Diagnostic Imaging

  • Giacomo Garlaschi
  • Enzo Silvestri
  • Luigi Satragno
  • Marco Amedeo Cimmino


Conventional radiography has always played a major role in the diagnosis and follow-up of RA. Since 1957, when the ARA published the first classificative criteria of the disease, conventional radiography, together with laboratory and clinical findings, has been included among the required criteria.


Synovial Membrane Carpal Tunnel Flexor Tendon Tendon Sheath Conventional Radiography 
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  1. Arnett FC, Edworthy SM, Bloch DA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31: 315–324.PubMedCrossRefGoogle Scholar
  2. Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ, Raber H, Hamm B, Burmester GR, Bol-low M. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound and CE magnetic resonance imaging. Arthritis Rheum. 1999 Jun; 42 (6): 1232–1245.PubMedCrossRefGoogle Scholar
  3. Berens DL, Lin RK (editors) (1969) Roentgen Diagnosis of Rheumatoid Arthritis. Springfield. Brahme SK, Gundry CR, Resnick D. Advanced imaging of the wrist. Radiol. Clin. North Am. 1990; 28 (2): 307–320.Google Scholar
  4. Brook A, Corbett M Radiographic changes in early rheumatoid disease. Ann. Rheum. Dis. 1977; 36: 71–73.PubMedCrossRefGoogle Scholar
  5. Cammisa M et al. (1988) Le malattie reumatiche, inquadramento e diagnosi radiologica. Ciba - Geigy, Origgio (VA).Google Scholar
  6. Gardner DL (1978) Pathology of rheumatoid arthritis. Churchill Livingstone, Edinburgh.Google Scholar
  7. Ghadially FN (1983) Fine structure of synovial joints. Butterworths, London.Google Scholar
  8. Grassi W, De Angelis R, Lamanna G, Cervini C. The clnical features of rheumaotid arthritis. Eur J Radiol 1998; 27: 18–24.CrossRefGoogle Scholar
  9. Jaffe HL (1972) Metabolic, degenerative and inflammatory disease of bones and joints. Lea and Febiger, Philadelphia.Google Scholar
  10. Kaarela K, Kautiainen H Continuos progression of radiological destruction in sieropositive rheumatoid arthritis. J Rheumatol 1997 Jul; 24 (7): 1285–1287.PubMedGoogle Scholar
  11. Kaye JJ, Nance EP, Callahan LF. Observer variation in quantitative assessment of rheumatoid arthritis. Part II. A simplified scoring system. Invest Radiol 1987; 22: 41–46.PubMedCrossRefGoogle Scholar
  12. Larsen A. How to apply Larsen score in evaluating radiographs of rheumatoid arthritis in long term studies. J Rheumatol 1995; 22: 1975.Google Scholar
  13. Martel W. The pattern of rheumatoid arthritis in the hand and wrist. Radiol Clin North Am 1964; 2:221. Resnick D ( 1995 ) Diagnosis of bones and joints disorders. Saunders, Philadelphia.Google Scholar
  14. Resnick D. Rheumatoid arthritis of the wrist. The compartmental approach. Med Radiogr Photogr 1976; 52: 50.PubMedGoogle Scholar
  15. Sharp JT, Litsky MD, Collins LC et al. Methods of scoring the progression of radiologie changes in rheumatoid arthritis: correlation of radiologie and laboratory abnormalities. Arthritis Rheum 1971; 14: 706–720.PubMedCrossRefGoogle Scholar
  16. Trentham DE, Masi AT. Carpo-metacarpal ratio. A new quantitative measure of radiologie progression of wrist involvement in rheumatoid arthritis. Arthritis Rheum 1976; 19: 939.PubMedCrossRefGoogle Scholar
  17. Aisen AM, Mc Cune WJ, MacGuire A, et al Sonographic evaluation of the cartilage of the knee. Radiology, 1984; 153: 781.PubMedGoogle Scholar
