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Feuerriegel GC, Goller SS, von Deuster C, Sutter R. Inflammatory Knee Synovitis: Evaluation of an Accelerated FLAIR Sequence Compared With Standard Contrast-Enhanced Imaging. Invest Radiol 2024; 59:599-604. [PMID: 38329824 DOI: 10.1097/rli.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic value and accuracy of a deep learning (DL)-accelerated fluid attenuated inversion recovery (FLAIR) sequence with fat saturation (FS) in patients with inflammatory synovitis of the knee. MATERIALS AND METHODS Patients with suspected knee synovitis were retrospectively included between January and September 2023. All patients underwent a 3 T knee magnetic resonance imaging including a DL-accelerated noncontrast FLAIR FS sequence (acquisition time: 1 minute 38 seconds) and a contrast-enhanced (CE) T1-weighted FS sequence (acquisition time: 4 minutes 50 seconds), which served as reference standard. All knees were scored by 2 radiologists using the semiquantitative modified knee synovitis score, effusion synovitis score, and Hoffa inflammation score. Diagnostic confidence, image quality, and image artifacts were rated on separate Likert scales. Wilcoxon signed rank test was used to compare the semiquantitative scores. Interreader and intrareader reproducibility were calculated using Cohen κ. RESULTS Fifty-five patients (mean age, 52 ± 17 years; 28 females) were included in the study. Twenty-seven patients (49%) had mild to moderate synovitis (synovitis score 6-13), and 17 patients (31%) had severe synovitis (synovitis score >14). No signs of synovitis were detected in 11 patients (20%) (synovitis score <5). Semiquantitative assessment of the whole knee synovitis score showed no significant difference between the DL-accelerated FLAIR sequence and the CE T1-weighted sequence (mean FLAIR score: 10.69 ± 8.83, T1 turbo spin-echo FS: 10.74 ± 10.32; P = 0.521). Both interreader and intrareader reproducibility were excellent (range Cohen κ [0.82-0.96]). CONCLUSIONS Assessment of inflammatory knee synovitis using a DL-accelerated noncontrast FLAIR FS sequence was feasible and equivalent to CE T1-weighted FS imaging.
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Affiliation(s)
- Georg C Feuerriegel
- From the Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland (G.C.F., S.S.G., R.S.); Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Zurich, Switzerland (C.v.D.); and Swiss Center for Musculoskeletal Imaging, Balgrist Campus, Zurich, Switzerland (C.v.D.)
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Milks KS, Singh J, Benedict JA, Rees MA. Fluid-attenuated inversion-recovery sequence with fat suppression as an alternative to contrast-enhanced MRI in pediatric synovitis. Pediatr Radiol 2024; 54:96-104. [PMID: 37962605 DOI: 10.1007/s00247-023-05804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Non-contrast magnetic resonance imaging (MRI) fluid-attenuated inversion-recovery sequence (FLAIR) with fat suppression (FS) has not been validated in children. OBJECTIVE Compare FLAIR to T1-weighted post contrast (T1CE) in the detection of knee synovitis. METHODS AND MATERIALS Institutional review board (IRB) waived consent. Children who underwent T1CE and FLAIR sequences of the knee on a 3-T magnet from April 2021 to December 2021 were included. Two pediatric radiologists assessed axial FLAIR and T1CE images for synovitis and synovial thickness. Reliability and agreement were assessed. Sensitivities, specificities, and accuracy were calculated for FLAIR using T1CE as reference standard. RESULTS In total, 42 knees (39 patients) were assessed (median age 12.9 years (2.3-17.8 years); 62% male, 38% female). Readers judged 20/42 (48%) knees to have synovitis. Sensitivity of FLAIR for reader 1 was 79% (19/24; 95% CI 0.58, 0.93) and 84% (16/19; 95% CI 0.60, 0.97) for reader 2. Specificity of FLAIR for reader 1 was 94% (17/18; 95% CI 0.73, 1) and 83% (19/23; 95% CI 0.61, 0.95) for reader 2. Accuracy for readers 1 and 2 was 86% (36/42; 95% CI 0.71, 0.95) and 83% (35/42; 95% CI 0.69, 0.93), respectively. Inter-reader reliability was good (0.75-0.90) for synovial measurements for FLAIR (ICC = 0.80; 95% CI 0.71, 0.86) and moderate for T1 CE (ICC = 0.62 (95% CI 0.48, 0.73)). CONCLUSION FLAIR FS depicts synovium in the pediatric knee with similar reliability to T1 CE and may be an acceptable alternative to contrast in the initial diagnosis of synovitis.
