1
|
Mao Y, Imahori K, Fang W, Sugimori H, Kiuch S, Sutherland K, Kamishima T. Artificial Intelligence Quantification of Enhanced Synovium Throughout the Entire Hand in Rheumatoid Arthritis on Dynamic Contrast-Enhanced MRI. J Magn Reson Imaging 2024. [PMID: 38807358 DOI: 10.1002/jmri.29463] [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: 01/23/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Challenges persist in achieving automatic and efficient inflammation quantification using dynamic contrast-enhanced (DCE) MRI in rheumatoid arthritis (RA) patients. PURPOSE To investigate an automatic artificial intelligence (AI) approach and an optimized dynamic MRI protocol for quantifying disease activity in RA in whole hands while excluding arterial pixels. STUDY TYPE Retrospective. SUBJECTS Twelve RA patients underwent DCE-MRI with 27 phases for creating the AI model and tested on images with a variable number of phases from 35 RA patients. FIELD STRENGTH/SEQUENCE 3.0 T/DCE T1-weighted gradient echo sequence (mDixon, water image). ASSESSMENT The model was trained with various DCE-MRI time-intensity number of phases. Evaluations were conducted for similarity between AI segmentation and manual outlining in 51 ROIs with synovitis. The relationship between synovial volume via AI segmentation with rheumatoid arthritis magnetic resonance imaging scoring (RAMRIS) across whole hands was then evaluated. The reference standard was determined by an experienced musculoskeletal radiologist. STATISTICAL TEST Area under the curve (AUC) of receiver operating characteristic (ROC), Dice and Spearman's rank correlation coefficients, and interclass correlation coefficient (ICC). A P-value <0.05 was considered statistically significant. RESULTS A minimum of 15 phases (acquisition time at least 2.5 minutes) was found to be necessary. AUC ranged from 0.941 ± 0.009 to 0.965 ± 0.009. The Dice score was 0.557-0.615. Spearman's correlation coefficients between the AI model and ground truth were 0.884-0.927 and 0.736-0.831, for joint ROIs and whole hands, respectively. The Spearman's correlation coefficient for the additional test set between the model trained with 15 phases and RAMRIS was 0.768. CONCLUSION The AI-based classification model effectively identified synovitis pixels while excluding arteries. The optimal performance was achieved with at least 15 phases, providing a quantitative assessment of inflammatory activity in RA while minimizing acquisition time. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Yijun Mao
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kiko Imahori
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Wanxuan Fang
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroyuki Sugimori
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | | | - Kenneth Sutherland
- Global Center for Biomedical Science and Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
2
|
Lau D, Corrie PG, Gallagher FA. MRI techniques for immunotherapy monitoring. J Immunother Cancer 2022; 10:e004708. [PMID: 36122963 PMCID: PMC9486399 DOI: 10.1136/jitc-2022-004708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
MRI is a widely available clinical tool for cancer diagnosis and treatment monitoring. MRI provides excellent soft tissue imaging, using a wide range of contrast mechanisms, and can non-invasively detect tissue metabolites. These approaches can be used to distinguish cancer from normal tissues, to stratify tumor aggressiveness, and to identify changes within both the tumor and its microenvironment in response to therapy. In this review, the role of MRI in immunotherapy monitoring will be discussed and how it could be utilized in the future to address some of the unique clinical questions that arise from immunotherapy. For example, MRI could play a role in identifying pseudoprogression, mixed response, T cell infiltration, cell tracking, and some of the characteristic immune-related adverse events associated with these agents. The factors to be considered when developing MRI imaging biomarkers for immunotherapy will be reviewed. Finally, the advantages and limitations of each approach will be discussed, as well as the challenges for future clinical translation into routine clinical care. Given the increasing use of immunotherapy in a wide range of cancers and the ability of MRI to detect the microstructural and functional changes associated with successful response to immunotherapy, the technique has great potential for more widespread and routine use in the future for these applications.
Collapse
Affiliation(s)
- Doreen Lau
- Centre for Immuno-Oncology, University of Oxford, Oxford, UK
| | - Pippa G Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | | |
Collapse
|
3
|
Aslanalp Z, Tikiz C, Ulusoy A, Orguc Ş, Bİlgİ Yedekcİ A, Ulman C. The Relationship Between Serum Angiogenic Factor Levels and Disease Activity in Rheumatoid Arthritis. Arch Rheumatol 2021; 35:416-425. [PMID: 33458666 PMCID: PMC7788655 DOI: 10.46497/archrheumatol.2020.7416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 09/04/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives
This study aims to evaluate the relationship between serum angiogenic factor levels and disease activity in patients with rheumatoid arthritis (RA) using both clinical and dynamic wrist magnetic resonance imaging (MRI) data. Patients and methods
Simultaneous serum angiogenesis markers [vascular endothelial growth factor (VEGF), angiopoietin-1 (ANG1), ANG2, and tyrosine-protein kinase receptor for angiopoietin (Tie-2)] were studied in 40 patients with RA (13 males, 27 females; mean age 51.1±10.8 years; range, 23 to 69 years) and 20 healthy controls (11 males, 9 females; mean age 47.3±12.8 years; range, 29 to 69 years) and dynamic contrast-enhanced wrist MRI was performed in 40 RA patients and seven controls. Rate of early in 55th second (REE) and Relative enhancement (REt) values were calculated from the signal time curve values obtained from the analysis of images. In clinical assessment, duration of morning stiffness, patient pain assessment [visual analog scale (VAS)], physician and patient global assessments (VAS) were recorded. The number of tender joints and swollen joints were determined. Disease activity score 28 and Ritchie scores were calculated. Health assessment questionnaire was used for functional evaluation. Anti-cyclic citrullinated peptide, rheumatoid factor, erythrocyte sedimentation rate and high sensitive C-reactive protein analyses were performed. Results
Serum VEGF, REE and REt values were significantly higher in RA patients than healthy controls (p=0.002, p=0.00, p=0.00, respectively). There was no significant correlation between serum angiogenesis markers and clinical parameters or REE and REt (p>0.05). VEGF value correlated positively with disease duration (p=0.024). Conclusion Serum VEGF was higher in RA patients. While its level was associated with disease duration, no significant correlation was found with disease activity. As a diagnostic test, dynamic contrast-enhanced MRI was a valuable method for showing disease activity.
Collapse
Affiliation(s)
- Zahide Aslanalp
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Aslıhan Ulusoy
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Şebnem Orguc
- Department of Radiodiagnostic, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Aysun Bİlgİ Yedekcİ
- Department of Biochemistry, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Cevval Ulman
- Department of Biochemistry, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| |
Collapse
|
4
|
Carotti M, Galeazzi V, Catucci F, Zappia M, Arrigoni F, Barile A, Giovagnoni A. Clinical utility of eco-color-power Doppler ultrasonography and contrast enhanced magnetic resonance imaging for interpretation and quantification of joint synovitis: a review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:48-77. [PMID: 29350637 PMCID: PMC6179068 DOI: 10.23750/abm.v89i1-s.7010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
With the introduction of new biologics such as anti-TNF-alpha antibodies and other therapies in the treatment of inflammatory arthritis, capable of halting joint destruction and functional disability, there are new pressures on diagnostic and prognostic imaging. Early demonstration of pre-erosive inflammatory features and monitoring of the long-term effects of treatment are becoming increasingly important. Early detection of synovitis offers advantages in terms of allowing early instigation of therapy and may allow the identification of those patients displaying more aggressive disease who might benefit from early intervention with expensive DMARD therapy. Advanced imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) have focussed on the demonstration and quantification of synovitis and allow early diagnosis of inflammatory arthropathies such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Synovitis represents a potential surrogate measure of disease activity that can be monitored using either MRI or US; the techniques have, generally, focused on monitoring synovial volume or quality as assessed by its vascularity. However to achieve these goals, standardisation and validation of US and MRI are required to ensure accurate diagnosis, reproducibility and reliability. Each modality has different strengths and weaknesses and levels of validation. This article aims to increase the awareness of radiologists and rheumatologists about this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration, it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. The first part addresses the role of US and colour or power Doppler sonography (PDUS) in the detection and monitoring of synovitis in inflammatory arthropathies. The second part will look at advanced MR imaging and Dynamic contrast-enhanced MRI techniques and in particular how they are applied to the monitoring of the disease process.
