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Steven Needell, MD presents "eMRI in Clinical Practice: A Radiologist's Perspective" |
Boca Radiology Group (BRG) is proud to be the nation's leader in providing interpretive telemedicine services to rheumatology practices throughout the United States. BRG offers high quality subspecialty interpretations over the internet utilizing high-speed, HIPAA- compliant teleradiology. Our professional services include supervision of MRI protocols, technologists and maintaining quality assurance. We provide prompt turnaround time of transcribed reports, immediate notification of significant findings, and competitive rates for our reading fees.
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Rheumatoid arthritis (RA) affects 2.1 million people in the United States, peaking between 30-50 years of age. Early detection and treatment of rheumatoid arthritis has been shown to decrease morbidity and preserve patients' quality of life. Therapeutic medications (anti-THF therapy and conventional DMARDs) used to treat RA are quite expensive. Early identification of patients who will develop more severe, disabling disease allows our health care system to best provide medication to those who will benefit most from these therapies. Detection of bone erosions is a specific finding in RA, and has proven an important role in therapeutic planning. For many years, x-ray was the best imaging test available to detect erosions in patients with aggressive disease. More recently, MRI has been shown to be highly sensitive for detection of erosions, and is able to detect erosions two years before x-rays. Current studies reveal over 37% of RA patients to have erosions visible on MRI but not seen on x-ray. Utilizing different pulse sequences allows MRI to characterize the activity of erosions. High resolution, submillimeter 3D MR imaging and extremity MR units offer early detection of erosions with greater reliablilty than ever before.
1mm T1W coronal image shows an erosion in the 3rd metacarpal head (left images, arrows). The erosion has decreased in size (right images, arrows) following DMARD therapy.
Recent literature references evaluating MRI in Rheumatoid Arthritis
Døhn UM, et al "Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography" Arthritis Research & Therapy 2008; 10: doi:10.1186/ar2378.
Durez P, Malghem J, Nzeusseu Toukap A, Depresseux G, Lauwerys BR, Westhovens R, Luyten FP, Corluy L, Houssiau FA, Verschueren P. Treatment of early rheumatoid arthritis: A randomized magnetic resonance imaging study comparing the effects of methotrexate alone, methotrexate in combination with infliximab, and methotrexate in combination with intravenous pulse methylprednisolone. Arthritis Rheum. 2007 Dec;56(12):3919-27.
McQueen FM. A vital clue to deciphering bone pathology: MRI bone oedema in rheumatoid arthritis and osteoarthritis.
Ann Rheum Dis. 2007 Dec;66(12):1549-52
Boutry N, Morel M, Flipo R, Demondion X, and Cotten A. Early Rheumatoid Arthritis: A Review of MRI and Sonographic Findings
Am J Roentgenol, Dec 2007; 189: 1502 - 1509.
Freeston JE, Conaghan PG, Dass S, Vital E, Hensor EM, Stewart SP, Emery P. Does extremity-MRI improve erosion detection in severely damaged joints? A study of long-standing rheumatoid arthritis using three imaging modalities. Ann Rheum Dis. 2007 Nov;66(11):1538-40.
M. Tamai, A. Kawakami, M. Uetani, et al. Bone Edema Determined by MRI Reflects Severe Disease Status in Patients with Early-Stage RA. J Rheumatol. 2007 Nov;34(11):2154-7.
Gaylis N, Needell S and Rudensky D. Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis. Modern Rheumatology. 2007 Aug;17(4):273-8.
Conaghan PG, Ejbjerg B, Lassere M, Bird P, Peterfy C, Emery P, McQueen F, Haavardsholm E, O'Connor P, Edmonds J, Genant H, Ostergaard M. A multicenter reliability study of extremity-magnetic resonance imaging in the longitudinal evaluation of rheumatoid arthritis. J Rheumatol. 2007 Apr;34(4):857-8.
Bird P, Ejbjerg B, Lassere M, Ostergaard M, McQueen F, Peterfy C, Haavardsholm E, O'Connor P, Genant H, Edmonds J, Emery P, Conaghan PG. A multireader reliability study comparing conventional high-field magnetic resonance imaging with extremity low-field MRI in rheumatoid arthritis. J Rheumatol. 2007 Apr;34(4):854-6.