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Affiliation(s)
- Kathryn S Milks
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43215, USA.
| | - Jasmeet Singh
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43215, USA
| | - Jason A Benedict
- Department of Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mitchell A Rees
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43215, USA
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Mostert JM, Dur NB, Li X, Ellermann JM, Hemke R, Hales L, Mazzoli V, Kogan F, Griffith JF, Oei EH, van der Heijden RA. Advanced Magnetic Resonance Imaging and Molecular Imaging of the Painful Knee. Semin Musculoskelet Radiol 2023; 27:618-631. [PMID: 37935208 PMCID: PMC10629992 DOI: 10.1055/s-0043-1775741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown. Recent developments in advanced magnetic resonance imaging (MRI) techniques and molecular imaging facilitate more in-depth research focused on the pathophysiology of chronic musculoskeletal pain and more specifically inflammation. The forthcoming new insights can help develop better targeted treatment, and some imaging techniques may even serve as imaging biomarkers for predicting and assessing treatment response in the future. This review highlights the latest developments in perfusion MRI, diffusion MRI, and molecular imaging with positron emission tomography/MRI and their application in the painful knee. The primary focus is synovial inflammation, also known as synovitis. Bone perfusion and bone metabolism are also addressed.
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Affiliation(s)
- Jacob M. Mostert
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels B.J. Dur
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xiufeng Li
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Jutta M. Ellermann
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, California
| | | | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California
| | - James F. Griffith
- Department of Imaging and Interventional Radiology Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rianne A. van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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Pandya S, Melville DM. Evaluation of the knee joint with ultrasound and magnetic resonance imaging. J Ultrason 2023; 23:e239-e250. [PMID: 38020509 PMCID: PMC10668946 DOI: 10.15557/jou.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
The knee joint relies on a combination of deep and superficial structures for stability and function. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these structures and associated pathology. This article reviews a combination of critical anatomic structures, joint abnormalities, and pathologic conditions at the knee joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method paired with its relative strengths will aid in expediting diagnosis and appropriate treatment for a wide range of knee joint conditions.
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Affiliation(s)
- Siddharth Pandya
- Department of Radiology, Valleywise Health Medical Center, Phoenix, USA
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Ma W, Cai J, Zhang W, Suo S, Zu J, Yao Q, Wei J, Lu Q. Diagnostic performance of double inversion recovery MRI sequence for synovitis of the wrist joints in rheumatoid arthritis. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01669-8. [PMID: 37402026 DOI: 10.1007/s11547-023-01669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of double inversion recovery (DIR) magnetic resonance imaging (MRI) sequences for synovitis of the wrist joints in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS Participants with newly diagnosed RA were enrolled between November 2019 and November 2020. MRI examinations of the wrist joints were performed using a contrast-enhanced T1-weighted imaging sequence (CE-T1WI) and DIR sequence. We measured synovitis score, number of synovial areas, synovial volume, mean synovium-to-bone signal ratio (SBR), and synovial contrast-to-noise ratio (SNR). The inter-reviewer agreement rated on a four-point scale was evaluated by calculating the weighted k statistics. Two MRI sequences were assessed using Bland-Altman analyses, and the diagnostic performance of DIR images was calculated using the chi-square test. RESULTS A total of 47 participants were evaluated, and 282 joint regions in 5076 images were reviewed by two readers. There was no significant difference in synovitis scores (P = 0.67), number of synovial areas (P = 0.89), and synovial volume (P = 0.086) between the two MRI sequences. DIR images showed better SBR and SNR (all P < 0.01). There was good agreement between the two reviewers in terms of synovitis distribution (κ = 0.79). The synovitis was well agreed upon by the two readers according to Bland-Altman analyses. Using CE-T1WI as the reference standard, DIR imaging demonstrated a sensitivity of 94.1% and a specificity of 84.6% at the patient level. CONCLUSION The non-contrast DIR sequence showed good consistency with CE-T1WI and potential for evaluating synovitis in patients with RA.
