Skip to main content

Advertisement

Log in

Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA).

Materials and methods

We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session.

Results

The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The “rheumatoid” type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%.

Conclusion

Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of the hands and wrists. Disease was more extensive in the wrists than in the hands.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. McGonagle D, Conaghan PG, Emery P. Psoriatic arthritis—a unified concept 20 years on. Arthritis Rheum 1999; 42: 1080–1086.

    Article  CAS  Google Scholar 

  2. Ory PA, Gladman DD, Mease PJ. Psoriatic arthritis and imaging. Ann Rheum Dis 2005; 64: ii55–ii57.

    Article  Google Scholar 

  3. McQueen FM, Lassere M, Ostergaard M. Magnetic resonance imaging in psoriatic arthritis: a review of the literature. Arthritis Res Ther 2006; 8: 207.

    Article  Google Scholar 

  4. Olivieri I, Salvarani C, Cantini F et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. Arthritis Rheum 2002; 46: 2964–2967.

    Article  Google Scholar 

  5. Offidani A, Cellini A, Valeri G, Giovagnoni A. Subclinical joint involvement in psoriasis: magnetic resonance imaging and X-ray findings. Acta Derm Venereol 1998; 78: 463–465.

    Article  CAS  Google Scholar 

  6. Cimmino MA, Parodi M, Innocenti S et al. Dynamic magnetic resonance of the wrist in psoriatic arthritis reveals imaging patterns similar to those of rheumatoid arthritis. Arthritis Res Ther 2005; 7: R725–R731.

    Article  Google Scholar 

  7. Cantini F, Salvarani C, Olivieri I et al. Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study. Clin Exp Rheumatol 2001; 19: 291–296.

    CAS  PubMed  Google Scholar 

  8. Tehranzadeh J, Ashikyan O, Anavim A, Tramma S. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skeletal Radiol 2006; 35: 814–822.

    Article  Google Scholar 

  9. Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 1995; 24: 351–355.

    Article  CAS  Google Scholar 

  10. Giovagnoni A, Grassi W, Terilli F et al. MRI of the hand in psoriatic and rheumatical arthritis. Eur Radiol 1995; 5: 590–595.

    Article  Google Scholar 

  11. Konig H, Sieper J, Wolf KJ. Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology 1990; 176: 473–477.

    Article  CAS  Google Scholar 

  12. Scarpa R, Mathieu A. Psoriatic arthritis: evolving concepts. Curr Opin Rheumatol 2000; 12: 274–280.

    Article  CAS  Google Scholar 

  13. Pierre-Jerome C, Bekkelund SI, Mellgren SI, Torbergsen T, Husby G, Nordstrøm R. The rheumatoid wrist: bilateral MR analysis of the distribution of rheumatoid lesions in axial plan in a female population. Clin Rheumatol 1997; 16: 80–86.

    Article  CAS  Google Scholar 

  14. Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J. Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med 1999; 14: 310–314.

    Article  CAS  Google Scholar 

  15. Mesgarzadeh M, Schneck CD, Bonakdarpour A, Mitra A, Conaway D. Carpal tunnel: MR imaging. II. Carpal tunnel syndrome. Radiology 1989; 171: 749–754.

    Article  CAS  Google Scholar 

  16. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 1999; 26: 1746–1751.

    CAS  PubMed  Google Scholar 

  17. McGonagle D. Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis. Ann Rheum Dis 2005; 64: ii58–ii60.

    Article  Google Scholar 

  18. Martel W, Stuck KJ, Dworin AM, Hylland RG. Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot. AJR Am J Roentgenol 1980; 134: 125–135.

    Article  CAS  Google Scholar 

  19. McQueen FM, Stewart N, Crabbe J et al. Magnetic resonance imaging in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999; 58: 156–163.

    Article  CAS  Google Scholar 

  20. McQueen FM, Benton N, Perry D et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003; 48: 1814–1827.

    Article  Google Scholar 

  21. Ghanem N, Uhl M, Pache G, Bley T, Walker UA, Langer M. MRI in psoriatic arthritis with hand and foot involvement. Rheumatol Int 2007; 27: 387–393.

    Article  Google Scholar 

  22. Milosavljevic J, Lindqvist U, Elvin A. Ultrasound and power Doppler evaluation of the hand and wrist in patients with psoriatic arthritis. Acta Radiol 2005; 46: 374–385.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jamshid Tehranzadeh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tehranzadeh, J., Ashikyan, O., Anavim, A. et al. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis. Skeletal Radiol 37, 433–442 (2008). https://doi.org/10.1007/s00256-008-0451-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-008-0451-6

Keywords

Navigation