  18. Beecker HK (1959) Measurement of Subjective Responses. New York, Oxford University Press. Buchberger W, Jadmaier W, Birbamer G, et al. Carpal tunnel syndrome: diagnosis with high resolution sonography. AJR 1992; 159: 793–798.Google Scholar
  19. Chen P, Maklad N, Redwine M, Zelitt D Dynamic high resolution sonography of the carpal tunnel. AJR 1997; 168: 533–537.PubMedGoogle Scholar
  20. Chiou HJ, Chang CY, Chou YH, et al Triangular fibrocartilage of the wrist: Presentation on high resolution ultrasonography. J Ultrasound Med 1998; 17: 41–48.PubMedGoogle Scholar
  21. Giovagnorio F, Andreoli C, De Cicco ML Ultrasonographic evaluation of De Quervaine disease. J Ultrasound Med 1997 16: 685–689.PubMedGoogle Scholar
  22. Koski JM, Anttila P, Hamalainen M, et al Hip joint ultrasonography: correlation with intra-articular effusion and synovitis. Br J Rheum 1990; 29, 189.CrossRefGoogle Scholar
  23. Marnix Van Holsbeeck, J Introcaso (1991): Musculoskeletal ultrasound, Mosby Year Book.Google Scholar
  24. Martino F, Monetti G (1993) Semeiotica ecografica delle malattie reumatiche, Piccin.Google Scholar
  25. Reinhardt M, Fritzsch T. Caratteristiche e applicazioni: attualità e prospettive. Radiol Med 1998; 95 (Suppl. 1 al N. 5): 1–5.PubMedGoogle Scholar
  26. Richardson ML, Selby B, Montana MA, et al Ultrasonography of the knee. Radiol Clin North Am 1988; 26 (1): 63.PubMedGoogle Scholar
  27. Ropes MW, Bennett GA, Cobb S et al Revision of the diagnostic criteria of rheumatoid arthritis. Ann Rheum Dis 1959; 18: 49.CrossRefGoogle Scholar
  28. Rubin JM, Bude RO, Carson PL, Bree RL, Adler RS. Power Doppler: a potentially useful alternative to mean-frequency based color Doppler sonography. Radiology 1994; 190: 853–856.PubMedGoogle Scholar
  29. Silvestri E, Martinoli C, Derchi LE, et al Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 1995; 197: 291–296.PubMedGoogle Scholar
  30. Silvestri E, Martinoli C, Onetto, F, Neumaier CE, Cimmino MA, Derchi LE. Valutazione dell’artrite reumatoide del ginocchio con color Doppler. Radio] Med 1994; 88: 364–367.Google Scholar
  31. Van Holsbeeck M, Van Holsbeeck K, Gevers G, et al Staging and follow up of Reumathoid Arthritis of the knee. Comparison of sonography, thermography, and clinical assessment. J Ultrasound Med 1988; 7: 561–566.PubMedGoogle Scholar
  32. Amer M, Jonsson K, Aspenberg P. Complete palmar dislocation of the lunate in rheumatoid arthritis. Avascularity without avascular changes. J Hand Surg [Br] 1996; 21: 384–387.CrossRefGoogle Scholar
  33. Beltran J, Caudill JC, Herman LH, Kantor SM, Hudson PN, Noto AM, et al. Rheumatoid arthritis: MR manifestations. Radiology 1987; 165: 153–7.PubMedGoogle Scholar
  34. Bjorkengren AG, Geborek P, Rydholm U, Holtâs S, Petterson H. MR imaging of the knee in acute rheumatoid arthritis: synovial uptake of gadolinium-DOTA. Am J Roentgenol 1990; 155: 329–32.Google Scholar
  35. Brahme SK, Gundry CR, Resnick D. Advanced imaging of the wrist. Radiol Clin North Am 1990; 28: 307–320.Google Scholar
  36. Brahme SK, Resnick D. Magnetic resonance imaging of the wrist. Rheum Dis Clin North Am 1991; 17: 721–739.PubMedGoogle Scholar
  37. Cimmino MA, Garlaschi G, Bountis C, Silvestri E, Delucchi S, Frisone G, et al. Reproducibility of magnetic resonance (MR) readings of erosions in the rheumatoid wrist. Arthritis Rheum 1998; 41 (Abstract): S51.Google Scholar
  38. Corvetta A, Giovagnoni A, Baldelli S, Ercolani P, Pomponio G, Luchetti MM, et al. MR imaging of rheumatoid hand lesions: comparison with conventional radiology in 31 patients. Clin Exp Rheumatol 1992; 10: 217–222.PubMedGoogle Scholar
