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Ogura T, Katagiri T, Kameda H. Cartilage evaluation by ultrasonography in patients with rheumatoid arthritis: a scoping review. Inflamm Regen 2023; 43:34. [PMID: 37403142 DOI: 10.1186/s41232-023-00286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND This study aimed to provide an overview of ultrasonographic cartilage evaluation in patients with rheumatoid arthritis (RA) and identify research gaps in the utilization of cartilage evaluation. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic literature search of the PubMed, Embase, and Cochrane Library databases was conducted for articles published up to July 2022 using the search term variations of "cartilage," "ultrasonography," and "rheumatoid arthritis." Studies that included patients with RA who underwent cartilage evaluation by ultrasonography were selected. Articles published in languages other than English and about juvenile idiopathic arthritis were excluded. RESULTS Twenty-nine articles were identified. Most were cross-sectional studies (86%), mainly involving the metacarpophalangeal (55%) and knee (34%) joints. Assessments were performed using quantitative, binary, and semi-quantitative methods in 15, 10, and 15 studies, respectively. Reliability assessments were conducted in 10 studies, which showed feasible reliability but were limited to the finger joints. The validity assessment was validated in one study each that compared cartilage thickness measurements with cadaveric specimens and histological and semi-quantitative methods with surgical specimens, respectively. Comparisons with conventional radiography were also performed in six studies, which showed significant correlations. However, there was heterogeneity in the examination and assessment methods, and no adequate longitudinal evaluation was conducted. CONCLUSION This review highlights the need for further research and validation of ultrasonographic cartilage assessment in patients with RA.
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Affiliation(s)
- Takehisa Ogura
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Toho University, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
| | - Takaharu Katagiri
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Toho University, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
| | - Hideto Kameda
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Toho University, 2-22-36, Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan
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Frenken M, Radke KL, Schäfer ELE, Valentin B, Wilms LM, Abrar DB, Nebelung S, Martirosian P, Wittsack HJ, Müller-Lutz A. Insights into the Age Dependency of Compositional MR Biomarkers Quantifying the Health Status of Cartilage in Metacarpophalangeal Joints. Diagnostics (Basel) 2023; 13:diagnostics13101746. [PMID: 37238230 DOI: 10.3390/diagnostics13101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: We aim to investigate age-related changes in cartilage structure and composition in the metacarpophalangeal (MCP) joints using magnetic resonance (MR) biomarkers. (2) Methods: The cartilage tissue of 90 MCP joints from 30 volunteers without any signs of destruction or inflammation was examined using T1, T2, and T1ρ compositional MR imaging techniques on a 3 Tesla clinical scanner and correlated with age. (3) Results: The T1ρ and T2 relaxation times showed a significant correlation with age (T1ρ: Kendall-τ-b = 0.3, p < 0.001; T2: Kendall-τ-b = 0.2, p = 0.01). No significant correlation was observed for T1 as a function of age (T1: Kendall-τ-b = 0.12, p = 0.13). (4) Conclusions: Our data show an increase in T1ρ and T2 relaxation times with age. We hypothesize that this increase is due to age-related changes in cartilage structure and composition. In future examinations of cartilage using compositional MRI, especially T1ρ and T2 techniques, e.g., in patients with osteoarthritis or rheumatoid arthritis, the age of the patients should be taken into account.
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Affiliation(s)
- Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Emilia Louisa Ernestine Schäfer
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, D-52074 Aachen, Germany
| | - Petros Martirosian
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Tübingen, D-72076 Tübingen, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany
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Proof-of-Concept Double-Blind Placebo-Controlled Trial Measuring Cartilage Composition in Early Rheumatoid Arthritis under TNF-α-Inhibitor Therapy. J Clin Med 2023; 12:jcm12062306. [PMID: 36983306 PMCID: PMC10051673 DOI: 10.3390/jcm12062306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Low levels of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) values are indicative of cartilage degeneration. Patients with early rheumatoid arthritis are known to have low dGEMRIC values due to inflammatory activity. The additional effect of biological disease-modifying antirheumatic drug (bDMARD) and conventional synthetic disease-modifying antirheumatic drug (csDMARD) treatment on cartilage status is still unclear. In this prospective, double-blinded, randomized proof-of-concept clinical trial, patients with early rheumatoid arthritis (disease duration less than 12 months from symptoms onset) were treated with methotrexate + adalimumab (10 patients: 6/4 (f/m)). A control group with methotrexate alone (four patients: 2/2 (f/m)) was used. Cartilage integrity in the metacarpophalangeal joints was compared using dGEMRIC at baseline, 12, and 24 weeks after treatment initiation. A statistically significant increase in dGEMRIC levels was found in the adalimumab group considering the results after 12 and 24 weeks of therapy (p < 0.05) but not in the control group (p: non-significant). After 24 weeks, a tendency towards increased dGEMRIC values under combination therapy was observed, whereas methotrexate alone showed a slight decrease without meeting the criteria of significance (dGEMRIC mean change: +85.8 ms [−156.2–+346.5 ms] vs. 30.75 ms [−273.0–+131.0 ms]; p: non-significant). After 24 weeks of treatment with a combination of methotrexate and adalimumab, a trend indicating improvement in cartilage composition is seen in patients with early rheumatoid arthritis. However, treatment with methotrexate alone showed no change in cartilage composition, as observed in dGEMRIC sequences of metacarpophalangeal joints.