Collapse
|
5
|
Beals C, Baumgartner R, Peterfy C, Balanescu A, Mirea G, Harabagiu A, Popa S, Cheng A, Feng D, Ashton E, DiCarlo J, Vallee MH, Dardzinski BJ. Magnetic resonance imaging of the hand and wrist in a randomized, double-blind, multicenter, placebo-controlled trial of infliximab for rheumatoid arthritis: Comparison of dynamic contrast enhanced assessments with semi-quantitative scoring. PLoS One 2017; 12:e0187397. [PMID: 29236711 PMCID: PMC5728526 DOI: 10.1371/journal.pone.0187397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 09/24/2017] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to compare the scope and the discriminative power of Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) to those of semi-quantitative MRI scoring for evaluating treatments for rheumatoid arthritis (RA) in multicenter randomized clinical trials (RCTs). Sixty-one patients with active RA participated in a double-blind, parallel group, randomized, multicenter methodology study receiving infliximab or placebo through 14 weeks. The most symptomatic wrist and metacarpophalangeal joints (MCPs) were imaged using MRI. In addition to clinical assessments with DAS28(CRP), the severity of inflammation was measured as synovial leak of gadolinium based contrast agent (GBCA) using DCE-MRI (Ktrans, primary endpoint) at weeks 0, 2, 4, and 14. Two radiologists independently scored synovitis, osteitis and erosion using RA MRI Score (RAMRIS) and cartilage loss using a 9-point MRI scale (CARLOS). Infliximab showed greater decrease from baseline in DAS28(CRP), DCE-MRI Ktrans of wrist and MCP synovium, and RAMRIS synovitis and osteitis at all visits compared with placebo (p<0.001). Treatment effect sizes of infliximab therapy were similar for DAS28(CRP) (1.08; 90% CI (0.63–1.53)) and MRI inflammation endpoints: wrist Ktrans (1.00 (0.55–1.45)), RAMRIS synovitis (0.85 (0.38–1.28)) and RAMRIS osteitis (0.99 (0.52–1.43)). Damage measures of bone erosion (RAMRIS) and cartilage loss (CARLOS) were reduced with infliximab compared to with placebo at 14 weeks (p≤0.025). DCE-MRI and RAMRIS were equally sensitive and responsive to the anti-inflammatory effects of infliximab. RAMRIS and CARLOS showed suppression of erosion and cartilage loss, respectively, at 14 weeks. (ClinicalTrials.gov registration: NCT01313520)
Collapse
Affiliation(s)
- Chan Beals
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
- * E-mail:
| | - Richard Baumgartner
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Charles Peterfy
- Spire Sciences, Inc., Boca Raton, Florida, United States of America
| | - Andra Balanescu
- Department of Immunology, U of Med and Pharm Carol Davila, Bucharest, Romania
| | - Gavrila Mirea
- Department of Rheumatology, Tractorul County Hospital, Brasov, Romania
| | | | - Serghei Popa
- Department of Rheumatology, Republican Clinical Hospital, Chisinau, MD, Moldova
| | - Amy Cheng
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Dai Feng
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Edward Ashton
- VirtualScopics, Rochester, New York, United States of America
| | - Julie DiCarlo
- Spire Sciences, Inc., Boca Raton, Florida, United States of America
| | - Marie-Helene Vallee
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Bernard J. Dardzinski
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| |
Collapse
|
6
|
Vyas S, Bhalla AS, Ranjan P, Kumar S, Kumar U, Gupta AK. Rheumatoid Arthritis Revisited - Advanced Imaging Review. Pol J Radiol 2016; 81:629-635. [PMID: 28105245 PMCID: PMC5223782 DOI: 10.12659/pjr.899317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 12/31/2022] Open
Abstract
Rheumatoid Arthritis (RA) is a multisystem disorder, which causes significant morbidity. An early diagnosis of RA is essential to prevent the development of irreversible bone and joint changes. The disease has characteristic clinical features, but an early evaluation of the quantum of disease may be difficult with plain radiography alone. Recent developments in the imaging of RA have contributed significantly to an early diagnosis of the disease. In this article, we review the role and current status of various imaging modalities including recent advances in the evaluation and follow-up of early RA.
Collapse
Affiliation(s)
- Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Gait A, Hodgson R, Parkes M, Hutchinson C, O'Neill T, Maricar N, Marjanovic E, Cootes T, Felson D. Synovial volume vs synovial measurements from dynamic contrast enhanced MRI as measures of response in osteoarthritis. Osteoarthritis Cartilage 2016; 24:1392-8. [PMID: 27038489 PMCID: PMC4967444 DOI: 10.1016/j.joca.2016.03.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/10/2016] [Accepted: 03/22/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Synovium is increasingly a target of osteoarthritis (OA) treatment, yet its optimal measurement is unclear. Using dynamic contrast enhanced (DCE) MRI in knee OA patients before and after intraarticular steroid injection, we compared the responsiveness of static synovial volume measures to measures of dynamic changes in synovial enhancement, changes that are strongly related to synovial vascularity. METHODS Ninety three patients underwent DCE-MRI before and 1-2 weeks after intra-articular injection of 80 mg methylprednisolone. Synovium was segmented and volume, relative enhancement rate (RER), maximum relative enhancement (REmax), late relative enhancement (RElate) and pharmacokinetic parameters (K(trans), ve) were calculated. KOOS (knee injury and osteoarthritis outcome score) pain score was recorded before and after injection. Standardized change scores were calculated for each parameter. Linear regression and Pearson's correlations were used to investigate the relationship between change in MRI parameters and change in pain. RESULTS The change in standardized score for the measures of synovial enhancement, RElate and REmax were -0.58 (95% CI -0.79 to -0.37) and -0.62 (95% CI -0.83 to -0.41) respectively, whereas the score for synovial volume was -0.30 (-0.52 to -0.09). Further, change in knee pain correlated more strongly with changes in enhancement (for both REmax and RElate, r = -0.27 (95% CI -0.45 to -0.07)) than with changes in synovial volume -0.15 (-0.35 to 0.05). CONCLUSION This study suggests DCE-MRI derived measures of synovial enhancement may be more sensitive to the response to treatment and more strongly associated with changes in pain than synovial volume and may be better outcomes for assessment of structural effects of treatment in OA.
Collapse
Affiliation(s)
- A.D. Gait
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK,Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK
| | - R. Hodgson
- Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - M.J. Parkes
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C.E. Hutchinson
- Warwick Medical School, The University of Warwick, Coventry, UK
| | - T.W. O'Neill
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - N. Maricar
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - E.J. Marjanovic
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - T.F. Cootes
- Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK
| | - D.T. Felson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA,Address correspondence and reprint requests to: D.T. Felson, Suite 200, 650 Albany Street, Boston University School of Medicine, Boston, MA 02118, USA. Tel: 617-638-5180.Boston University School of MedicineSuite 200650 Albany StreetBostonMA02118USA
| |
Collapse
|
8
|
Maijer KI, van der Leij C, de Hair MJH, Tas SW, Maas M, Gerlag DM, Tak PP, Lavini C. Dynamic Contrast-Enhanced Magnetic Resonance Imaging Using Pharmacokinetic Modeling: Initial Experience in Patients With Early Arthritis. Arthritis Rheumatol 2016; 68:587-96. [PMID: 26473331 DOI: 10.1002/art.39469] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/01/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using pharmacokinetic modeling (PKM) provides quantitative measures that mirror microvessel integrity and can be used as an objective marker of the level of synovial inflammation. The aim of this study was to investigate the PKM parameters K(trans) , kep , and ve in a prospective cohort of disease-modifying antirheumatic drug (DMARD)-naive patients with early arthritis, and to validate the results by assessing their correlation with the number of synovial endothelial cells (ECs). METHODS Forty-seven patients with early arthritis (arthritis duration <1 year, DMARD naive; comprising 14 patients with rheumatoid arthritis, 22 with unclassified arthritis, 6 with spondyloarthritis [SpA], and 5 with other arthritides) were included. At baseline, DCE-MRI was performed on an inflamed knee joint of each patient. These images were used to calculate the K(trans) (volume transfer constant between the plasma and extracellular extravascular space [EES]), the kep (transfer constant between the EES and plasma), and the ve (fractional volume of the EES). Second, markers of disease activity were collected. Finally, vascularity was evaluated by immunohistochemical analysis of synovial tissue samples obtained from the inflamed knee joints, using antibodies to detect von Willebrand factor (vWF), a marker of ECs. RESULTS The 3 PKM parameters differed significantly between diagnostic groups at baseline, with the highest K(trans) value being observed in patients with SpA (median 0.050/minute, interquartile range [IQR] 0.041- 0.069). Furthermore, the K(trans) , kep , and ve values correlated significantly with markers of disease activity. Finally, the PKM parameters K(trans) and kep , but not ve , correlated significantly with synovial expression of vWF (r = 0.647, P = 0.004 for K(trans) ; r = 0.614, P = 0.007 for kep ; r = 0.398, P = 0.102 for ve ). CONCLUSION These results suggest that the K(trans) , kep , and ve can be used to detect synovial inflammation in patients with early arthritis, and these PKM parameters may be helpful in differential diagnosis. This approach may also be useful in translational research analyzing tissue microcirculation and angiogenesis.