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Affiliation(s)
- Weiwei Ma
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Jianguo Cai
- Department of Radiology, Xinhua Hospital Chongming Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, 202150, China
| | - Wei Zhang
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Shiteng Suo
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Jinyan Zu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Qiuying Yao
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Jiaxu Wei
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Qing Lu
- Department of Radiology, Shanghai East Hospital Affiliated to Tongji University, 150 Jimo Road, Shanghai, 200120, China.
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Kang JH, Moon SG, Jung HG, Kwon EY. Fluid-Attenuated Inversion Recovery Sequence with Fat Suppression for Assessment of Ankle Synovitis without Contrast Enhancement: Comparison with Contrast-Enhanced MRI. Diagnostics (Basel) 2023; 13:diagnostics13111960. [PMID: 37296812 DOI: 10.3390/diagnostics13111960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
The purpose of this study was to investigate the feasibility of the fluid-attenuated inversion recovery sequence with fat suppression (FLAIR-FS) for the assessment of ankle synovitis without contrast enhancement. FLAIR-FS and contrast-enhanced, T1-weighted sequences (CE-T1) of 94 ankles were retrospectively reviewed by two radiologists. Grading of synovial visibility (four-point scale) and semi-quantitative scoring of synovial thickness (three-point scale) were performed in four compartments of the ankle in both sequences. Synovial visibility and thickness in FLAIR-FS and CE-T1 images were compared, and agreement between both sequences was assessed. Synovial visibility grades and synovial thickness scores for FLAIR-FS images were lower than those for CE-T1 images (reader 1, p = 0.016, p < 0.001; reader 2, p = 0.009, p < 0.001). Dichotomized synovial visibility grades (partial vs. full visibility) were not significantly different between both sequences. The agreement in synovial thickness scores between the FLAIR-FS and CE-T1 images was moderate to substantial (κ = 0.41-0.65). The interobserver agreement between the two readers was fair for synovial visibility (κ = 0.27-0.32) and moderate to substantial for synovial thickness (κ = 0.54-0.74). In conclusion, FLAIR-FS is a feasible MRI sequence for the evaluation of ankle synovitis without contrast enhancement.
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Affiliation(s)
- Ji Hee Kang
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Eun Young Kwon
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Verkuil F, Hemke R, van Gulik EC, Barendregt AM, Rashid ANS, Schonenberg-Meinema D, Dolman KM, Deurloo EE, van Dijke KF, Harder JMD, Kuijpers TW, van den Berg JM, Maas M. Double inversion recovery MRI versus contrast-enhanced MRI for evaluation of knee synovitis in juvenile idiopathic arthritis. Insights Imaging 2022; 13:167. [PMID: 36264355 PMCID: PMC9584003 DOI: 10.1186/s13244-022-01299-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Double inversion recovery (DIR) MRI has the potential to accentuate the synovium without using contrast agents, as it allows simultaneous signal suppression of fluid and fat. The purpose of this study was (1) to compare DIR MRI to conventional contrast-enhanced (CE) MRI for delineation of the synovium in the knee in children with juvenile idiopathic arthritis (JIA) and (2) to assess the agreement between DIR MRI and CE-MRI regarding maximal synovial thickness measurements. RESULTS In this prospective study, 26 children with JIA who consecutively underwent 3.0-T knee MRI between January 2018 and January 2021 were included (presence of knee arthritis: 13 [50%]; median age: 14 years [interquartile range [IQR]: 11-17]; 14 girls). Median confidence to depict the synovium (0-100 mm visual analogue scale; scored by 2 readers [consensus based]) was 88 (IQR: 79-97) for DIR MRI versus 100 (IQR: 100-100) for CE-MRI (p value = < .001). Maximal synovial thickness per child (millimeters; scored by 4 individual readers) on DIR MRI was greater (p value = < .001) in the children with knee arthritis (2.4 mm [IQR: 2.1-3.1]) than in those without knee arthritis (1.4 mm [IQR: 1.0-1.6]). Good inter-technique agreement for maximal synovial thickness per child was observed (rs = 0.93 [p value = < .001]; inter-reader reliability: ICC DIR MRI = 0.87 [p value = < .001], ICC CE-MRI = 0.90 [p value = < .001]). CONCLUSION DIR MRI adequately delineated the synovium in the knee of children with JIA and enabled synovial thickness measurement similar to that of CE-MRI. Our results demonstrate that DIR MRI should be considered as a child-friendly alternative to CE-MRI for evaluation of synovitis in children with (suspected) JIA.