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DGEMRIC in the Assessment of Pre-Morphological Cartilage Degeneration in Rheumatic Disease: Rheumatoid Arthritis vs. Psoriatic Arthritis. Diagnostics (Basel) 2021; 11:diagnostics11020147. [PMID: 33498217 PMCID: PMC7908973 DOI: 10.3390/diagnostics11020147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Even though cartilage loss is a known feature of psoriatic (PsA) and rheumatoid arthritis (RA), research is sparse on its role in the pathogenesis of PsA, its potential use for disease monitoring and for differentiation from RA. We therefore assessed the use of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) to evaluate biochemical cartilage changes in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in PsA patients and compared these to RA patients. Materials and Methods: A total of 17 patients with active PsA and 20 patients with active RA were evaluated by high-resolution 3 Tesla dGEMRIC using a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices and joint space width (JSW) at MCP and PIP joint levels. Results: No significant differences of dGEMRIC values could be found between both study populations (PsA 472.25 ms, RA 461.11 ms; p = 0.763). In all RA and most PsA patients, PIP joints showed significantly lower dGEMRIC indices than MCP joints (RA: D2: p = 0.009, D3: p = 0.008, D4: p = 0.002, D5: p = 0.002; PsA: D3: p = 0.001, D4: p = 0.004). Most joint spaces had similar widths in both disease entities and no significant differences were found. Conclusions: As evaluated by dGEMRIC, the molecular composition of the MCP and PIP joint cartilage of PsA patients is similar to that of RA patients, demonstrating the scientific and clinical feasibility of compositional magnetic resonance (MR) imaging in these disease entities. Patterns and severity of compositional cartilage degradation of the finger joints may therefore be assessed beyond mere morphology in PsA and RA patients.
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Abrar DB, Schleich C, Müller-Lutz A, Frenken M, Radke KL, Vordenbäumen S, Schneider M, Ostendorf B, Sewerin P. Cartilage Degradation in Psoriatic Arthritis Is Associated With Increased Synovial Perfusion as Detected by Magnetic Resonance Imaging. Front Med (Lausanne) 2020; 7:539870. [PMID: 33102496 PMCID: PMC7546830 DOI: 10.3389/fmed.2020.539870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/21/2020] [Indexed: 01/27/2023] Open
Abstract
Objective: Even though cartilage loss is a known feature of psoriatic arthritis (PsA), research is sparse on its role in the pathogenesis of PsA and its potential use for disease detection and monitoring. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and dynamic contrast-enhanced MRI (DCE MRI), research has shown that early cartilage loss is strongly associated with synovial inflammation in rheumatoid arthritis (RA). The aim of this study was to determine if acute inflammation is associated with early cartilage loss in small finger joints of patients with PsA. Methods: Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution 3 Tesla dGEMRIC and DCE MRI using a dedicated 16-channel hand coil. Semi-quantitative and quantitative perfusion parameters were calculated. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), total cartilage thickness (TCT), and joint space width (JSW). Results: We found significant negative correlations between perfusion parameters (except Kep) and dGEMRIC indices, with the highest value at the MCP joints (KTrans: τ = −0.54, p = 0.01; Kep: τ = −0.02, p = 0.90; IAUC: τ = −0.51, p = 0.015; Initial Slope: τ = −0.54, p = 0.01; Peak: τ = −0.67, p = 0.002). Heterogeneous correlations were detected between perfusion parameters and both, total PsAMRIS and PsAMRIS synovitis sub-scores. No significant correlation was seen between any perfusion parameter and JSW and/or TCT. Conclusion: As examined by DCE MRI and dGEMRIC, there is a potential association between early cartilage loss and acute synovial inflammation in small finger joints of PsA patients.
