Detection of degenerative and inflammatory osseous changes on an magnetic resonance imaging (MRI) of the hands and wrists: T2-weighted Dixon imaging can replace pre-contrast T1-weighted images.

AIM: To evaluate whether pre-contrast T1-weighted magnetic resonance imaging (MRI) sequences can be omitted when using T2-weighted Dixon imaging to detect inflammatory and degenerative osseous changes in the hands and wrists.

MATERIALS AND

METHODS

Two radiologists retrospectively reviewed bilateral hand and wrist MRI examinations from 48 patients with hand pain. A standard protocol (coronal and axial T1-weighted images) was compared with a simplified protocol including coronal and axial fat-only, in-phase, and water-only T2-weighted Dixon images. Readers independently scored osteophytes, joint space narrowing, subchondral sclerosis, and subchondral bone defects across five articulation groups per hand. Item-specific and per-hand scores were summed. An inter-protocol agreement was assessed using Bland-Altman analysis (bias, 95% limits of agreement, and proportional bias), and inter-reader and inter-protocol reliability were evaluated using Cohen's kappa (κ).

RESULTS

The inter-protocol agreement was substantial to almost perfect for all items (κ = 0.74-0.84), and inter-reader agreement ranged from moderate to almost perfect (κ = 0.56-0.81). Bland-Altman analysis showed minimal systematic bias for subchondral sclerosis (-0.04) and osteophytes (-0.43). Small but significant proportional bias was found for subchondral bone defects (P=.043), joint space narrowing (P=.017), and total scores (P=.009). The simplified protocol demonstrated significantly higher contrast-to-noise ratios (P<.05).

CONCLUSION

T2-weighted Dixon imaging reliably detects inflammatory and degenerative osseous changes in the hands and wrists and may obviate the need for pre-contrast T1-weighted sequences.