E Jimenez-Boj, I Nöbauer-Huhmann, B Hanslik-Schnabel, et al. Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis & Rheumatism 2007; 56: 1118-1124.
Furst DE, Gaylis N, Bray V, Olech E, Yocum D, Ritter J, Weisman M, Wallace DJ, Crues J, Khanna D, Eckel G, Yeilding N, Callegari P, Visvanathan S, Rojas J, Hegedus R, George L, Mamun K, Gilmer K, Troum O. Open-label, pilot protocol of patients with rheumatoid arthritis who switch to infliximab after an incomplete response to etanercept: the opposite study. Ann Rheum Dis. 2007 Jul;66(7):893-9.
Sharp JT. Magnetic resonance imaging in rheumatologic practice: low field or standard. J Rheumatol. 2006 Oct;33(10):1925-7.
Yocum DE, Conaghan PG, Olech E, Peterfy CG. Response: office-based low-field extremity magnetic resonance imaging: is the glass half empty or half full? Arthritis & Rheumatism. 2006 Apr;54(4):1048-50.
TS Chen, JV Crues 3rd, M Ali, and OM Troum. Magnetic resonance imaging is more sensitive than radiographs in detecting change in size of erosions in rheumatoid arthritis. J Rheumatol, 2006; 33(10): 1957-67.
H M Lindegaard, J Vallø, K Hørslev-Petersen, P Junker, and M Østergaard. Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1-year follow-up study. Ann Rheum Dis, 2006; 65: 1208 - 1212.
Schoellnast H, Deutschmann HA, Hermann J, Schaffler GJ, Reittner P, Kammerhuber F, Szolar DH, Preidler KW. Psoriatic Arthritis and Rheumatoid Arthritis: Findings in Contrast-Enhanced MRI. Am J Roentgenol. 2006;187(2):351-357
David E. Yocum, Philip G. Conaghan, Ewa Olech, Charles G. Peterfy. Office-based low-field extremity magnetic resonance imaging: Is the glass half empty or half full? Arthritis & Rheumatism 2006; 54:1048-1050.
Eshed I, Althoff CE, Schink T, Scheel AK, Schirmer C, Backhaus M, Lembcke A, Bollow M, Hamm B, Hermann KG. Low-field MRI for assessing synovitis in patients with rheumatoid arthritis. Impact of Gd-DTPA dose on synovitis scoring. Scand J Rheumatol. 2006 Jul-Aug;35(4):277-82.
B J Ejbjerg, E Narvestad, S Jacobsen, H S Thomsen, and M Østergaard. Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography. Ann Rheum Dis, Sep 2005; 64: 1280 - 1287.
J Ejbjerg, A Vestergaard, S Jacobsen, H Thomsen, M ØStergaard. The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: A comparison of the omeract rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the sharp/van der heijde radiographic score. Arthritis & Rheumatism 2006;52: 2300-2306
P Conaghan, P Bird, B Ejbjerg, P O’Connor, C Peterfy, F McQueen, M Lassere, P Emery, R Shnier, J Edmonds, and M Østergaard. The EULAR–OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis, 2005 64.
Sommer O, Kladosek A, Weiler V, et al. Rheumatoid Arthritis: A Practical Guide to State-of-the-Art Imaging, Image Interpretation, and Clinical Implications. RadioGraphics 2005;25:381-398.
M Østergaard, J Edmonds, F McQueen, C Peterfy, M Lassere, B Ejbjerg, P Bird, P Emery, H Genant, and P Conaghan. EULAR–OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis, Feb 2005; 64.
C G Peterfy. MRI of the wrist in early rheumatoid arthritis. Ann Rheum Dis, May 2004; 63: 473 - 477.
N Benton, N Stewart, J Crabbe, E Robinson, S Yeoman, and F M McQueen. MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis, May 2004; 63: 555 - 561.
Cimmino MA, Innocenti S, Livrone F, Magnaguagno F, Silvestri E, Garlaschi G. Dynamic Gadolinium-Enhanced Magnetic Resonance Imaging of the Wrist in Patients With Rheumatoid Arthritis Can Discriminate Active From Inactive Disease. Arthritis Rheum 2003, 48(5),1207–1213.
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