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Affiliation(s)
- Floris Verkuil
- Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Robert Hemke
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - E. Charlotte van Gulik
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anouk M. Barendregt
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Amara Nassar-Sheikh Rashid
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.417773.10000 0004 0501 2983Department of Pediatrics, Zaans Medical Center, Koningin Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Koert M. Dolman
- grid.440209.b0000 0004 0501 8269Department of Pediatrics; Location OLVG Oost, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands ,grid.440209.b0000 0004 0501 8269Department of Pediatrics; Location OLVG West, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands ,grid.418029.60000 0004 0624 3484Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands
| | - Eline E. Deurloo
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kees F. van Dijke
- Department of Radiology and Nuclear Medicine, Noordwest Hospital Group Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - J. Michiel den Harder
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Taco W. Kuijpers
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - J. Merlijn van den Berg
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mario Maas
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Imaging of Synovial Inflammation in Osteoarthritis, From the AJR Special Series on Inflammation. AJR Am J Roentgenol 2021; 218:405-417. [PMID: 34286595 DOI: 10.2214/ajr.21.26170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Synovitis, inflammation of the synovial membrane, is a common manifestation in osteoarthritis (OA) and is recognized to play a role in the complex pathophysiology of OA. Increased recognition of the importance of synovitis in the OA disease process and potential as a target for treatment has increased the need for non-invasive detection and characterization of synovitis using medical imaging. Numerous imaging methods can assess synovitis involvement in OA with varying sensitivity and specificity as well as complexity. This article reviews the role of contrast-enhanced MRI, conventional MRI, novel unenhanced MRI, gray-scale ultrasound (US), and power Doppler US in the assessment of synovitis in patients with OA. The role of imaging in disease evaluation as well as challenges in conventional imaging methods are discussed. We also provide an overview into the potential utility of emerging techniques for imaging of early inflammation and molecular inflammatory markers of synovitis, including quantitative MRI, superb microvascular imaging, and PET. The potential development of therapeutic treatments targeting inflammatory features, particularly in early OA, would greatly increase the importance of these imaging methods for clinical decision making and evaluation of therapeutic efficacy.
