Multimodality Imaging of Rheumatoid and Psoriatic Arthritis of the Hand

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Computed Tomography: 2.00
Procedures: 2.00
Head, Spine, and Musculoskeletal: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Musculoskeletal: 2.00

Radiography: 2.00
Procedures: 2.00
Extremity Procedures: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Musculoskeletal and Endocrine Sections: 2.00

Sonography: 2.00
Procedures: 2.00
Superficial Structures and Other Sonographic Procedures: 2.00

Outline

1. Introduction
2. Pathophysiology
3. Synovio-Entheseal Complex
4. Imaging Modalities
   1. Radiography
   2. Ultrasonography
   3. Magnetic Resonance Imaging
   4. CT and Dual-Energy CT
5. Systematic Approach to Differentiate RA and PsA of the Hand: Multimodality Imaging Characteristics
   1. Alignment
   2. Bone Change: Bone Density, Erosion, and Proliferation
   3. Bone Marrow Edema
   4. Cartilage Damage
   5. Distribution
   6. Effusion with Synovitis or Enthesitis
6. Summary of Imaging Features
7. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the percentage of RA patients with negative test results for rheumatoid factor
2. be familiar with the factors associated with the development of RA and PsA
3. identify the most investigated cytokines in RA
4. be familiar with the inhibitors for PsA
5. understand the synovio-entheseal complex
6. identify the primary imaging modality for evaluating inflammatory arthritis
7. identify the imaging modality of choice when evaluating arthritis, even when findings at radiography are unremarkable
8. be familiar with the limitations of using US to evaluate patients presenting with RA or PsA
9. identify the imaging modality with higher sensitivity than radiography and US for detecting bone erosions
10. be familiar with MRI sequences used for diagnosing inflammatory arthritis
11. identify the imaging modality regarded as the standard examination when evaluating structural changes in patients presenting with RA or PsA
12. be familiar with dual-energy CT processing techniques used to depict inflammatory lesions in inflammatory arthritis
13. be familiar with the mnemonic ABCDE used when interpreting images of RA or PsA patients
14. be familiar with the deformities most frequently found in RA patients
15. be familiar with the swan neck deformity
16. be familiar with the development of bone erosions within 1 year after the onset of RA
17. be familiar with the bone formation associated with patients presenting with PsA
18. be familiar with the pencil-in-cup deformity in patients presenting with PsA
19. identify the MRI sequences used to assess bone marrow edema
20. identify the mouse ear sign associated with PsA
21. identify the pencil-in-cup deformity associated with patients presenting with PsA
22. be familiar with the advantages of dual-energy CT for assessing bone marrow edema
23. be familiar with the result of cartilage results on medical imaging
24. identify the imaging modality used for evaluating joint spaces
25. be familiar with the imaging patterns of inflammation associated with dactylitis
26. be familiar with the imaging modalities of choice for diagnosing effusion in the joint
27. be familiar with the use of MRI contrast when diagnosing effusion
28. be familiar with the administration of MRI contrast when differentiating between synovium and joint fluid
29. be familiar with the MRI sequences used to diagnose synovitis in patients with RA
30. identify the imaging modality that allows detailed visualization of the proliferated synovium and perfusional changes induced by synovitis
31. be familiar with the findings of Gutierrez et al
32. be familiar with the imaging feature of tenosynovitis
33. identify the imaging modality found to be superior in demonstrating inflammatory lesions in small joints
34. identify the imaging modalities used for diagnosing inflammatory lesions
35. be familiar with the findings of sacroiliitis in patients presenting with RA