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Affiliation(s)
- Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - K Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Abrar DB, Schleich C, Nebelung S, Frenken M, Ullrich T, Radke KL, Antoch G, Vordenbäumen S, Brinks R, Schneider M, Ostendorf B, Sewerin P. Proteoglycan loss in the articular cartilage is associated with severity of joint inflammation in psoriatic arthritis-a compositional magnetic resonance imaging study. Arthritis Res Ther 2020; 22:124. [PMID: 32471515 PMCID: PMC7257142 DOI: 10.1186/s13075-020-02219-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background Even though cartilage loss is a known feature of psoriatic arthritis (PsA), little is known about its role in the pathogenesis of PsA. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) as a non-invasive marker of the tissue’s proteoglycan content, such early (i.e., pre-morphological) changes have been associated with inflammation in rheumatoid arthritis (RA). Yet, this association has not been studied before in PsA. Methods The metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution clinical standard morphological and dGEMRIC sequences using a 3T MRI scanner (Magnetom Skyra, Siemens) and a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), and total cartilage thickness (TCT). Kendall tau correlation coefficients (τ) were calculated. Results We found significant negative correlations between dGEMRIC indices and total PsAMRIS (τ = − 0.5, p = 0.012), synovitis (τ = − 0.56, p = 0.006), flexor tenosynovitis (τ = − 0.4, p = 0.049), and periarticular inflammation (τ = − 0.72, p < 0.001). Significant positive correlations were found between TCT and dGEMRIC indices at all joint levels (τ = 0.43, p < 0.001). No significant correlations were determined between dGEMRIC indices and bone erosion, bone edema, or bone proliferation. Conclusion In PsA, proteoglycan loss as assessed by dGEMRIC is associated with periarticular inflammation, synovitis, and flexor tenosynovitis, but not with bone erosion or proliferation. Thereby, these findings contribute to in vivo concepts of the disease’s pathophysiology. Beyond morphology, advanced MRI techniques may be used to assess cartilage composition in PsA and to identify early changes in the cartilage as an imaging biomarker with potential application in detection, monitoring, and prediction of outcomes of PsA. Trial registration 2014123117, December 2014.
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Affiliation(s)
- Daniel B Abrar
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany.
| | - Christoph Schleich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Sven Nebelung
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Miriam Frenken
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Tim Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Gerald Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralph Brinks
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Emerging quantitative MR imaging biomarkers in inflammatory arthritides. Eur J Radiol 2019; 121:108707. [PMID: 31707169 DOI: 10.1016/j.ejrad.2019.108707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/14/2019] [Accepted: 10/09/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To review quantitative magnetic resonance imaging (qMRI) methods for imaging inflammation in connective tissues and the skeleton in inflammatory arthritis. This review is designed for a broad audience including radiologists, imaging technologists, rheumatologists and other healthcare professionals. METHODS We discuss the use of qMRI for imaging skeletal inflammation from both technical and clinical perspectives. We consider how qMRI can be targeted to specific aspects of the pathological process in synovium, cartilage, bone, tendons and entheses. Evidence for the various techniques from studies of both adults and children with inflammatory arthritis is reviewed and critically appraised. RESULTS qMRI has the potential to objectively identify, characterize and quantify inflammation of the connective tissues and skeleton in both adult and pediatric patients. Measurements of tissue properties derived using qMRI methods can serve as imaging biomarkers, which are potentially more reproducible and informative than conventional MRI methods. Several qMRI methods are nearing transition into clinical practice and may inform diagnosis and treatment decisions, with the potential to improve patient outcomes. CONCLUSIONS qMRI enables specific assessment of inflammation in synovium, cartilage, bone, tendons and entheses, and can facilitate a more consistent, personalized approach to diagnosis, characterisation and monitoring of disease.