  39. Delfaut EM, Beltran J, Johnson G, Rousseau J, Marchandise X, Cotten A. Fat suppression in MR imaging: techniques and pitfalls. Radiographies 1999; 19: 372–82.Google Scholar
  40. Dooley MA, Messina JP, Gilkeson GS, Spritzer CE, Pisetsky DS. MRI features in early rheumatoid arthritis correlation with clinical and immunological response to NSAID therapy. Arthritis Rheum 1991; 34 (Abstract): S63CrossRefGoogle Scholar
  41. Dooley MA, Pisetsky DS, Scarlett EL, Gilkeson GS, Collins AJ, Spritzer CE. Longitudinal MRI studies in early RA: correlation with clinical and radiographic disease activity. Arthritis Rheum 1992; 35 (Abstract): S196Google Scholar
  42. Foley-Nolan D, Stack JP, Ryan M, Redmond U, Barry C, Ennis J, et al. Magnetic resonance imaging in the assessment of rheumatoid arthritis — a comparison with plain film radiographs. Br J Rheumatol 1991; 30: 101–106.PubMedCrossRefGoogle Scholar
  43. Franklin PD, Lemon RA, Barden HS. Accuracy of imaging the menisci on an in-office, dedicated magnetic resonance imaging extremity system. Am J Sports Med 1997; 25: 382–7.PubMedCrossRefGoogle Scholar
  44. Gilkenson G, Polisson R, Sinclair HD, Vogler J, Rice J, Caldwell D, et al.. Early detection of carpal erosions in patients with rheumatoid arthritis: a pilot study of magnetic resonance imaging. J Rheumatol 1988; 15: 1361–6.Google Scholar
  45. Giovagnoni A, Baldelli S, Ercolani P, Misericordia M, Corvetta A, Lucchetti MM, et al. Magnetic resonance of the rheumatoid hand. Radiol Med (Torino) 1991; 81: 396–403.Google Scholar
  46. Giovagnoni A, Ercolani P, Soccetti A, Misericordia M, De Nigris E. Magnetic resonance imaging of carpal tunnel syndrome. Radiol Med 1991; 82: 35–39.PubMedGoogle Scholar
  47. Gubler FM, Algra PR, Maas M, Dijkstra PF, Falke TH. Gadolinium-DTPA enhanced magnetic resonance imaging of bone cysts in patients with rheumatoid arthritis. Ann Rheum Dis 1993; 520: 716–719.CrossRefGoogle Scholar
  48. Gubler FM, Maas M, Dijkstra PF, de Jongh HR. Cystic rheumatoid arthritis: description of a nonerosive form. Radiology 1990; 177: 829–34.PubMedGoogle Scholar
  49. Hug C, Huber I, Terrier F, Häuselmann Hi, Aue W, Vock P, et al. Detection of flexor tenosynovitis by magnetic resonance imaging: its relationship to diurnal variation of symptoms. J Rheumatol 1991; 18: 1055–59.PubMedGoogle Scholar
  50. Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jath O. Use of contrast-enhanced MRI in the assessment of therapeutic response to a disease-modifying antirheumatic drug. Case study. Br J Rheum 1995; 34: 956–959.CrossRefGoogle Scholar
  51. Jevtic V, Watt I, Rozman B, Kos-Golja M, Rupenovic S, Logar D, et al. Precontrast and postcontrast (GdDTPA) magnetic resonance imaging of hand joints in patients with rheumatoid arthritis. Clin Radiol 1993; 48: 176–181.PubMedCrossRefGoogle Scholar
  52. Jevtic V, Watt I, Rozman B, Kos-Goljia M, Praprotnik S, Logar D, et al. Contrast enhanced Gd-DTPA magnetic resonance imaging in evaluation of rheumatoid arthritis during a clinical trial with DMARDs. A prospective two-year follow-up study on hand joints in 31 patients. Clin Exp Rheum 1997; 15: 151–156.Google Scholar
  53. Jorgensen C, Cyteval C, Anaya JM, Baron MP, Lamarque JL, Sany J. Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis. Clin Exp Rheumatol 1993; 11: 163–168.PubMedGoogle Scholar
