MR imaging

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Summary

MRI is a tool of unprecedented capabilities for evaluating arthritis and its progression. Not only can it non-invasively delineate the anatomy of all components of a joint with unparalleled clarity, MRI is also capable of probing important functional and compositional parameters of disease in these tissues. Particularly intriguing is MRI's potential for identifying very early changes of joint disease when clinical symptoms may be minimal or absent. Early detection of patients who are at risk for developing progressive disease may allow appropriate treatment to be initiated earlier, when there may be a greater chance of favourable outcome. MRI can, furthermore, provide objective and quantitative measures of disease progression and treatment response. Certain parameters, such as articular cartilage volume, have been validated cross-sectionally; however, their longitudinal performance has yet to be established. Further work is, therefore, necessary to thoroughly validate and optimize some of these measures so that they can begin to be used in more powerful ways to explore the pathophysiology and potential therapies of arthritic disorders.

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      This is because it combines tomographic capability with the capacity to image bony structures and cartilage, as well as soft tissues and fluid. It produces images by detecting signal from H+ ions as they are exposed to a powerful magnetic field and are forced to reorientate their spin direction following the application of electromagnetic pulses [22]. This means that the images are produced in a completely different way from radiographic modalities, which depend upon the attenuation (blocking) of X-rays as they pass through tissue, thus providing clear detail of Ca++-containing structures such as bone but minimal information about soft tissues.

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      In 1996, an issue of this journal was published called ‘Imaging techniques part II: modern methods’. The 15-year history of developments in MRI in bone, cartilage and synovitis were reviewed and MRI was proposed as an outcome measure for inflammatory and degenerative disease progression and therapeutic response.22 The review was extensive but there was little to report on the measurement properties of MRI.

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