MRI Area of Interest Without and With IV Contrast Regarding the diagnosis of RA, the 2013 EULAR task force recommendations on use of imaging of the joints in RA state that when there is diagnostic doubt following radiographs, either US or MRI can be used to improve certainty of diagnosis of RA above clinical criteria as well as to detect early joint damage before it is radiographically visible [13]. Both MRI and US outperform clinical evaluation in the detection of inflammation and structural damage and provide prognostic information concerning radiographic progression [18-20]. The evidence is inconclusive as to whether MRI or US should be considered the preferred method for evaluation of RA [18]. However, MRI with IV gadolinium contrast has been shown to be more sensitive compared with US in the early stages of RA [21] and aids in detection of synovitis and tenosynovitis [22,23]. Therefore, when safe to do so, MRI of the area of interest should ideally be performed without and with IV contrast. MRI area of interest without IV contrast can show cortical erosions, bone edema, synovial hypertrophy, and soft tissue abnormalities such as tenosynovitis and dactylitis. The use of IV gadolinium is less important in the detection of osseous erosions and bone edema but enhances detection of synovitis and tenosynovitis [22,23]. Cortical irregularity from inflammatory enthesitis and periostitis and increased fluid signal in the subjacent bone marrow may be seen on MRI without IV contrast [24]. Entheseal involvement in a characteristic distribution can suggest the diagnosis of seronegative spondyloarthropathy [25].
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. MRI Area of Interest Without and With IV Contrast Regarding the diagnosis of RA, the 2013 EULAR task force recommendations on use of imaging of the joints in RA state that when there is diagnostic doubt following radiographs, either US or MRI can be used to improve certainty of diagnosis of RA above clinical criteria as well as to detect early joint damage before it is radiographically visible [13]. Both MRI and US outperform clinical evaluation in the detection of inflammation and structural damage and provide prognostic information concerning radiographic progression [18-20]. The evidence is inconclusive as to whether MRI or US should be considered the preferred method for evaluation of RA [18]. However, MRI with IV gadolinium contrast has been shown to be more sensitive compared with US in the early stages of RA [21] and aids in detection of synovitis and tenosynovitis [22,23]. Therefore, when safe to do so, MRI of the area of interest should ideally be performed without and with IV contrast. MRI area of interest without IV contrast can show cortical erosions, bone edema, synovial hypertrophy, and soft tissue abnormalities such as tenosynovitis and dactylitis. The use of IV gadolinium is less important in the detection of osseous erosions and bone edema but enhances detection of synovitis and tenosynovitis [22,23]. Cortical irregularity from inflammatory enthesitis and periostitis and increased fluid signal in the subjacent bone marrow may be seen on MRI without IV contrast [24]. Entheseal involvement in a characteristic distribution can suggest the diagnosis of seronegative spondyloarthropathy [25].