Collapse
Affiliation(s)
- Karen I Maijer
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Maria J H de Hair
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander W Tas
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle M Gerlag
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul P Tak
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristina Lavini
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
9
|
van der Leij C, Lavini C, van de Sande MG, de Hair MJ, Wijffels C, Maas M. Reproducibility of DCE-MRI time-intensity curve-shape analysis in patients with knee arthritis: A comparison with qualitative and pharmacokinetic analyses. J Magn Reson Imaging 2015; 42:1497-506. [DOI: 10.1002/jmri.24933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/13/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- Christiaan van der Leij
- Department of Radiology; Academic Medical Center/University of Amsterdam; Amsterdam the Netherlands
| | - Cristina Lavini
- Department of Radiology; Academic Medical Center/University of Amsterdam; Amsterdam the Netherlands
| | - Marleen G.H. van de Sande
- Division of Clinical Immunology and Rheumatology; Academic Medical Center/University of Amsterdam; Amsterdam the Netherlands
| | - Marjolein J.H. de Hair
- Division of Clinical Immunology and Rheumatology; Academic Medical Center/University of Amsterdam; Amsterdam the Netherlands
| | - Christophe Wijffels
- Department of Radiology; Academic Medical Center/University of Amsterdam; Amsterdam the Netherlands
| | - Mario Maas
- Department of Radiology; Academic Medical Center/University of Amsterdam; Amsterdam the Netherlands
| |
Collapse
|
10
|
Dynamic contrast enhanced MRI of wrist as a useful diagnostic tool in early rheumatoid arthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
11
|
|
12
|
Meier R, Thuermel K, Noël PB, Moog P, Sievert M, Ahari C, Nasirudin RA, Golovko D, Haller B, Ganter C, Wildgruber M, Schaeffeler C, Waldt S, Rummeny EJ. Synovitis in patients with early inflammatory arthritis monitored with quantitative analysis of dynamic contrast-enhanced optical imaging and MR imaging. Radiology 2013; 270:176-85. [PMID: 23901126 DOI: 10.1148/radiol.13130039] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate quantitative perfusion measurements of dynamic indocyanine green (ICG)-enhanced optical imaging for monitoring synovitis in the hands of patients with inflammatory arthritis compared with dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and clinical outcome. MATERIALS AND METHODS This study was approved by the ethics committee at the institution. Individual joints (n = 840) in the hands and wrists of 28 patients (14 women; mean age, 53.3 years) with inflammatory arthritis were examined at three different time points: before start of therapy and 12 and 24 weeks after start of therapy or therapy escalation. Treatment response was assessed by using clinical measures (simple disease activity index [SDAI]), ICG-enhanced optical imaging, and DCE MR imaging. Dynamic images were obtained for optical imaging and DCE MR imaging. The rate of early enhancement (REE) of the perfusion curves of each joint was calculated by using in-house developed software. Correlation coefficients were estimated to evaluate the associations of changes of imaging parameters and SDAI change. RESULTS Quantitative perfusion measurements with optical imaging and MR imaging correctly identified patients who responded (n = 18) and did not respond to therapy (n = 10), as determined by SDAI. The difference of REE after 24 weeks of treatment compared with baseline in responders was significantly reduced in optical imaging and MR imaging (optical imaging: mean, -21.5%; MR imaging: mean, -41.0%; P < .001 for both), while in nonresponders it was increased (optical imaging: mean, 10.8%; P = .075; MR imaging: mean, 8.7%; P = .03). The REE of optical imaging significantly correlated with MR imaging (ρ = 0.80; P < .001) and SDAI (ρ = 0.61; P < .001). CONCLUSION Quantitative analysis of contrast-enhanced optical imaging allows for potential therapeutic monitoring of synovitis in patients with inflammatory arthritis.
Collapse
Affiliation(s)
- Reinhard Meier
- From the Departments of Radiology (R.M., P.B.N., M.S., C.A., R.A.N., C.G., M.W., C.S., S.W., E.J.R.) and Rheumatology (K.T., P.M.), II. Medizinische Klinik, and Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar (B.H.), Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany; and Department of Internal Medicine, University of Colorado, Denver, Colo (D.G.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Rastogi A, Kubassova O, Krasnosselskaia LV, Lim AKP, Satchithananda K, Boesen M, Binks M, Hajnal JV, Taylor PC. Evaluating automated dynamic contrast enhanced wrist 3T MRI in healthy volunteers: one-year longitudinal observational study. Eur J Radiol 2013; 82:1286-91. [PMID: 23562303 DOI: 10.1016/j.ejrad.2013.02.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 02/04/2013] [Accepted: 02/25/2013] [Indexed: 12/17/2022]
Abstract
RATIONAL AND OBJECTIVE Dynamic contrast enhanced (DCE)-MRI has great potential to provide quantitative measure of inflammatory activity in rheumatoid arthritis. There is no current benchmark to establish the stability of signal in the joints of healthy subjects when imaged with DCE-MRI longitudinally, which is crucial so as to differentiate changes induced by treatment from the inherent variability of perfusion measures. The objective of this study was to test a pixel-by-pixel parametric map based approach for analysis of DCE-MRI (Dynamika) and to investigate the variability in signal characteristics over time in healthy controls using longitudinally acquired images. MATERIALS AND METHODS 10 healthy volunteers enrolled, dominant wrists were imaged with contrast enhanced 3T MRI at baseline, week 12, 24 and 52 and scored with RAMRIS, DCE-MRI was analysed using a novel quantification parametric map based approach. Radiographs were obtained at baseline and week 52 and scored using modified Sharp van der Heidje method. RAMRIS scores and dynamic MRI measures were correlated. RESULTS No erosions were seen on radiographs, whereas MRI showed erosion-like changes, low grade bone marrow oedema and low-moderate synovial enhancement. The DCE-MRI parameters were stable (baseline scores, variability) (mean±st.dev); in whole wrist analysis, MEmean (1.3±0.07, -0.08±0.1 at week 24) and IREmean (0.008±0.004, -0.002±0.005 at week 12 and 24). In the rough wrist ROI, MEmean (1.2±0.07, 0.04±0.02 at week 52) and IREmean (0.001±0.0008, 0.0006±0.0009 at week 52) and precise wrist ROI, MEmean (1.2±0.09, 0.04±0.04 at week 52) and IREmean (0.001±0.0008, 0.0008±0.001 at week 24 and 52). The Dynamic parameters obtained using fully automated analysis demonstrated strong, statistically significant correlations with RAMRIS synovitis scores. CONCLUSION The study demonstrated that contrast enhancement does occur in healthy volunteers but the inherent variability of perfusion measures obtained with quantitative DCE-MRI method is low and stable, suggesting its suitability for longitudinal studies of inflammatory arthritis. These results also provide important information regarding potential cut-off levels for imaging remission goals in patients with RA using both RAMRIS and DCE-MRI extracted parametric parameters.
Collapse
Affiliation(s)
- Anshul Rastogi
- Kennedy Institute of Rheumatology, Imperial College London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Axelsen MB, Poggenborg RP, Stoltenberg M, Kubassova O, Boesen M, Hørslev-Petersen K, Bliddal H, Hanson LG, Østergaard M. Reliability and responsiveness of dynamic contrast-enhanced magnetic resonance imaging in rheumatoid arthritis. Scand J Rheumatol 2012; 42:115-22. [DOI: 10.3109/03009742.2012.723745] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
15
|
Saveraid TC, Judy CE. Use of Intravenous Gadolinium Contrast in Equine Magnetic Resonance Imaging. Vet Clin North Am Equine Pract 2012. [DOI: 10.1016/j.cveq.2012.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
16
|
Balducci A, Helfer BM, Ahrens ET, O'Hanlon CF, Wesa AK. Visualizing arthritic inflammation and therapeutic response by fluorine-19 magnetic resonance imaging (19F MRI). JOURNAL OF INFLAMMATION-LONDON 2012; 9:24. [PMID: 22721447 PMCID: PMC3506445 DOI: 10.1186/1476-9255-9-24] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/05/2012] [Indexed: 12/05/2022]
Abstract
Background Non-invasive imaging of inflammation to measure the progression of autoimmune diseases, such as rheumatoid arthritis (RA), and to monitor responses to therapy is critically needed. V-Sense, a perfluorocarbon (PFC) contrast agent that preferentially labels inflammatory cells, which are then recruited out of systemic circulation to sites of inflammation, enables detection by 19F MRI. With no 19F background in the host, detection is highly-specific and can act as a proxy biomarker of the degree of inflammation present. Methods Collagen-induced arthritis in rats, a model with many similarities to human RA, was used to study the ability of the PFC contrast agent to reveal the accumulation of inflammation over time using 19F MRI. Disease progression in the rat hind limbs was monitored by caliper measurements and 19F MRI on days 15, 22 and 29, including the height of clinically symptomatic disease. Naïve rats served as controls. The capacity of the PFC contrast agent and 19F MRI to assess the effectiveness of therapy was studied in a cohort of rats administered oral prednisolone on days 14 to 28. Results Quantification of 19F signal measured by MRI in affected limbs was linearly correlated with disease severity. In animals with progressive disease, increases in 19F signal reflected the ongoing recruitment of inflammatory cells to the site, while no increase in 19F signal was observed in animals receiving treatment which resulted in clinical resolution of disease. Conclusion These results indicate that 19F MRI may be used to quantitatively and qualitatively evaluate longitudinal responses to a therapeutic regimen, while additionally revealing the recruitment of monocytic cells involved in the inflammatory process to the anatomical site. This study may support the use of 19F MRI to clinically quantify and monitor the severity of inflammation, and to assess the effectiveness of treatments in RA and other diseases with an inflammatory component.
Collapse
Affiliation(s)
- Anthony Balducci
- Department of Research and Development, Celsense, Inc,, Pittsburgh, PA 15222, USA.
| | | | | | | | | |
Collapse
|
17
|
Axelsen MB, Stoltenberg M, Poggenborg RP, Kubassova O, Boesen M, Bliddal H, Hørslev-Petersen K, Hanson LG, Østergaard M. Dynamic gadolinium-enhanced magnetic resonance imaging allows accurate assessment of the synovial inflammatory activity in rheumatoid arthritis knee joints: a comparison with synovial histology. Scand J Rheumatol 2012; 41:89-94. [DOI: 10.3109/03009742.2011.608375] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
Dynamic contrast-enhanced 3-T magnetic resonance imaging: a method for quantifying disease activity in early polyarthritis. Skeletal Radiol 2012; 41:51-9. [PMID: 21318271 DOI: 10.1007/s00256-011-1112-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/15/2011] [Accepted: 01/24/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether measurement of synovial enhancement and thickness quantification parameters with 3.0-Tesla magnetic resonance imaging (3-T MRI) can reliably quantify disease activity in patients with early polyarthritis. MATERIALS AND METHODS Eighteen patients (16 women, 2 men; mean age 46 years) with early polyarthritis with less than 12 months of symptoms were included. MRI examination using 3-T device was performed by a new approach including both wrists and hands simultaneously in the examination field-of-view. MRI scoring of disease activity included quantification of synovial enhancement with simple measurements such as rate of early enhancement (REE; REE(57) = S(57)/S(200), where S(57) and S(200) are the signal intensities 57 s and 200 s after gadolinium injection) and rate of relative enhancement (RE; RE = S(200) - S(0)). Both wrists and hands were scored according to the Rheumatoid Arthritis MRI Scoring System (RAMRIS) for synovitis. Disease activity was clinically assessed by the 28-joint Disease Activity Score (DAS28). RESULTS DAS28 score was strongly correlated with RE (r = 0.8331, p < 0.0001), REE (r = 0.8112, p < 0.0001), and RAMRIS score for synovitis (r = 0.7659, p < 0.0002). An REE score above 0.778 accurately identified patients with clinically active disease (sensitivity 92%; specificity 67%; p < 0.05). A statistically significant difference was observed in the RE, REE, and RAMRIS scores for synovitis between patients with active and inactive disease (p < 0.05). CONCLUSIONS Our findings support the use of 3-T dynamic contrast-enhanced MRI for precise quantification of disease activity and for discriminating active disease from inactive disease in early polyarthritis.
Collapse
|
19
|
Boesen M, Kubassova O, Bouert R, Axelsen MB, Ostergaard M, Cimmino MA, Danneskiold-Samsøe B, Hørslev-Petersen K, Bliddal H. Correlation between computer-aided dynamic gadolinium-enhanced MRI assessment of inflammation and semi-quantitative synovitis and bone marrow oedema scores of the wrist in patients with rheumatoid arthritis--a cohort study. Rheumatology (Oxford) 2011; 51:134-43. [PMID: 22075065 DOI: 10.1093/rheumatology/ker220] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To test the correlation between assessment of inflammation using dynamic contrast-enhanced MRI (DCE-MRI) analysed by a novel computer-aided approach and semi-quantitative scores of synovitis and bone marrow oedema (BME) using the OMERACT-RA MRI Scoring (RAMRIS) system, in the wrist of patients with RA. METHODS Fifty-four RA patients had conventional and DCE-MRI of a symptomatic wrist using a low-field 0.2T extremity scanner. RAMRIS synovitis and BME of the wrist joint were done. DCE-MRI data were analysed in three ways: (i) in all images (fully automated approach), (ii) within a large extended region of interest (ROI) placed around the wrist joint (semi-automated approach) and (iii) within a small ROI placed in the area with most visual enhancement (semi-automated approach). Time spent on each procedure was noted. Spearman's rank correlation test was applied to assess the correlation between RAMRIS and the computer-generated dynamic parameters. RESULTS RAMRIS synovitis (range 2-9), BME (range 0-39) and the dynamic parameters reflecting the number of enhancing voxels were significantly correlated, especially when an extended ROI around the wrist was used (ρ = 0.74; P < 0.01 for synovitis and ρ = 0.82; P < 0.01 for BME). The observer spent on average 20 min (range 12-25 min) to perform RAMRIS, including acquisition of the results in the database, and 8 min (range 7-10 min) to perform all above-mentioned computer-aided analyses. CONCLUSION Computer-aided analysis of DCE-MRI data correlated with RAMRIS synovitis and BME and was twice as fast to perform. This technique may be useful for quick semi-automated assessment of joint inflammation, but needs further validation.
Collapse
Affiliation(s)
- Mikael Boesen
- Department of Radiology, Frederiksberg Hospital, Nordrefasanvej 57, Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
The impact of MRI on the clinical management of inflammatory arthritides. Skeletal Radiol 2011; 40:1153-73. [PMID: 21847747 DOI: 10.1007/s00256-011-1204-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 02/02/2023]
Abstract
In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.
Collapse
|
21
|
Bird P, Joshua F. New applications of imaging techniques for monitoring progression of rheumatoid arthritis and predicting outcome. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.10.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
22
|
Laurell L, Court-Payen M, Nielsen S, Zak M, Boesen M, Fasth A. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J 2011; 9:4. [PMID: 21276257 PMCID: PMC3041992 DOI: 10.1186/1546-0096-9-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 01/29/2011] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity. The aim of the study was to evaluate the role of ultrasonography (US) of the ankle and midfoot (ankle region) in JIA. Doppler-US detected synovial hypertrophy, effusion and hyperemia and US was used for guidance of steroid injection and to assess treatment efficacy. METHODS Forty swollen ankles regions were studied in 30 patients (median age 6.5 years, range 1-16 years) with JIA. All patients were assessed clinically, by US (synovial hypertrophy, effusion) and by color Doppler (synovial hyperemia) before and 4 weeks after US-guided steroid injection. RESULTS US detected 121 compartments with active disease (joints, tendon sheaths and 1 ganglion cyst). Multiple compartments were involved in 80% of the ankle regions. The talo-crural joint, posterior subtalar joint, midfoot joints and tendon sheaths were affected in 78%, 65%, 30% and 55% respectively. Fifty active tendon sheaths were detected, and multiple tendons were involved in 12 of the ankles. US-guidance allowed accurate placement of the corticosteroid in all 85 injected compartments, with a low rate of subcutaneous atrophy (4,7%). Normalization or regression of synovial hypertrophy was obtained in 89%, and normalization of synovial hyperemia in 89%. Clinical resolution of active arthritis was noted in 72% of the ankles. CONCLUSIONS US enabled exact anatomical location of synovial inflammation in the ankle region of JIA patients. The talo-crural joint was not always involved. Disease was frequently found in compartments difficult to evaluate clinically. US enabled exact guidance of steroid injections, gave a low rate of subcutaneous atrophy and was proved valuable for follow-up examinations. Normalization or regression of synovial hypertrophy and hyperemia was achieved in most cases, which supports the notion that US is an important tool in the management of ankle involvement in JIA.
Collapse
Affiliation(s)
- Louise Laurell
- Department of Pediatrics, Skåne University Hospital, Lund University, Sweden.
| | - Michel Court-Payen
- Department of Diagnostic Imaging, Gildhøj Private Hospital, University of Copenhagen, Denmark
| | - Susan Nielsen
- Department of Pediatrics, Rigshospital, University of Copenhagen, Denmark
| | - Marek Zak
- Department of Pediatrics, Rigshospital, University of Copenhagen, Denmark
| | - Mikael Boesen
- Parker Institute, Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Anders Fasth
- Department of Pediatrics, University of Gothenburg, Sweden
| |
Collapse
|
23
|
KEEN HELENI, MEASE PHILIPJ, BINGHAM CLIFTONO, GILES JONT, KAELEY GURJIT, CONAGHAN PHILIPG. Systematic Review of MRI, Ultrasound, and Scintigraphy as Outcome Measures for Structural Pathology in Interventional Therapeutic Studies of Knee Arthritis: Focus on Responsiveness. J Rheumatol 2010; 38:142-54. [DOI: 10.3899/jrheum.100377] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Validated imaging outcome tools to assess response to therapies in a single joint are required. Our aim was to review the published literature to ascertain the responsiveness of novel imaging techniques as outcome measures in interventional therapeutic studies of knee arthritis.Methods.An Ovid Medline search was performed for original articles in English that used imaging techniques to assess response at the knee joint to therapy in osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. Changes in response to therapy were assessed with regard to both internal and external responsiveness.Results.In the studies that presented appropriate statistical data to allow responsiveness to be assessed, MRI was generally found to be internally responsive to pathologies imaged, and externally responsive, referenced against both other imaging modalities and biochemical biomarkers of arthritis. Ultrasonography was found to demonstrate internal responsiveness with regard to synovial thickness, effusion size, and popliteal cyst size. External responsiveness was demonstrated against several referenced health status measures. Scintigraphy was found to be externally responsive in the majority of studies, with internal responsiveness demonstrated in 1 study.Conclusion.While the imaging techniques appear to be responsive from the data we present, further inspection reveals that interpreting the responsiveness of imaging techniques was difficult, largely because of a lack of standardization of image acquisition, definitions of pathology, and scoring systems. Refined pathological definitions and scoring systems are required to enable the development of valid and responsive tools for interventional clinical trials.
