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Background  To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel high-resolution hand coil.    Methods  Seventeen patients with active PsA, 20 patients with active RA, and 16 healthy controls (HC) underwent high-resolution 3 T MRI using the dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, thickness of flexor tendon pulleys, and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores. For correlation analyses, Spearman rho correlation was calculated.    Results  Flexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm,  p  < 0.001) and HC (mean difference 0.2 mm,  p  < 0.001) and showed a higher degree of associated inflammatory changes (mean difference from RA 4.7,  p  = 0.048; mean difference from HC 14.65,  p  < 0.001). Additionally, there was a strong correlation of accessory pulley inflammation and PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis, and periarticular inflammation (for the second digit synovitis  ρ  = 0.72, flexor tenosynovitis  ρ  = 0.7, overall PsAMRIS  ρ  = 0.72,  p  < 0.01). Similar robust correlations were evident in digits 3–5. Weaker correlations were evident in RA (synovitis  ρ  = 0.49, flexor tenosynovitis  ρ  = 0.49, periarticular inflammation  ρ  = 0.4).    Conclusion  The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection in PsA, as well as for its distinction from RA and HC.    Trial registration   2014123117 , December 2014.

High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis