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Early detection of carpal erosions in patients with rheumatoid arthritis: a pilot study of magnetic resonance imaging.

A pilot study comparing standard radiography to magnetic resonance imaging (MRI) was performed on the wrists of 10 patients with early (anatomic Stage I or II) rheumatoid arthritis (RA). MRI was found to be superior to standard radiographs in 2 respects: (1) synovial inflammation was impressively demonstrated on T2 weighted images, whereas plain films merely suggested soft tissue swelling; and (2) T1 and T2 weighted images clearly revealed erosions of several carpal bones which were not noted on standard radiographs. Although the expense of MRI currently precludes its routine use in clinical practice, the apparent sensitivity of this diagnostic modality for detecting early changes in RA might make it an invaluable tool for therapeutic decision making or for assessing response in interventional trials.