VIENNA - MRI is still the most efficient modality for detecting synovial inflammation and joint effusions associated with rheumatoid arthritis (RA), according to German researchers.
Dr. Gunter Wamser of the department of internal medicine at Zentralklinikum in Augsburg compared MRI to power Doppler sonography, with and without a contrast agent. What gives contrast-enhanced MRI the edge over ultrasound is its ability to distinguish between synovial inflammation and joint effusions in the shoulder, he said at a European Congress of Radiology scientific session on upper extremity imaging on March 9.
In this study sample, 23 shoulders of 23 patients with known RA were evaluated. The patients had a mean age of 64 and had RA for more than six years. Power Doppler sonography with 9-MHz linear transducer, and pre- and post-contrast media (Levovist) was performed. Patients also underwent a 1.5-tesla, contrast-enhanced (Omniscan) MRI scan using T2 turbo spin echo and T1 fat-saturation spin echo sequences.
Changes in the subacromial-deltoid bursa, biceps tendon, rotator cuff, axillary pouch, and glenohumeral joint were recorded. The degree of vascular signal in power Doppler was compared to the MRI findings. Blinded readings were done by two radiologists in consensus, Wamser said.
Both modalities revealed joint effusion in 61% of the patients, but only MRI was able to locate synovial inflammation in all 23 patients. MRI also showed the full thickness of a partial tear in the joint in 75% of the patients, while sonography revealed the same in 63% of cases. Power Doppler without the contrast agent showed inflammation in 43% of the patients, and in 52% of the patients when a contrast agent was administered.
"MRI is superior to ultrasound and power Doppler in detecting synovial inflammation," Wamser said. "Power Doppler does not have the potential to distinguish this inflammation, although it is useful for the detection of joint effusion."
By Shalmali Pal
AuntMinnie.com staff writer
March 9, 2000
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