Collapse
|
24
|
Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol 2010; 29:347-56. [PMID: 20101428 DOI: 10.1007/s10067-009-1357-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
Intra-articular corticosteroid injection (IACI) is a very popular procedure. In this review, we wanted to review all that had been published about local effects of IACIs. English literature search was made through PubMed using the terms intra-articular and local effect. Effects on subjective, functional, structural, cellular, humoral, molecular, and imaging aspects were included. Also, all local adverse effects were documented. The main beneficial effect of IACI is pain relief. The duration of this effect is variable and depends on underlying disease, type of disease, amount of structural damage, type of IACI, dose of IACI, presence of joint effusion, level of inflammatory mediators, emptiness of joint effusion, availability of imaging, and others. At large, inflammatory problems had higher rate of favorable response in terms of pain and function. IACI at the knee joint in juvenile idiopathic arthritis patients resulted in remission for >6 months in >80% of the patients with a mean duration of approximately 1.2 years, while in the osteoarthritic knee there was a pain relief for 3 weeks only and in rheumatoid arthritis (RA) knee for 8 weeks. There was no joint space loss at the knee joint following multiple IACI in osteoarthritis and also no increase in cartilage or bone erosions in RA following a single IACI. IACI guide imaging is important in achieving better results in particular joints. Joint infection rate is very low. Other adverse effects included intra-articular and periarticular calcifications, cutaneous atrophy, cutaneous depigmentation, avascular necrosis, rapid destruction of the femoral head, acute synovitis, Charcot's arthropathy, tendinopathy, Nicolau's syndrome, and joint dislocation. IACI is associated with a wide range of local effects. Subjective and functional favorable response is prominent mainly in juvenile idiopathic arthritis patients. Adverse effects are either rare or insignificant.
Collapse
Affiliation(s)
- George S Habib
- Department of Medicine, Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel.
| | | | | |
Collapse
|
25
|
Malattia C, Damasio MB, Basso C, Verri A, Magnaguagno F, Viola S, Gattorno M, Ravelli A, Tomà P, Martini A. Dynamic contrast-enhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2009; 49:178-85. [DOI: 10.1093/rheumatology/kep343] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
26
|
Magnetic resonance imaging in osteoarthritis: which method best reflects synovial membrane inflammation? Correlations with clinical, macroscopic and microscopic features. Osteoarthritis Cartilage 2009; 17:1186-92. [PMID: 19332177 DOI: 10.1016/j.joca.2009.03.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 12/30/2008] [Accepted: 03/06/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES : To study synovial membrane (SM) inflammation near the patella with different magnetic resonance imaging (MRI) approaches performed using a T1-injected sequence in knee osteoarthritis (OA), and to compare MRI results with macroscopic, microscopic and clinical findings. METHODS Fifteen patients fulfilling American College of Rheumatology (ACR) criteria for knee OA and requiring joint lavage completed a functional index (Lequesne's functional index) and a pain visual analog scale (VAS). SM inflammation near the patella was assessed on axial fat saturation post-injected T1 MRI images using three different methods: (1) semi-quantitative score=MRI synovitis score; (2) synovial membrane volume (SMV) analysis; (3) SMV with low (SMVL) (<0.3%/s(-1)), intermediate (SMVI) (0.3%/s(-1) to 1%/s(-1)) and high (SMVH) (> or =1%/s(-1)) speed of enhancement. Chondral lesions and SM inflammation were macroscopically graded and SM biopsies performed for microscopic scoring. RESULTS All MRI approaches exhibited excellent intra- and inter-observer reproducibility. MRI synovitis score correlated well with macroscopic (r=0.61, P=0.003) and total microscopic scores (r=0.55, P=0.03). Correlations between SMV and macroscopic (r=0.60, P=0.02) and microscopic congestion (r=0.63, P=0.01) were good. SMVH was correlated only with microscopic congestion (r=0.79, P=0.01). Low SMV was associated with neither macroscopic nor microscopic scores. However, it did correlate well with pain-VAS score (r=0.61, P=0.03) and moderately with a functional index (r=0.46, P=0.10). CONCLUSION The three MRI approaches used here provided highly reproducible information on SM inflammation near the patella in knee OA. Compared to SMV, MRI synovitis score seems sufficient to assess synovial inflammation but high SMV is an appropriate indicator of vascular congestion, and low SMV reflects pain in knee OA.
Collapse
|
27
|
van der Leij C, van de Sande MGH, Lavini C, Tak PP, Maas M. Rheumatoid synovial inflammation: pixel-by-pixel dynamic contrast-enhanced MR imaging time-intensity curve shape analysis--a feasibility study. Radiology 2009; 253:234-40. [PMID: 19703863 DOI: 10.1148/radiol.2531081722] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To analyze the distribution of different shapes of time-intensity curves (TICs) in synovial tissue of patients with rheumatoid arthritis (RA) and to compare relative numbers of TIC shapes between patients with RA and healthy control subjects. MATERIALS AND METHODS This prospective study was approved by the institutional review board; patients and control subjects gave written informed consent. Dynamic contrast material-enhanced magnetic resonance (MR) imaging of the knee joint in five patients with early RA and in five control subjects was performed. Parametric maps showing seven TIC shape types were created. Spatial information of the synovial TIC shape distribution pattern and relative number of TIC shapes were calculated on a three-dimensional region of interest. Relative TIC shape numbers were compared by using a nonparametric Mann-Whitney U test. RESULTS Synovial enhancement in patients with RA consisted of type 2 TIC shapes (slow enhancement) with heterogeneous zones of types 3 (fast enhancement followed by plateau phase), 4 (fast enhancement followed by early washout phase), and 5 (fast enhancement followed by slow enhancement increase) TIC shapes, compared with almost only type 2 TIC shapes in control subjects. The heterogeneous zones were seen in the lateral and medial knee compartments and around the cruciate ligaments. A significantly higher relative number of type 4 TIC shapes was observed in the patient group compared with the control group (16.5% vs 6.9%, P = .008). CONCLUSION The pixel-by-pixel dynamic contrast-enhanced MR imaging TIC shape analysis may help distinguish patients with RA from control subjects on the basis of the relative number of type 4 TIC shapes. This study provides the rationale for future research to evaluate the utility of this approach in clinical practice.
Collapse
Affiliation(s)
- Christiaan van der Leij
- Department of Radiology and Division of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, NL-1105 AZ Amsterdam, the Netherlands.
| | | | | | | | | |
Collapse
|
28
|
Boesen M, Østergaard M, Cimmino MA, Kubassova O, Jensen KE, Bliddal H. MRI quantification of rheumatoid arthritis: current knowledge and future perspectives. Eur J Radiol 2009; 71:189-96. [PMID: 19477615 DOI: 10.1016/j.ejrad.2009.04.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/15/2009] [Indexed: 12/20/2022]
Abstract
The international consensus on treatment of rheumatoid arthritis (RA) involves early initiation of disease modifying anti-rheumatic drugs (DMARDs) for which a reliable identification of early disease is mandatory. Conventional radiography of the joints is considered the standard method for detecting and quantifying joint damage in RA. However, radiographs only show late disease manifestations as joint space narrowing and bone erosions, whereas it cannot detect synovitis and bone marrow oedema, i.e., inflammation in the synovium or the bone, which may be visualized by magnetic resonance imaging (MRI) months to years before erosions develop. Furthermore, MRI allows earlier visualization of bone erosions than radiography. In order to allow early treatment initiation and optimal guidance of the therapeutic strategy, there is a need for methods which are capable of early detection of inflammatory joint changes. In this review, we will discuss available data, advantages, limitations and potential future of MRI in RA.
Collapse
Affiliation(s)
- Mikael Boesen
- Parker Institute, Frederiksberg University Hospital, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
29
|
USPIO-enhanced magnetic resonance imaging of the knee in asymptomatic volunteers. Eur Radiol 2009; 19:1715-22. [PMID: 19330333 DOI: 10.1007/s00330-009-1343-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 01/11/2009] [Indexed: 10/21/2022]
Abstract
The aim of this study was to compare signal characteristics of the synovium in knees of asymptomatic volunteers before and after intravenous administration of ultrasmall superparamagnetic iron oxide particles (USPIO). Ten knees of 10 asymptomatic volunteers were examined before and 36 h after intravenous administration of USPIO on a 1.5-T MR system using T1-weighted spin-echo, T2-weighted fast spin-echo, T2*-weighted gradient-echo (GRE), and short inversion time inversion-recovery sequences. In addition, synovial perfusion was measured using Gd-enhanced GRE imaging during the first imaging session. Images were analyzed qualitatively for any visual changes before and after USPIO administration. Signal-to-noise ratios (SNR) of the synovium were determined on unenhanced and USPIO-enhanced sequences. All MR images were reviewed for presence of any degenerative changes. Qualitative image analysis revealed no visually detectable changes of any knee joint before and after USPIO administration. The SNR values of the synovium on T1w, T2w, and T2*w images before and after USPIO administration showed no significant difference (T1, P = 0.86; T2, P = 0.95; T2*, P = 0.86). None of the volunteers showed any relevant degenerative changes of the knee and synovial perfusion was within normal limits. In knees of asymptomatic volunteers without any relevant degenerative changes and normal synovial perfusion neither visual changes nor changes of SNR values of the synovium can be depicted after USPIO administration. This means that USPIO-enhanced MRI may be used for assessment of knee disorders with increased macrophage activity.
