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  • Review Article
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Emerging MRI methods in rheumatoid arthritis

Nature Reviews Rheumatology volume 7, pages 85–95 (2011)Cite this article

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Abstract

New MRI techniques have been developed to assess not only the static anatomy of synovial hyperplasia, bone changes and cartilage degradation in patients with rheumatoid arthritis (RA), but also the activity of the physiological events that cause these changes. This enables an estimation of the rate of change in the synovium, bone and cartilage as a result of disease activity or in response to therapy. Typical MRI signs of RA in the pre-erosive phase include synovitis, bone marrow edema and subchondral cyst formation. Synovitis can be assessed by T2-weighted imaging, dynamic contrast-enhanced MRI or diffusion tensor imaging. Bone marrow edema can be detected on fluid-sensitive sequences such as short-tau inversion recovery or T2-weighted fast-spin echo sequences. Detection of small bone erosions in the early erosive phase using T1-weighted MRI has sensitivity comparable to CT. Numerous MRI techniques have been developed for quantitative assessment of potentially pathologic changes in cartilage composition that occur before frank morphologic changes. In this Review, we summarize the advances and new directions in the field of MRI, with an emphasis on their current state of development and application in RA.

Key Points

  • The optimal roles of MRI in rheumatoid arthritis (RA) research and clinical practice lie in identifying the early, pre-erosive stages of disease and monitoring therapy

  • MRI signs of synovitis have been validated histologically and clinically both in animal studies and in humans

  • Modern high-field extremity MRI scanners maximize patient comfort without sacrificing image quality, and have been validated against conventional MRI units using the RAMRIS (rheumatoid arthritis magnetic resonance imaging score) system

  • The capability of MRI to quantify outcome measures provides a powerful research tool that can also incorporate pharmacokinetic modeling

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Figure 1: Imaging of anatomical, tissue and cellular changes in synovium, cartilage and bone in RA.
Figure 2: MRI of early RA.
Figure 3: Use of DCE-MRI to assess inflammation.
Figure 4: Kinetic modeling technique to examine the pathophysiology of synovial inflammation in the RA wrist using DCE-MRI-derived data.
Figure 5: DTI in a 42-year-old woman with RA.
Figure 6: Bone erosions in the wrist of an RA patient.
Figure 7: T2 mapping of cartilage.
Figure 8: 23Na MRI of cartilage.

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Acknowledgements

Funding for this research was made possible by grants from the ACR Research and Education Foundation Within Our Reach: Finding a Cure for Rheumatoid Arthritis campaign, the Alliance for Lupus Research—Target Identification in Lupus program, VA Merit Review Grants (1I01BX000600-01), Daiichi-Sankyo Co., Ltd., and NIH grants (1AI 071110 and ARRA 3RO1AI71110-02S1) (all to J. D. Mountz). We also thank Dr Hui-Chen Hsu for critical reading of this manuscript and Dr Fiona Hunter for editorial suggestions. We also thank Ms Carol Humber and Ms Darlene M. Frasher for assistance with manuscript preparation.

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  1. Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, 15213, PA, USA

    Camilo G. Borrero & James M. Mountz

  2. Department of Medicine, University of Alabama at Birmingham, 1825 University Boulevard, Room 307, Shelby Building, Birmingham, 35294, AL, USA

    John D. Mountz

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C. G. Borrero and J. D. Mountz researched data for the article and made substantial contributions to discussion of the content. C. G. Borrero wrote the article. C. G. Borrero and J. M. Mountz performed reviewing/editing of the manuscript before submission.

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Borrero, C., Mountz, J. & Mountz, J. Emerging MRI methods in rheumatoid arthritis. Nat Rev Rheumatol 7, 85–95 (2011). https://doi.org/10.1038/nrrheum.2010.173

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