3 Tesla magnetic resonance imaging (3T MRI) scans of the dominant wrist from a 61-year-old American Indian man with seropositive rheumatoid arthritis of 19 months' duration. (A) T1-weighted (T1w) coronal image of the wrist shows a region of bone marrow edema (BME) as low-signal within the pole of the scaphoid (circle). A circumscribed low-signal region in the distal ulna (arrow) is consistent with erosion, which is confirmed on adjacent slices. (B) BME within the scaphoid appears as a high-signal region on a T2-weighted spectral selection attenuated inversion recovery (SPAIR) coronal image, and BME is adjacent to the ulnar erosion (arrow). (C) Post-contrast T1w axial image confirms BME within the scaphoid. This and adjacent slices were used to score the BME as RAMRIS grade 2. Extensive synovitis within the joint, an erosion at the capitate (wide arrow), and low-grade tenosynovitis within the extensor tendon sheath (two short arrows) are shown. (D) Post-contrast T1w axial image shows erosion within the ulna containing weakly enhancing synovium. RAMRIS, rheumatoid arthritis magnetic resonance imaging score.