  54. Kersting-Sommerhoff B, Hof N, Lenz M, Gerhardt P. MRI of peripheral joints with a low-field dedicated system: a reliable and cost-effective alternative to high-field units? Eur Radiol 1996; 6: 561–5.PubMedCrossRefGoogle Scholar
  55. König H, Lucas D, Meissner R. The wrist: a preliminary report on high-resolution MR imaging. Radiology 1986; 160: 463–467.Google Scholar
  56. Krahe T, Landwehr P, Stolzenburg T, Richthammer A, Schindler R, Lackner K. Magnetic resonance tomography (MRT) of the hand in chronic polyarthritis. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1990; 152: 206–213.PubMedCrossRefGoogle Scholar
  57. Lee J, Lee SK, Suh JS, Yoon M, Song JH, Lee CH. Magnetic resonance imaging of the wrist in defining remission of rheumatoid arthritis. J Rheumatol 1997; 24: 1303–1308.PubMedGoogle Scholar
  58. Link TM, Bongertz GM, Böger K, Heinke Daldrup, Smitz-Linneweber B, Peters PE. Einsatz von Gado- teridol in der MR-Diagnostik rheumatoider Gelenkveränderungen. Radiologe 1996; 36: 141–147.PubMedCrossRefGoogle Scholar
  59. Mc Queen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PLJ, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symtom onset. Ann Rheum Dis 1998; 57: 350–356.CrossRefGoogle Scholar
  60. McGonagle D, Gibbon W, Green M, Proudmann S, O’Connor P, Emery P. A longitudinal MR study of the relationship between synovitis, bone oedema and bone erosion in early rheumatoid arthritis. Br J Rheumato11998, 37 (Abstract): 105.Google Scholar
  61. McGonagle D, Green MJ, Proudman S, Richardson C, Veale D, O’Connor P, et al. The majority of patients with rheumatoid arthritis have erosive disease at presentation when MRI of the dominant hand is employed. Br J Rheumatol 1997; 36 (Suppl 1) (Abstract): 121.Google Scholar
  62. Mesgarzadeh M, Schneck CD, Bonakdarpour A, Mitra A, Conaway D. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. Radiology 1989; 171: 749–754.PubMedGoogle Scholar
  63. Meske S, Friedburg H, Hennig J, Reinbold W, Stappert K, Schumichen C. Rheumatoid arthritis lesions of the wrist examined by rapid gradient-echo magnetic resonance imaging. Scand J Rheumatol 1990; 19: 235–238.PubMedCrossRefGoogle Scholar
  64. Meske S, Stappert K, Friedburg H, Mundinger A. Attempt at staging articular changes in rheumatoid arthritis using magnetic resonance tomography exemplified by the wrist joint. Z Rheumatol 1990; 49: 294–297.PubMedGoogle Scholar
  65. Nägele M, Kunze V, Koch W, Brüning R, Seelos K, Ströhmann I, et al. Rheumatoid arthritis of the wrist. Dynamic Gd-DTPA enhanced MRT. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1993; 158: 141–146.PubMedCrossRefGoogle Scholar
  66. Nakahara N, Uetani M, Hayashi K, Kawahara Y, Matsumoto T, Oda J. Gadolinium-enhanced MR imaging of the wrist in rheumatoid arthritis: value of fat suppression pulse sequences. Skeletal Radiol 1996; 25: 639–647.PubMedCrossRefGoogle Scholar
  67. Østergaard M, Gideon P, Sorensen K, Hansen M, Stoltenberg M, Henriksen O, et al. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol 1995; 24: 212–218.PubMedCrossRefGoogle Scholar
  68. Østergaard M, Hansen M, Stoltenberg M, Lorenzen I. Quantitative assessment of the synovial membrane in the rheumatoid wrist: an easily obtained MRI score reflects the synovial volume. Br J Rheumatol 1996; 35: 965–971.PubMedCrossRefGoogle Scholar
  69. Østergaard M. Different approaches to synovial membrane volume determination by magnetic resonance imaging: manual versus automated segmentation. Br J Rheumato11997; 36: 1166–77.Google Scholar