Collapse
|
30
|
|
31
|
Kubassova O, Boesen M, Peloschek P, Langs G, Cimmino MA, Bliddal H, Torp-Pedersen S. Quantifying Disease Activity and Damage by Imaging in Rheumatoid Arthritis and Osteoarthritis. Ann N Y Acad Sci 2009; 1154:207-38. [DOI: 10.1111/j.1749-6632.2009.04392.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Østergaard M, Pedersen SJ, Døhn UM. Imaging in rheumatoid arthritis--status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 2009; 22:1019-44. [PMID: 19041075 DOI: 10.1016/j.berh.2008.09.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sensitive and reproducible tools for diagnosis, monitoring of disease activity and damage, and prognostication are essential in the management of patients with rheumatoid arthritis (RA). Conventional radiography (X-ray), the traditional gold standard for imaging in RA, is not able to detect early disease manifestations such as inflammatory changes in the soft tissues (synovitis, tensynovitis, enthesitis etc.) and the earliest stages of bone erosion. In contrast, magnetic resonance imaging (MRI) and ultrasonography (US) allow direct visualization of early inflammatory and destructive joint changes, and have several documented and potential applications in RA patients. This chapter will review key aspects of the current status and recent important advances in imaging in RA, briefly discussing X-ray and computed tomography, and particularly focusing on MRI and US. Suggestions for use in clinical trials and practice are provided.
Collapse
Affiliation(s)
- Mikkel Østergaard
- Department of Rheumatology, Copenhagen University Hospitals at Herlev and Hvidovre, Copenhagen, Denmark.
| | | | | |
Collapse
|
33
|
Boss A, Martirosian P, Fritz J, Kötter I, Henes JC, Claussen CD, Schick F, Horger M. Magnetic resonance spin-labeling perfusion imaging of synovitis in inflammatory arthritis at 3.0 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2009; 22:175-80. [PMID: 19172323 DOI: 10.1007/s10334-008-0162-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/18/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to test the feasibility of arterial spin labeling (ASL) perfusion imaging of synovitis in inflammatory joint diseases on a clinical 3.0 T whole-body scanner. MATERIALS AND METHODS Fifteen patients (geometric mean 47 years, range 8-69 years) with different types of inflammatory arthritis of the finger or wrist joints participated in the study. In addition to conventional spin-echo and dynamic contrast-enhanced FLASH3D sequences, a novel spin-labeling technique (FAIR-TrueFISP) for quantitative assessment of tissue perfusion was applied. Perfusion maps were calculated pixel-wise by means of the extended Bloch equations. RESULTS Perfusion maps showed good image quality with clear visualization of hyperaemia in synovitis. The computed perfusion maps corresponded best to subtraction images of the dynamic series from 30 to 60 s after contrast-medium injection. The quantitative perfusion values of synovitis showed a good correlation with the disease activity. Perfusion values for inflamed synovium in phase of high activity were up to 230 ml/100 g tissue/min. CONCLUSION The proposed modality allows for the assessment of disease activity in arthritis without the application of contrast-medium offering a new tool for therapy monitoring. As the technique provides quantitative information on hyperaemia, it potentially offers new insights in the pathophysiology of arthritic diseases.
Collapse
Affiliation(s)
- Andreas Boss
- Section of Experimental Radiology, Department of Diagnostic and Interventional Radiology, Eberhard-Karls University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis. Skeletal Radiol 2008; 37:201-7. [PMID: 18058095 DOI: 10.1007/s00256-007-0408-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/17/2007] [Accepted: 10/09/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Dynamic contrast-enhanced MRI of patients with rheumatoid arthritis has shown a decrease in the early enhancement rate (EER) of synovitis after treatment. The purpose of this work was to investigate the underlying changes. METHODS 3D dynamic contrast-enhanced images were acquired from 13 patients before and 1-2 weeks after anti-TNF alpha treatment. The EER of the inflamed synovium was measured. The T1 relaxation time of the synovitis was calculated from images at different flip angles. The time course of the arrival of gadolinium at the radial artery was determined. The gadolinium enhancement of the inflamed synovium was modeled to calculate the fractional plasma volume (vp), the fractional extravascular, extracellular fluid volume (ve), and the volume transfer constant (Ktrans). Pre- and post-treatment values were compared and the dependence of the EER on each parameter was assessed. RESULTS There was a decrease in the EER measured over 26 s after treatment (29%, p = 0.002). Reductions in T1 (12%, p = 0.001), Ktrans (31%, p = 0.002), and vp (43%, p = 0.01) contributed to this; however, the EER was relatively insensitive to changes in ve. CONCLUSIONS The decrease in EER after anti-TNF alpha treatment is largely caused by reductions in the volume transfer constant Ktrans, the fractional plasma volume vp, and the T1 relaxation time. Only the contributions from Ktrans and vp directly reflect synovial vascularity.
Collapse
|
35
|
Abstract
Synovial disorders often affect the knee joint and are a common cause of morbidity. Before MR imaging, radiologists were limited in their ability to provide information about the presence or absence of synovial disease. With the advent of MR imaging, useful information can now be provided to referring clinicians, often at a time when the initiation of therapy may mitigate significantly the long-term sequelae of synovial disorders. MR imaging, owing to its superior soft-tissue contrast, is the imaging modality of choice for demonstrating and quantifying pathologic changes of the synovium. MR imaging provides invaluable information to the clinician regarding the need to either initiate or modify therapy in those patients suffering from diseases of, or affecting, the synovium.
Collapse
|
36
|
Pilar Lisbona M, Maymó J, Carbonell J. [Magnetic resonance of the hand in rheumatoid arthritis. Review of methodology, and its use in diagnosis, monitoring and prognosis]. REUMATOLOGIA CLINICA 2007; 3:126-136. [PMID: 21794414 DOI: 10.1016/s1699-258x(07)73679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 04/10/2006] [Indexed: 05/31/2023]
Abstract
The ideal aim of treatment in rheumatoid arthritis (RA) is to suppress synovial inflammation and to stop or reduce structural joint damage progression. To evaluate joint damage in RA, radiographic assessment of hands and feet is the traditional method. Nevertheless, plain film radiography can only evaluate bone damage (erosion) and, indirectly, joint cartilage. Magnetic resonance imaging presents important advantages since allows to study, not only the cortical bone and the marrow, but also the synovial membrane, tendon and ligament structures,and adjacent soft tissue that usually are involved in early disease. Moreover, hand-magnetic resonance (h-MRI) has shown to be more sensitive than plain radiography in detecting early erosions and predicting progression of bone damage, allowing a rapid diagnosis and to start the most efficient therapy as well as to achieve better outcomes for this disease.
Collapse
Affiliation(s)
- M Pilar Lisbona
- Hospitales del Mar y de la Esperanza. Institut Municipal d'Assistència Sanitària (IMAS). Universidad Autónoma de Barcelona. Barcelona. España
| | | | | |
Collapse
|
37
|
Frick MA, Wenger DE, Adkins M. MR Imaging of Synovial Disorders of the Knee: An Update. Magn Reson Imaging Clin N Am 2007; 15:87-101. [PMID: 17499183 DOI: 10.1016/j.mric.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Synovial disorders often affect the knee joint and are a common cause of morbidity. Before MR imaging, radiologists were limited in their ability to provide information about the presence or absence of synovial disease. With the advent of MR imaging, useful information can now be provided to referring clinicians, often at a time when the initiation of therapy may mitigate significantly the long-term sequelae of synovial disorders. MR imaging, owing to its superior soft-tissue contrast, is the imaging modality of choice for demonstrating and quantifying pathologic changes of the synovium. MR imaging provides invaluable information to the clinician regarding the need to either initiate or modify therapy in those patients suffering from diseases of, or affecting, the synovium.
Collapse
Affiliation(s)
- Matthew A Frick
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
38
|
Hodgson RJ, Connolly S, Barnes T, Eyes B, Campbell RSD, Moots R. Pharmacokinetic modeling of dynamic contrast-enhanced MRI of the hand and wrist in rheumatoid arthritis and the response to anti-tumor necrosis factor-α therapy. Magn Reson Med 2007; 58:482-9. [PMID: 17763341 DOI: 10.1002/mrm.21349] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dynamic contrast-enhanced MRI (DCE-MRI) of the hand and wrist was performed in 11 patients with rheumatoid arthritis twice before and once 2 weeks after treatment with anti-tumor necrosis factor (TNF)-alpha therapy. A rapid, T1-weighted 3D spoiled gradient echo (SPGR) sequence was used for the dynamic imaging. T1 estimation was performed using similar images obtained at different flip angles. The relative radiofrequency field was estimated from the known T1 of the periarticular fatty marrow. The arterial input function (AIF) was measured at each examination, and normalized to the expected plasma concentration to reduce partial volume effects. Synovial enhancement was modeled to yield values for Ktrans, ve, and vp. Ktrans and ve showed good reproducibility. There was a significant decrease of about 20% in Ktrans after 2 weeks of treatment. This study demonstrates the potential of DCE-MRI and pharmacokinetic modeling to study early changes in inflammatory activity in rheumatoid arthritis following treatment.
