What is the best imaging study for rheumatoid (RH) diagnosis?

From the Guidelines

The best imaging study for evaluating rheumatoid arthritis (RA) is MRI, as it provides a more detailed evaluation of both soft tissue inflammation and bone damage, making it excellent for detecting early disease and monitoring progression. According to the EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis 1, MRI and ultrasound are superior to clinical examination in the detection of joint inflammation. The study suggests that MRI bone oedema is a strong independent predictor of subsequent radiographic progression in early RA and should be considered for use as a prognostic indicator.

Some key points to consider when choosing an imaging study for RA include:

• MRI and ultrasound can detect inflammation that predicts subsequent joint damage, even when clinical remission is present and can be used to assess persistent inflammation 1
• Ultrasound and MRI are superior to clinical examination in the detection of joint inflammation; these techniques should be considered for more accurate assessment of inflammation 1
• Conventional radiography (CR) of the hands and feet should be used as the initial imaging technique to detect damage, but ultrasound and/or MRI should be considered if conventional radiographs do not show damage and may be used to detect damage at an earlier time point (especially in early RA) 1

Overall, MRI is the preferred imaging modality for evaluating rheumatoid arthritis due to its high sensitivity and ability to detect early disease and monitor progression. However, the choice of imaging study ultimately depends on the clinical question, disease stage, availability, and cost considerations, with many rheumatologists using a combination of imaging techniques for comprehensive assessment.

From the Research

Best Image Study for Abdominal Pain

• The best image study for abdominal pain depends on various factors such as the location of pain, patient considerations, and suspected etiologies 2.
• Computed Tomography (CT) is often the imaging modality of choice for undifferentiated abdominal pain 2.
• Ultrasound and Magnetic Resonance Imaging (MRI) may be helpful in specific scenarios, such as in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT 2.
• MRI provides the most accurate diagnoses in the investigation of hepatic, adrenal, and pancreatic disease, while ultrasound is most accurate for gallbladder disease 3.
• CT is readily available and has excellent tissue resolution, but its usage is limited by the risk of ionizing radiation and contrast-induced nephropathy 4.

Comparison of Imaging Modalities

• A study comparing the diagnostic accuracy of abdominal ultrasound, CT, and MRI found that MRI provided the most accurate information in 92% of cases, followed by CT in 62% of cases, and ultrasound in 46% of cases 3.
• Another study found that CT detected 67% of abnormalities, while MRI detected 84% of abnormalities, and ultrasound detected 54% of abnormalities 3.
• The choice of imaging modality should be guided by the American College of Radiology Appropriateness Criteria, which outlines imaging options based on the location of pain and specific suspected etiologies 2.

Limitations and Risks

• Each imaging modality has its own limitations and risks, such as ionizing radiation from CT, contrast-induced nephropathy, and allergies to contrast media 4, 5.
• MRI has contraindications such as the presence of MRI "unsafe" implants and devices, and the presence of metallic foreign bodies 4.
• The risk of nephrogenic systemic fibrosis from MRI contrast media is a concern in patients with renal insufficiency 4.