Assessment of synovitis in rheumatoid arthritis by enhanced magnetic resonance imaging (OMERACT RAMRIS score) and power Doppler ultrasound: a comparative study

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Abstract

Background and objectives
Disease activity in rheumatoid arthritis (RA) joints is conventionally assessed clinically in combination with the measurement of levels of biochemical surrogate markers. Plain radiography shows only late signs of preceding disease activity. Newer imaging modalities such as contrast-enhanced MRI and power Doppler ultrasonography (PDUS) may offer improved monitoring.
Patients and methods
Fifty patients (39 female patients and 11 male patients) with RA were subjected to a PDUS study and enhanced MRI examination of the clinically dominant wrist and hand joints. The mean age of the patients was 45.3 years and mean disease duration was 6.2 years. Power Doppler score of synovitis was correlated and compared with MRI OMERACT score.
Results
PDUS detected increased vascularity within 30 (60%) wrist joints denoting active synovitis and MRI detected synovial enhancement within 38 (76%) wrist joints denoting active synovitis; both scoring systems agreed in the assessment of synovitis degree in 20 wrist joints. PDUS missed detection of synovitis in nine joints detected by MRI, seven of them estimated by MRI to be of mild activity (grade 1).
Conclusion
Our results showed that both modalities are comparable and closely related in the assessment of synovial inflammatory process of the hand and wrist joints in RA patients.

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