Collapse
Affiliation(s)
- Richard J Hodgson
- Magnetic Resonance and Image Analysis Research Centre, and School of Clinical Sciences, University of Liverpool, Liverpool, and Whiston Hospital, Merseyside, UK.
| | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent developments in imaging in juvenile arthritis. RECENT FINDINGS The developments in imaging in juvenile arthritis are primarily focused on evaluation of destructive changes and inflammatory changes in joints. Plain radiography can demonstrate destructive changes in juvenile arthritis. The most validated instrument for assessing destructive changes juvenile arthritis is the Poznanski index, and this index is being used more in studies to understand the natural history and clinical correlates of destructive disease. Magnetic resonance imaging has been shown to be superior to plain radiography in demonstrating destructive changes. Further work is proceeding to detect earlier, biochemical changes in articular cartilage prior to the development of thinning or erosion. Magnetic resonance imaging and ultrasound can demonstrate both inflammatory and destructive changes. Utilization of these techniques to show inflammatory changes can provide information about joints that can supplement physical examination, particularly in difficult joints to examine, such as the hips, temporomandibular joints, small joints of the feet, and tenosynovial locations. This information may help to guide therapy. SUMMARY Imaging provides useful information to supplement clinical and laboratory examination in the optimal treatment of patients with juvenile arthritis.
Collapse
Affiliation(s)
- T Brent Graham
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, OH 45229, USA.
| |
Collapse
|
41
|
Cimmino MA, Parodi M, Innocenti S, Succio G, Banderali S, Silvestri E, Garlaschi G. Dynamic magnetic resonance of the wrist in psoriatic arthritis reveals imaging patterns similar to those of rheumatoid arthritis. Arthritis Res Ther 2005; 7:R725-31. [PMID: 15987474 PMCID: PMC1175028 DOI: 10.1186/ar1734] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 03/02/2005] [Accepted: 03/07/2005] [Indexed: 12/11/2022] Open
Abstract
This dynamic magnetic resonance imaging (MRI) study is concerned with a prospective evaluation of wrist synovitis in patients with psoriatic arthritis (PsA) in comparison with patients with rheumatoid arthritis (RA) and healthy controls. Fifteen consecutive patients with PsA, 49 consecutive patients with RA, 30 RA patients matched for disease severity with those with PsA, and 8 healthy controls were studied. MRI was performed with a low-field (0.2T), extremity-dedicated machine. After an intravenous bolus injection of gadolinium-diethylenetriaminepentaacetic acid, 20 consecutive fast spin-echo axial images of the wrist were obtained every 18 s. The enhancement ratio was calculated both as rate of early enhancement (REE), which shows the slope of the curve of contrast uptake per second during the first 55 s, and as relative enhancement (RE), which indicates the steady state of enhancement. The REE was 1.0 ± 0.6 in patients with PsA, 1.6 ± 0.7 in consecutive patients with RA, and 0.1 ± 0.1 in controls (p <0.001). The RE was 87.1 ± 39.2 in patients with PsA, 125.8 ± 48.0 in consecutive RA patients, and 15.5 ± 19.2 in controls (p <0.001). However, the same figures in matched RA patients were 1.3 ± 0.7 and 107.3 ± 48.2, respectively (not significant in comparison with PsA). Rheumatoid-like PsA and oligoarticular PsA did not differ from each other in terms of synovial enhancement. Dynamic MRI shows the same pattern of synovitis in patients with PsA and RA when the two groups are matched for disease severity. This technique cannot be used to differentiate PsA from RA. However, REE and RE were significantly higher in PsA than in normal controls, with only one instance of overlap between values found for the two groups.
Collapse
Affiliation(s)
- Marco A Cimmino
- Clinica Reumatologica, Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy
| | - Massimiliano Parodi
- Clinica Reumatologica, Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Italy
| | | | - Giulia Succio
- Sezione di Diagnostica Radiologica, Dipartimento di Medicina Sperimentale, Università di Genova, Italy
| | - Simone Banderali
- Sezione di Diagnostica Radiologica, Dipartimento di Medicina Sperimentale, Università di Genova, Italy
| | - Enzo Silvestri
- Sezione di Diagnostica Radiologica, Dipartimento di Medicina Sperimentale, Università di Genova, Italy
| | - Giacomo Garlaschi
- Sezione di Diagnostica Radiologica, Dipartimento di Medicina Sperimentale, Università di Genova, Italy
| |
Collapse
|
42
|
Østergaard M, Duer A, Møller U, Ejbjerg B. Magnetic resonance imaging of peripheral joints in rheumatic diseases. Best Pract Res Clin Rheumatol 2005; 18:861-79. [PMID: 15501187 DOI: 10.1016/j.berh.2004.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The need for better methods than the conventional clinical, biochemical and radiographical examinations in the management of inflammatory joint diseases is evident, since these methods are not sensitive or specific to early pathologies and subtle changes. Magnetic resonance imaging (MRI) offers improved sensitivity to early inflammatory and destructive changes in peripheral joints in rheumatoid arthritis (RA) and, even though less well documented, in other inflammatory joint diseases. Good evidence is available that MRI bone erosions represent true bone abnormalities and are predictors of radiographical outcome in RA. Similarly, there is solid evidence for MRI synovitis representing true synovial inflammation and being of considerable practical, clinical and radiological significance in RA. Describing the encouraging current knowledge regarding MRI for diagnosis, monitoring and prognosis, this chapter discusses the potential for the use of MRI in the clinical management of patients with suspected and diagnosed inflammatory joint diseases, as well as research priorities and clinical situations where the use of MRI could be suggested.
Collapse
Affiliation(s)
- Mikkel Østergaard
- Department of Rheumatology, Copenhagen University Hospitals at Herlev and Hvidovre, Kettegaard alle 30, DK-2650 Hvidovre, Copenhagen, Denmark.
| | | | | | | |
Collapse
|
43
|
d'Agostino MA, Ayral X, Baron G, Ravaud P, Breban M, Dougados M. Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. ACTA ACUST UNITED AC 2005; 53:284-92. [PMID: 15818652 DOI: 10.1002/art.21078] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the impact of ultrasonography (US) on local corticosteroid (CS) injections of painful ankle, hindfoot, and midfoot in chronic inflammatory diseases. METHODS Consecutive patients with chronic rheumatic diseases admitted to the hospital for local CS injections of painful ankle, hindfoot, or midfoot were enrolled in this study. Clinical and radiographic evaluation was performed by the physician in charge of CS injections, and US examination was performed by an independent examiner blinded to the clinical and radiologic findings. According to a randomized weekly-periods design, the physician planned CS injections either aware (G1 group) or unaware (G2 group) of US results. In the latter case, he was nonetheless informed of US results after he had performed the injections. Impact of this information on the treatment planning was assessed in all cases. Prognostic impact of US was also evaluated by comparing the change in global assessment of efficacy of CS injections, in activity of the disease, and in the Western Ontario and McMaster Universities (WOMAC) subscales after 1 and 3 months, between G1 and G2 groups. RESULTS The knowledge of US findings led the physician to change his decision of local CS injections in 56 (82%) of 68 patients studied. Among 1,131 assessed sites, by clinical, radiographic, and US evaluation, injection was cancelled in 37 (15%) of 242 proposed sites, whereas it was decided in 74 (8%) additional sites. After 1 month, there was an improvement in G1 as compared with G2 groups. The mean +/- SD change in WOMAC physical function subscale was 15.6 +/- 17.5 in G1 versus 8 +/- 13 in G2 (P = 0.0305). After 3 months, only the global assessment of efficacy of CS injections was statistically greater in G1 than in G2 group (P = 0.0170). CONCLUSION US frequently led the physician to change his diagnosis of inflammatory lesions in painful foot, and consequently his planning of CS injections. Moreover, US could improve the response to local treatment.
Collapse
|
44
|
Tamai K, Mashitori H, Ohno W, Hamada J, Sakai H, Saotome K. Synovial response to intraarticular injections of hyaluronate in frozen shoulder: a quantitative assessment with dynamic magnetic resonance imaging. J Orthop Sci 2004; 9:230-4. [PMID: 15168175 DOI: 10.1007/s00776-004-0766-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 01/14/2004] [Indexed: 11/26/2022]
Abstract
To clarify the response of frozen shoulder (FS) to intraarticular injections of high-molecular-weight sodium hyaluronate (HA), a mixture of 2.5 ml of HA and 1.5 ml of 1% lidocaine was injected into the glenohumeral joint of 11 patients with FS, 8 of whom received five weekly injections. The patients were assessed using the Japanese Orthopaedic Association shoulder score (JOA score) before the first injection, 1 week after the first injection, and 1 week after the final injection. Following each clinical evaluation, the patients underwent dynamic magnetic resonance imaging enhanced with Gd-DTPA, and the coefficient of enhancement (CE) in the glenohumeral synovium was calculated, with the examiners blinded to the clinical information. The JOA score tended to be greater and the CE smaller after injection than before injection. The changes in the CE following both single and repeated injections were negatively correlated with changes in the JOA score. Thus, clinical improvement in patients with FS was associated with a decrease in the CE. Because the CE depends on the degree of synovitis, the therapeutic effect of intraarticular HA injection for FS results, at least in part, from suppression of synovitis in the glenohumeral joint through an antiinflammatory effect.