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Non-contrast MRI of synovitis in the knee using quantitative DESS. Eur Radiol 2021; 31:9369-9379. [PMID: 33993332 DOI: 10.1007/s00330-021-08025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/22/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine whether synovitis graded by radiologists using hybrid quantitative double-echo in steady-state (qDESS) images can be utilized as a non-contrast approach to assess synovitis in the knee, compared against the reference standard of contrast-enhanced MRI (CE-MRI). METHODS Twenty-two knees (11 subjects) with moderate to severe osteoarthritis (OA) were scanned using CE-MRI, qDESS with a high diffusion weighting (qDESSHigh), and qDESS with a low diffusion weighting (qDESSLow). Four radiologists graded the overall impression of synovitis, their diagnostic confidence, and regional grading of synovitis severity at four sites (suprapatellar pouch, intercondylar notch, and medial and lateral peripatellar recesses) in the knee using a 4-point scale. Agreement between CE-MRI and qDESS, inter-rater agreement, and intra-rater agreement were assessed using a linearly weighted Gwet's AC2. RESULTS Good agreement was seen between CE-MRI and both qDESSLow (AC2 = 0.74) and qDESSHigh (AC2 = 0.66) for the overall impression of synovitis, but both qDESS sequences tended to underestimate the severity of synovitis compared to CE-MRI. Good inter-rater agreement was seen for both qDESS sequences (AC2 = 0.74 for qDESSLow, AC2 = 0.64 for qDESSHigh), and good intra-rater agreement was seen for both sequences as well (qDESSLow AC2 = 0.78, qDESSHigh AC2 = 0.80). Diagnostic confidence was moderate to high for qDESSLow (mean = 2.36) and slightly less than moderate for qDESSHigh (mean = 1.86), compared to mostly high confidence for CE-MRI (mean = 2.73). CONCLUSIONS qDESS shows potential as an alternative MRI technique for assessing the severity of synovitis without the use of a gadolinium-based contrast agent. KEY POINTS The use of the quantitative double-echo in steady-state (qDESS) sequence for synovitis assessment does not require the use of a gadolinium-based contrast agent. Preliminary results found that low diffusion-weighted qDESS (qDESSLow) shows good agreement to contrast-enhanced MRI for characterization of the severity of synovitis, with a relative bias towards underestimation of severity. Preliminary results also found that qDESSLow shows good inter- and intra-rater agreement for the depiction of synovitis, particularly for readers experienced with the sequence.
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de Vries BA, Breda SJ, Sveinsson B, McWalter EJ, Meuffels DE, Krestin GP, Hargreaves BA, Gold GE, Oei EHG. Detection of knee synovitis using non-contrast-enhanced qDESS compared with contrast-enhanced MRI. Arthritis Res Ther 2021; 23:55. [PMID: 33581741 PMCID: PMC7881494 DOI: 10.1186/s13075-021-02436-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/02/2021] [Indexed: 01/15/2023] Open
Abstract
Background To assess diagnostic accuracy of quantitative double-echo in steady-state (qDESS) MRI for detecting synovitis in knee osteoarthritis (OA). Methods Patients with different degrees of radiographic knee OA were included prospectively. All underwent MRI with both qDESS and contrast-enhanced T1-weighted magnetic resonance imaging (CE-MRI). A linear combination of the two qDESS images can be used to create an image that displays contrast between synovium and the synovial fluid. Synovitis on both qDESS and CE-MRI was assessed semi-quantitatively, using a whole-knee synovitis sum score, indicating no/equivocal, mild, moderate, and severe synovitis. The correlation between sum scores of qDESS and CE-MRI (reference standard) was determined using Spearman’s rank correlation coefficient and intraclass correlation coefficient for absolute agreement. Receiver operating characteristic analysis was performed to assess the diagnostic performance of qDESS for detecting different degrees of synovitis, with CE-MRI as reference standard. Results In the 31 patients included, very strong correlation was found between synovitis sum scores on qDESS and CE-MRI (ρ = 0.96, p < 0.001), with high absolute agreement (0.84 (95%CI 0.14–0.95)). Mean sum score (SD) values on qDESS 5.16 (3.75) were lower than on CE-MRI 7.13 (4.66), indicating systematically underestimated synovitis severity on qDESS. For detecting mild synovitis or higher, high sensitivity and specificity were found for qDESS (1.00 (95%CI 0.80–1.00) and 0.909 (0.571–1.00), respectively). For detecting moderate synovitis or higher, sensitivity and specificity were good (0.727 (95%CI 0.393–0.927) and 1.00 (0.800–1.00), respectively). Conclusion qDESS MRI is able to, however with an underestimation, detect synovitis in patients with knee OA.