  70. Palmer WE, Rosenthal DI, Schoenberg OI, Fischman AJ, Simon LS, Rubin RH, et al. Quantification of inflammation in the wrist with gadolinium-enhanced MR imaging and PET with 2-[F-18]-fluoro-2-deoxyD-glucose. Radiology 1995; 196: 647–655.PubMedGoogle Scholar
  71. Pierre-Jerome C, Bekkelund SI, Husby G, Mellgren SI, Torbergsen T. Bilateral fast MR imaging of the rheumatoid wrist. Clin Rheumatol 1996; 15: 42–46.PubMedCrossRefGoogle Scholar
  72. Pierre-Jerome C, Bekkelund SI, Mellgren SI, Torbergsen T, Husby G, Nordstrom R. The rheumatoid wrist: bilateral MR analysis of the distribution of rheumatoid lesions in axial plane in a female population. Clin Rheumatol 1997; 16: 80–86.PubMedCrossRefGoogle Scholar
  73. Polisson RP, Schoenberg QI, Fischman A, Rubin R, Simon LS, Rosenthal D, et al. Use of magnetic resonance imaging and positron emission tomography in the assessment of synovial volume and glucose metabolism in patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 819–825.PubMedCrossRefGoogle Scholar
  74. Reiser MF, Bongartz GP, Erlemann R, Schneider M, Pauly T, Sittek H, et al. Gadolinium-DTPA in rheumatoid arthritis and related disease: first results with dynamic resonance imaging. Skeletal Radiol 1989; 18: 591–7.PubMedCrossRefGoogle Scholar
  75. Reiser MF, Schneider M, Sittek H, Bongartz GP. Stellenwert der Magnetresonanz-tomographie (MTR) bei entzüntlich-rheumatischen Erkrankungen. Z Rheumatol 1990; 49: 61–9.PubMedGoogle Scholar
  76. Rominger MB, Bernreuter WK, Kenney PI, Morgan SL, Blackburn WD, Alarcon GS. MR Imaging of the hands in early rheumatoid arthritis: preliminary results. Radiographies 1993; 13: 37–46.Google Scholar
  77. Rubens DJ, Blebea JS, Totterman SM, Hooper MM. Rheumatoid arthritis: evaluation of wrist extensor tendons with clinical examination versus MR imaging–a preliminary report. Radiology 1993; 187: 831–838.PubMedGoogle Scholar
  78. Sugimoto H, Takeda A, Kano S. Assessment of disease activity in rheumatoid arthritis using magnetic resonance imaging: quantification of pannus volume in the hands. Br J Rheumatol 1998; 37: 854–61.PubMedCrossRefGoogle Scholar
  79. Sugimoto H, Takeda A, Masuyama J, Furuse M. Early-stage rheumatoid arthritis: diagnostic accuracy of MR imaging. Radiology 1996; 198: 185–192.PubMedGoogle Scholar
  80. Tonolli-Serabian I, Poet JL, Dufour M, Carasset S, Mattei JP, Roux H. Magnetic resonance imaging of the wrist in rheumatoid arthritis: comparison with other inflammatory joint diseases and control subjects. Clin Rheumatol 1996; 15: 137–142.PubMedCrossRefGoogle Scholar
  81. Winalski CS, Palmer WE, Rosenthal DI, Weissman BN. Magnetic resonance imaging of rheumatoid arthritis. Radiol Clin North Am 1996; 34: 243–58.PubMedGoogle Scholar
  82. Yanagawa A, Takano K, Nishioka K, Shimada J, Mizushima Y, Ashida H. Clinical staging and gadoliniumDTPA enhanced images of the wrist in rheumatoid arthritis. J Rheumatol 1993; 20: 781–784.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2002

Authors and Affiliations

  • Giacomo Garlaschi
    • 1
  • Enzo Silvestri
    • 1
  • Luigi Satragno
    • 2
  • Marco Amedeo Cimmino
    • 3
  1. 1.Department of Experimental MedicineUniversity of GenoaItaly
  2. 2.MRI DivisionEsaote GroupGenoaItaly
  3. 3.Department of Internal Medicine, Division of RheumatologyUniversity of GenoaItaly

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