Ultrasound and magnetic resonance imaging correlation of the wrist and metacarpophalangeal joints in fifty consecutive patients of rheumatoid arthritis

Abstract

Background: Gray-scale ultrasound and Power Doppler ultrasound (GSUS, PDUS) and contrast Magnetic Resonance Imaging (MRI) are the imaging modalities to detect the disease in this early stage of rheumatoid arthritis (RA). This study was conducted to observe the advantages and disadvantages of USG and MRI of wrist and metacarpophalangeal joints in patients with rheumatoid arthritis. Methods: Clinically diagnosed cases of RA were included. GSUS-PDUS and high field (1.5T) MRI with contrast were used by two assessors. The evaluation and scoring was done using the RAMRIS score. Other assessed parameters included Joint space narrowing, GSUS bone erosions, Gray scale USG synovial hypertrophy, MRI tenosynovitis and tenosynovitis on GSUS. Results: Total 50 patients (44 female, 6 male; age 18-76 years) with 100 joints and 400 Metacarpophalangeal joints (2nd to 5th) including 2300 bone areas were evaluated. GSUS, PDUS evaluation was equal to contrast MRI evaluation in detecting joint space narrowing, effusion, flexor tenosynovitis (except for FPL tendon), extensor tenosynovitis. Whereas synovial thickening was better picked up in GSUS, PDUS than on contrast MRI. Contrast MRI picked up more cases of bone erosions, triangular fibro cartilage lesions and active synovitis as compared to GSUS, PDUS. Bone marrow edema which indicates active ostitis could only be directly detected on contrast MRI. Conclusions: GSUS, PDUS can be used as radiological investigative modality for the diagnosis of cases of early rheumatoid arthritis specially for synovial thickening, joint effusion, flexor and extensor tenosynovitis.