Abstract
Currently, clinical indications for the application of gadolinium-based contrast agents (GBCA) in magnetic resonance imaging (MRI) are increasingly being questioned. Consequently, this study aimed to evaluate the additional diagnostic value of contrast enhancement in MRI of the hand in patients with rheumatoid arthritis (RA). Thirty-one patients with RA (mean age, 50 ± 14 years (range, 18–72 years)) underwent morphologic MRI scans on a clinical 3 T scanner. MRI studies were analyzed based on (1) the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) and (2) the GBCA-free RAMRIS version, termed RAMRIS Sine-Gadolinium-For-Experts (RAMRIS-SAFE), in which synovitis and tenosynovitis were assessed using the short-tau inversion-recovery sequence instead of the post-contrast T1-weighted sequence. The synovitis subscores in terms of Spearman’s ρ, as based on RAMRIS and RAMRIS-SAFE, were almost perfect (ρ = 0.937; p < 0.001), while the tenosynovitis subscores were less strongly correlated (ρ = 0.380 p = 0.035). Correlation between the total RAMRIS and RAMRIS-SAFE was also almost perfect (ρ = 0.976; p < 0.001). Inter-rater reliability in terms of Cohen’s κ was high (0.963 ≤ κ ≤ 0.925). In conclusion, RAMRIS-SAFE as the GBCA-free version of the well-established RAMRIS is a patient-friendly and resource-efficient alternative for assessing disease-related joint changes in RA. As patients with RA are subject to repetitive GBCA applications, non-contrast imaging protocols should be considered.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting small joints of the hand and the feet, characterized by pain, inflammation, and joint destruction that can lead to functional disability and severe reduction in quality of life, followed by a significant economic burden for individual patients and society as a whole [1,2,3]
As patients with rheumatoid arthritis (RA) are subject to repetitive gadolinium-based contrast agents (GBCA) applications, non-contrast imaging protocols should be considered
In times of persistent safety concerns regarding the use of GBCA in clinical magnetic resonance imaging (MRI), refined imaging protocols that maintain diagnostic quality while avoiding the use of GBCA are beneficial to both patients and healthcare providers, as the degree of invasiveness and the chance of allergic reactions are reduced, patient comfort is increased, and clinical workflows and patient turnaround are further streamlined
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting small joints of the hand and the feet, characterized by pain, inflammation, and joint destruction that can lead to functional disability and severe reduction in quality of life, followed by a significant economic burden for individual patients and society as a whole [1,2,3]. A variety of different therapies are available for RA. To ensure comprehensive monitoring under therapy, sensitive diagnostic tools are beneficial [5,6,7]. Magnetic resonance imaging (MRI) provides insight into disease status and treatment response by accurate assessment of inflammation and structural damage in joints [8]. RAtypical findings can be assessed by the semiquantitative outcome measures in rheumatology (OMERACT) RA-MRI scoring system (RAMRIS), a sum score that evaluates inflammatory (i.e., osteitis/bone marrow edema, synovitis, tenosynovitis) and destructive changes (i.e., erosions, cartilage loss/joint space narrowing (JSN)) in the metacarpophalangeal (MCP) joints, hand, and wrist [8,9]
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