Clinical interpretation:

A consultant rheumatologist (with greater than 10 years’ experience) retrospectively reviewed each clinical case, focusing on the clinical presentation, blood tests, provisional diagnosis and medication history. The aim was to group diagnoses together where possible, give a semi-quantitative degree of diagnostic confidence, and assess for any correlation with the MRI findings.

 The clinical grading system is outlined below:

 

We collected qualitative analysis from each reader regarding the value of the fusion sequences in each case.

We also compared the OMERACT scores obtained from the standard imaging with those obtained from the TRICKS MRA fusions images to assess for intra-observer and inter-observer variability, using interclass correlation (ICC) and a paired student's T-test. All calculations were performed using SPSS software (ver ***).

Example Images / Fusion Images

Example Fused PEAK images

Example 4th + 5th Metacarphophalangeal Joints Synovitis

20 patients were included in the final analysis. 4 of these patients had complete TRICKS imaging but the volumetric pre-contrast T1 images were not available, therefore the peak enhancement data was fused to the standard T1 coronal images.

 

**demographic data

The patients tolerated the study well and the TRICKS images were of diagnostic quality. The total study time was 40 min to acquire the standard post contrast images. Acquisition of the TRICKS sequence took approximately 8 minutes and was completed prior to the final images in the standard sequence. 

The post-processing was semi-automated and could be performed easily by a novice user with the aid of our guidebook. 

The interpreting radiologists reported a high level of confidence in reading the MRA and fusion sequences following a brief period of training.

 Each radiologist assessed 4 joints per patient in twenty patients, giving a total of 80 joints in the standard and fusion groups in the final analysis. 

 We used an intraclass coefficient correlation to assess the consistency of the mean scores of the raters for the standard post contrast images and for the fusion images. 

 Insert fusion and post contrast ICC tables