skip to main content

MRI Sequences for RA — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardMusculoskeletal ImagingMRI Sequences for RASCE Rheumatology

A 40-year-old woman with established rheumatoid arthritis is enrolled in a study requiring semiquantitative OMERACT RAMRIS assessment of the wrist and metacarpophalangeal joints for bone erosion, osteitis/bone marrow oedema and active synovitis. There is no contraindication to gadolinium. Which sequence-to-lesion mapping is correct?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Erosion—pre-contrast T1; osteitis—STIR or T2 fat-suppressed; synovitis—post-gadolinium T1 fat-suppressed

Pre-contrast T1-weighted imaging provides anatomical detail and demonstrates cortical bone erosions as sharply marginated defects with loss of normal low-signal cortex. Osteitis, conventionally termed bone marrow oedema in RAMRIS, is best detected as high marrow signal on a fluid-sensitive fat-suppressed sequence such as STIR or T2 fat-suppressed imaging. Active synovitis is assessed most reliably by enhancement on post-gadolinium T1-weighted fat-suppressed images. Thus, C gives the correct mapping. The other options interchange the structural and inflammatory sequence characteristics: STIR is not the principal erosion sequence, unenhanced T1 is insensitive to marrow oedema, and diffusion-weighted imaging is not the standard RAMRIS sequence for synovitis. Although validated non-contrast approaches are emerging, conventional RAMRIS synovitis assessment remains contrast-enhanced.

Reference: Frenken M et al. To Contrast or Not to Contrast? On the Role of Contrast Enhancement in Hand MRI Studies of Patients with Rheumatoid Arthritis. Diagnostics. 2022. https://pubmed.ncbi.nlm.nih.gov/35204555/