Collapse
Affiliation(s)
- Kazuya Tamai
- Department of Orthopaedic Surgery, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan
| | | | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- C G Peterfy
- Synarc Inc, 575 Market Street, 17th Floor, San Francisco 94105, CA, USA.
| |
Collapse
|
46
|
Ejbjerg B, Narvestad E, Rostrup E, Szkudlarek M, Jacobsen S, Thomsen HS, Østergaard M. Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis. ACTA ACUST UNITED AC 2004; 50:1097-106. [PMID: 15077291 DOI: 10.1002/art.20135] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the presence of changes resembling rheumatoid arthritis erosions and synovitis in metacarpophalangeal (MCP) and wrist joints of healthy individuals on magnetic resonance imaging (MRI) and to compare the MRI findings with conventional radiographic, clinical, and biochemical findings. METHODS Twenty-eight healthy individuals were studied. Contrast-enhanced MRI and conventional radiography of the dominant wrist and second through fifth MCP joints were performed, coupled with standard clinical assessments and biochemical analyses. MR images were evaluated according to the latest OMERACT (Outcome Measures in Rheumatology Clinical Trials) recommendations with respect to synovitis, erosions, and bone marrow edema. RESULTS Conventional radiography revealed erosion-like changes in 1 of 224 MCP joint bones (0.4%) and in 1 of 420 wrist joint bones (0.2%). MRI depicted low-grade erosion-like changes in 5 of 224 MCP joint bones (2.2%) and in 7 of 420 wrist joint bones (1.7%), but postcontrast enhancement within the lesion was detected in only 8.3% of these. MRI depicted low-grade synovitis-like changes in 10 of 112 MCP joints (8.9%) and in 8 of 84 assessed wrist areas (9.5%), while only minimal early synovial enhancement was detected by dynamic MRI. Three subjects had elevated serum levels of C-reactive protein, and these subjects displayed 44.5% of the synovitis-like changes and 41.7% of the erosion-like changes. Bone marrow edema-like changes were not found in any joints. CONCLUSION Changes resembling mild synovitis or small bone erosions are occasionally found in the MCP and wrist joints of healthy controls. Signs of synovitis on dynamic MRI, enhancement within bone erosion-like changes, and signs of bone marrow edema appear rarely or are absent in healthy controls. These signs may thus prove to be very specific in the distinction between arthritic and normal joints.
Collapse
Affiliation(s)
- Bo Ejbjerg
- Department of Radiology, Copenhagen University Hospital at Hvidovre, Hvidovre, Denmark.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
This article reviews aspects of arthritis imaging that are specific to children. The pediatric skeleton is unique and responds in characteristic ways to articular inflammation. Epiphyseal and physeal cartilage are affected by joint diseases, and disturbances of growth and maturation are sometimes the cardinal manifestations of arthritis. The target joints of pediatric articular diseases differ considerably from those of diseases in adults. Imaging techniques should be tailored to the children being studied.
Collapse
MESH Headings
- Adolescent
- Adult
- Age Factors
- Algorithms
- Arthritis/diagnosis
- Arthritis/diagnostic imaging
- Arthritis/etiology
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/diagnostic imaging
- Arthritis, Juvenile/diagnosis
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/diagnostic imaging
- Arthritis, Reactive/diagnosis
- Arthritis, Reactive/diagnostic imaging
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Hip Joint/diagnostic imaging
- Humans
- Infant
- Infant, Newborn
- Lyme Disease/complications
- Lyme Disease/diagnosis
- Magnetic Resonance Imaging
- Male
- Radiography
- Spondylarthropathies/diagnosis
- Spondylarthropathies/diagnostic imaging
- Synovitis/diagnosis
- Synovitis/diagnostic imaging
- Synovitis, Pigmented Villonodular/diagnosis
- Synovitis, Pigmented Villonodular/diagnostic imaging
- Time Factors
- Ultrasonography, Doppler, Color
Collapse
Affiliation(s)
- Robert F Buchmann
- Department of Radiology, Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02114, USA
| | | |
Collapse
|
48
|
Maillefert JF, Dardel P, Cherasse A, Mistrih R, Krause D, Tavernier C. Magnetic resonance imaging in the assessment of synovial inflammation of the hindfoot in patients with rheumatoid arthritis and other polyarthritis. Eur J Radiol 2003; 47:1-5. [PMID: 12810213 DOI: 10.1016/s0720-048x(02)00065-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe the localisation of synovitis and tenosynovitis of the hindfoot observed on magnetic resonance imaging (MRI) in patients with chronic polyarthritis, and to correlate the findings of physical examination and MRI. METHODS Patients with chronic polyarthritis, and one or two painful hindfoot were included. On physical examination and on MRI, the tibio-talar, talo-calcaneal, and talo-navicular and calcaneo-cuboidal joints were adjudged to have or not synovitis, and the tibialis anterior and posterior, the peroneus longus and brevis, the flector digitorum and hallucis longus tendons to have or not tenosynovitis. Criteria for synovitis and tenosynovitis were a high signal intensity on T2-weighted images, a low signal intensity on T1-weighted images, and enhancement after Gd-DTPA injection, in the joint area, and around the tendon, respectively. The correlation between the findings of physical examination and those of MRI were evaluated using the Kappa statistics. RESULTS 12 patients (three men, nine women, mean age of 55.5 years+/-11.4 S.D.) with chronic polyarthritis (rheumatoid arthritis (RA): nine, ankylosing spondylitis: one; psoriatic arthritis: one, unclassified: one) were included. All presented with one (7 patients) or two (5 patients) painful hindfeet (and swelling for 16 out of 17 hindfeet). On physical examination, 25 joints and eight tendons were adjudged to have synovitis and tenosynovitis. MRI showed synovitis in 12 out of 25 of these joints (48%), and tenosynovotis in three out of eight of these tendons (37.5%). Moreover, MRI showed ten and seven clinically unsuspected synovitis and tenosynovitis, respectively. The proportion of agreements between physical examination and MRI were 54.9% (kappa=0.1) and 88.2% (kappa=0.27) for synovitis and tenosynovitis, respectively. CONCLUSION A weak correlation was observed between the findings of physical examination and MRI in patients with chronic polyarthritis and a painful hindfoot. MRI might be used to localise synovitis in the area before performing some intra-articular injections. However, other studies are needed to address this question.
Collapse
Affiliation(s)
- Jean Francis Maillefert
- Department of Rheumatology, Dijon University Hospital, INSERM/ERITm, University of Burgondy, 3 rue du Fb Raines, 21000 Dijon, France.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
Despite the advances made in medical imaging over the past 3 decades and the central role that magnetic resonance imaging and other sophisticated technologies now play in routine clinical practice, patients with rheumatoid arthritis have benefited relatively little from these advances thus far. Over the past few years, however, evidence has accumulated to show that magnetic resonance imaging and ultrasonography can identify joint damage in patients with rheumatoid arthritis earlier and more sensitively than other techniques can, and that these techniques can directly visualize and monitor changes in synovium and bone that precede actual bone erosion. Much of this development is being driven by the pharmaceutical and biotechnology industries as they search for novel therapies to combat this disease. Accordingly, the imaging tools that ultimately will be used to direct patients to specific therapies and then to monitor treatment effectiveness and safety are currently being refined and validated in rigorous multicenter and multinational clinical trials aimed at gaining regulatory approval of these new therapies. As these therapies become available for clinical use, we can anticipate increased demand for expertise and experience in evaluating disease progression and treatment response, and to the emergence of magnetic resonance imaging systems specifically adapted for this application. The following discussion reviews the current status of this development, and notable advances that have been reported in the literature in the past year.
Collapse
|
50
|
Cimmino MA, Innocenti S, Livrone F, Magnaguagno F, Silvestri E, Garlaschi G. Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease. ARTHRITIS AND RHEUMATISM 2003; 48:1207-13. [PMID: 12746893 DOI: 10.1002/art.10962] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the efficacy of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of the wrist in the evaluation of disease activity in patients with rheumatoid arthritis (RA). METHODS Thirty-six patients with RA (with different degrees of disease activity) and 5 healthy controls were studied. MRI was performed with a low-field (0.2T), extremity-dedicated machine. After an intravenous bolus injection of gadolinium-diethylenetriamine pentaacetic acid, 20 consecutive fast spin-echo images of 3 slices of the wrist were obtained every 18 seconds. RESULTS The curves of synovial membrane enhancement identified the following 2 groups: controls and RA patients in remission, and RA patients with active or intermediately active disease. Both the rate of early enhancement (REE) and relative enhancement (RE) were significantly higher in patients with active RA than in those with inactive RA and controls. The REE and RE were significantly correlated with the number of swollen joints (P < 0.00001 and P = 0.003, respectively), the number of tender joints (P < 0.00001 and P = 0.004, respectively), the Ritchie index (P = 0.0002 for both REE and RE), the Disease Activity Score (P = 0.0004 and P = 0.0008, respectively), the Health Assessment Questionnaire (HAQ) (P = 0.0002 and P = 0.0007, respectively), early morning stiffness (P = 0.001 and P = 0.009, respectively), the C-reactive protein level (P = 0.015 and P = 0.03, respectively), the erythrocyte sedimentation rate (P = 0.03, RE only), and alpha2 globulins (P = 0.036 and P = 0.028, respectively). CONCLUSION Our data support use of dynamic MRI for discriminating active from inactive RA. Enhancement curves are associated not only with laboratory and clinical indicators of inflammation, but also with the HAQ, a relevant predictor of RA functional outcome. This technique can be repeated frequently and is an excellent candidate for the ideal method for the followup of patients with RA.
Collapse
|