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MRI Erosion Early Detection — SCE Rheumatology MCQ

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ModerateMusculoskeletal ImagingMRI Erosion Early DetectionSCE Rheumatology

A 42-year-old woman has newly diagnosed rheumatoid arthritis with 4 months of metacarpophalangeal and wrist synovitis. Baseline hand radiographs show periarticular soft-tissue swelling but no erosions. Which statement best describes the potential added value of MRI of the hands and wrists at this stage?

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Correct answer: E — It may show radiographically occult erosions and bone marrow oedema (osteitis), which predicts later structural progression.

MRI can detect erosions that are not yet visible on conventional radiographs and can demonstrate synovitis, tenosynovitis and bone marrow oedema, also termed osteitis. In early RA, MRI bone marrow oedema is associated with subsequent erosive or radiographic structural progression, giving MRI prognostic as well as structural value. Radiography remains the standard UK baseline investigation but is less sensitive for early erosive damage. CT provides excellent depiction of cortical erosions and is a reference technique for bone damage, but it does not demonstrate marrow inflammation or synovitis as effectively as MRI and is not preferred for routine early RA assessment. The timing cannot reliably be expressed as a universal number of months or years, and the predictive value of bone marrow oedema should not be presented as a fixed percentage.

Reference: Østergaard M, Boesen M. Imaging in rheumatoid arthritis: the role of magnetic resonance imaging and computed tomography. Radiol Med. 2019;124:1128–1141. https://pubmed.ncbi.nlm.nih.gov/30880357/