RESEARCH - MRI better monitor of RA bone erosion

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MRI better monitor of RA bone erosion

11/16/2006

By: Reuters Health

NEW YORK (Reuters Health), Nvo 16 - MRI appears to be a sensitive way to

follow structural damage in patients with rheumatoid arthritis (RA), with

significant advantages over conventional radiography and ultrasound,

physicians in California report. This means of visualization may also be

feasible and cost-effective for an individual practice, with the advent of

portable in-office scanners.

According to co-author Dr. V. Crues III, from Radnet Management in Los

Angeles, and associates, better and more frequent imaging studies may detect

and monitor bony erosions early in the course of the disease, when more

advanced damage can be prevented by early treatment.

MRI examinations were performed using a portable high-resolution scanner

(Applause, GE Medical Systems). As the investigators note in the October

issue of the Journal of Rheumatology, it requires no magnetic shielding, can

be plugged into an ordinary 110 V AC wall adaptor, and is portable when

mounted on wheels.

The investigators used the scanner to visualize the second and third

metacarpophalangeal joints and wrists. Images were compared with those

obtained by standard posteroanterior, lateral, and oblique radiography of

the hands and wrist.

One hundred fifty-six patients underwent at least two MRIs, an average of

eight weeks apart. The radiologists observed changes in 50% of follow-up MRI

exams, including increased number or size of erosions in 30%, a decrease in

size or number in 15%, and a combination of the two in 4%.

The authors followed 632 individual erosions. Increases in size were

observed in 14%, decreases in 8%, and both increases and decreases in less

than 1%.

In contrast, only one radiographic image follow-up out of 165 revealed a new

erosion, and one showed increased size in another.

Dr. Crues and his associates point out that ultrasound may reveal erosions

and demonstrate pannus formation, but cannot identify changes in bone

marrow. Computed tomography, on the other hand, demonstrates erosions

accurately but falls short in its ability to evaluate periarticular soft

tissues and bone marrow. High-resolution, multidetector CT is not portable

and exposes patients to ionizing radiation.

And although MRI is expensive, it may be cost-effective when considering the

costs of disability and advanced treatment, including cytokine blockers, if

erosions are not detected early in the course of rheumatic arthritis.

" For these reasons, MRI is the most promising modality for evaluating bony

erosive disease, " the investigators conclude.

Last Updated: 2006-11-15 16:30:58 -0400 (Reuters Health)

J Rheumatol 2006:33:1957-1967.

http://www.auntminnie.com/index.asp?Sec=sup & Sub=mri & Pag=dis & ItemId=73542 & wf=1431

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