the reproducibility of results obtained with low-field units in different centers, or addressing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) MRI scoring systems. The second group consists of publications that confirm previously recorded observations, e.g., MRI scanning is more sensitive in detecting erosions compared with conventional radiography and predicts future radiographic erosions. The third group consists of publications that advance our knowledge of peripheral MRI further by breaking new ground. Although there are now extremity MRI units that are higher field at 1.0–1.5T, there was no available literature to determine the role of high-field extremity MRI in the diagnosis and management of RA. Stanley B. Cohen, MD: Presbyterian Hospital and University of Texas Southwestern Medical School, Dallas; Hollis Potter, MD: Hospital for Special Surgery and Weill Medical College of Cornell University, New York, New York; Atul Deodhar, MD: Rheumatology Clinics, Oregon Health and Science University, Portland; Paul Emery, MA, MD, FRCP, Philip Conaghan, MBBS, PhD, FRACP, FRCP: University of Leeds and National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Mikkel Ostergaard, MD: Copenhagen University Hospital at Glostrup and Hvidovre, Copenhagen, Denmark. Dr. Potter has received institutional research support from General Electric Healthcare. Dr. Deodhar has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Centocor. Dr. Emery has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from MSD, Pfizer, Roche, BMS, and Abbott. Dr. Conaghan has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from BMS, Centocor, MSD, Novartis, Roche, and Pfizer. Address correspondence to Stanley B. Cohen, MD, 8144 Walnut Hill, Suite 800, Dallas, TX 75231. E-mail: Arthdoc@aol.com. Submitted for publication August 25, 2010; accepted November 22, 2010. Arthritis Care & Research Vol. 63, No. 5, May 2011, pp 660–665 DOI 10.1002/acr.20413 © 2011, American College of Rheumatology