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Affiliation(s)
- Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Stephan J Breda
- Department of Radiology & Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Orthopedic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Bragi Sveinsson
- Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Emily J McWalter
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Duncan E Meuffels
- Department of Orthopedic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, USA
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Treutlein C, Bäuerle T, Nagel AM, Guermazi A, Kleyer A, Simon D, Schett G, Hepp T, Uder M, Roemer FW. Comprehensive assessment of knee joint synovitis at 7 T MRI using contrast-enhanced and non-enhanced sequences. BMC Musculoskelet Disord 2020; 21:116. [PMID: 32085776 PMCID: PMC7035667 DOI: 10.1186/s12891-020-3122-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Seven T ultra-high field MRI systems have recently been approved for clinical use by the U.S. and European regulatory agencies. These systems are now being used clinically and will likely be more widely available in the near future. One of the applications of 7 T systems is musculoskeletal disease and particularly peripheral arthritis imaging. Since the introduction of potent anti-rheumatic therapies over the last two decades MRI has gained increasing importance particularly for assessment of disease activity in early stages of several rheumatic disorders. Commonly gadolinium-based contrast agents are used for assessment of synovitis. Due to potential side-effects of gadolinium non-enhanced techniques are desirable that enable visualization of inflammatory disease manifestations. The feasibility of 7 T MRI for evaluation of peripheral arthritis has not been shown up to now. Aim of our study was to evaluate the feasibility of contrast-enhanced (CE) and non-enhanced MRI at 7 T for the assessment of knee joint synovitis. Method Seven T MRI was acquired for 10 patients with an established diagnosis of psoriatic or rheumatoid arthritis. The study pulse sequence protocol was comprised of a sagittal intermediate-weighted fat-suppressed (FS), axial fluid-attenuated inversion recovery (FLAIR) FS, sagittal 3D T1-weighted dynamic contrast enhanced (DCE) and an axial static 2D T1-weighted FS contrast-enhanced sequence (T1-FS CE). Ordinal scoring on non-enhanced (Hoffa- and effusion-synovitis) and enhanced MRI (11-point synovitis score), and comparison of FLAIR-FS with static T1-FS CE MRI using semiquantitative (SQ) grading and volume assessment was performed. For inter- and intra-reader reliability assessment weighted kappa statistics for ordinal scores and intraclass correlation coefficients (ICC) for continuous variables were used. Results The total length of study protocol was 15 min 38 s. Different amounts of synovitis were observed in all patients (mild: n = 3; moderate: n = 5; severe: n = 2). Consistently, SQ assessment yielded significantly lower peripatellar summed synovitis scores for the FLAIR-FS sequence compared to the CE T1-FS sequence (p < 0.01). FLAIR-FS showed significantly lower peripatellar synovial volumes (p < 0.01) compared to CE T1-FS imaging with an average percentage difference of 18.6 ± 9.5%. Inter- and intra-reader reliability for ordinal SQ scoring ranged from 0.21 (inter-reader Hoffa-synovitis) to 1.00 (inter-reader effusion-synovitis). Inter- and intra-observer reliability of SQ 3D-DCE parameters ranged from 0.86 to 0.99. Conclusions Seven T FLAIR-FS ultra-high field MRI is a potential non-enhanced imaging method able to visualize synovial inflammation with high conspicuity and holds promise for further application in research endeavors and clinical routine by trained readers.
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Affiliation(s)
- Christoph Treutlein
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Tobias Bäuerle
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Armin M Nagel
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany.,Institute of Medical Physics, University of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Division of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, Suite 1B105, Boston, MA, 02132, USA
| | - Arnd Kleyer
- Department of Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - David Simon
- Department of Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Tobias Hepp
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University of Erlangen-Nuremberg, Waldstraße 6, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany. .,Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
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Double-inversion recovery with synthetic magnetic resonance: a pilot study for assessing synovitis of the knee joint compared to contrast-enhanced magnetic resonance imaging. Eur Radiol 2018; 29:2573-2580. [DOI: 10.1007/s00330-018-5800-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 12/23/2022]
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Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. Eur Radiol 2018; 28:4669-4680. [DOI: 10.1007/s00330-018-5460-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 12/29/2022]
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