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Sewerin P, Ostendorf B, Schleich C. [MRI diagnostics in inflammatory joint and spinal diseases: protocols and special sequences: when and for what?]. Z Rheumatol 2019; 77:538-548. [PMID: 29916005 DOI: 10.1007/s00393-018-0497-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging (MRI) is an important component in rheumatology for imaging diagnostics and therapy monitoring of inflammatory and non-inflammatory diseases of the spine and peripheral joints. The correct selection of suitable and practical MRI protocols and sequences represents a great challenge for physicians with respect to requesting and interpreting the indications for MRI investigations. This review article provides recommendations and suggestions for MRI investigation protocols for clinical utilization and practice. New sequences are evaluated and assessed in order to generate the best possible standardized and comparable examinations for rheumatology in the future and therefore optimize the quality of radiological interventions.
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Affiliation(s)
- P Sewerin
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum, Heinrich-Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - B Ostendorf
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum, Heinrich-Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - C Schleich
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
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Mori V, Sawicki LM, Sewerin P, Eichner M, Schaarschmidt BM, Oezel L, Gehrmann S, Bittersohl B, Antoch G, Schleich C. Differences of radiocarpal cartilage alterations in arthritis and osteoarthritis using morphological and biochemical magnetic resonance imaging without gadolinium-based contrast agent administration. Eur Radiol 2018; 29:2581-2588. [PMID: 30542752 DOI: 10.1007/s00330-018-5880-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/19/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify differences of radiocarpal cartilage alterations in osteoarthritis and arthritis using multiparametrical magnetic resonance imaging (MRI) comprising morphological and biochemical sequences without gadolinium-based contrast agent administration. METHODS In this prospective study, multiparametrical MRI of the radiocarpal cartilage was performed in 47 participants (mean age, 46.6 ± 17.6 years; min., 20 years; max., 79 years) on a 3 Tesla MRI. The cohort consisted of 11 patients suffering from arthritis, 10 patients with osteoarthritis, 14 patients after distal radius fracture, and 12 healthy volunteers. The radiocarpal cartilage was assessed using morphological (DESS, TrueFISP) and biochemical (T2*) MRI sequences without the application of intravenous contrast agent. The modified Outerbridge classification system for morphological and region-of-interest analyses for biochemical analysis was applied to assess the degree of cartilage damage in each patient before data were statistically tested for significant difference between the groups using a post hoc Tukey test. RESULTS In morphological imaging, cartilage damage was significantly more frequent in arthritis and osteoarthritis than in healthy volunteers (DESS: p = 0.01, p = 0.0004; TrueFISP: p = 0.02, p = 0.0001). In T2* imaging, patients with osteoarthritis showed higher cartilage damage compared to patients with arthritis (p = 0.01). CONCLUSION With multiparametrical MRI, it is possible to identify differences of radiocarpal cartilage alterations of patients with arthritis and osteoarthritis using the combination of morphological and biochemical MR imaging of the radiocarpal cartilage without the application of contrast agent. Multiparametrical MRI without the usage of contrast agent may be a potential tool helping to distinguish both entities. KEY POINTS • Multiparametrical MRI with morphological and biochemical sequences allows the differentiation of patients with arthritis and osteoarthritis. • High-resolution MRI of radiocarpal cartilage is possible without administration of contrast agent.
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Affiliation(s)
- Valentina Mori
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany.
| | - Philipp Sewerin
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Eichner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Lisa Oezel
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Sebastian Gehrmann
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, 40225, Düsseldorf, Germany
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Ostrowska M, Maśliński W, Prochorec-Sobieszek M, Nieciecki M, Sudoł-Szopińska I. Cartilage and bone damage in rheumatoid arthritis. Reumatologia 2018; 56:111-120. [PMID: 29853727 PMCID: PMC5974634 DOI: 10.5114/reum.2018.75523] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/13/2018] [Indexed: 01/19/2023] Open
Abstract
Rheumatoid arthritis (RA), which is a chronic inflammatory disease with a multifactorial aetiology, leads to partial or permanent disability in the majority of patients. It is characterised by persistent synovitis and formation of pannus, i.e. invasive synovial tissue, which ultimately leads to destruction of the cartilage, subchondral bone, and soft tissues of the affected joint. Moreover, inflammatory infiltrates in the subchondral bone, which can lead to inflammatory cysts and later erosions, play an important role in the pathogenesis of RA. These inflammatory infiltrates can be seen in magnetic resonance imaging (MRI) as bone marrow oedema (BME). BME is observed in 68-75% of patients in early stages of RA and is considered a precursor of rapid disease progression. The clinical significance of synovitis and bone marrow oedema as precursors of erosions is well established in daily practice, and synovitis, BME, cysts, hyaline cartilage defects and bone erosions can be detected by ultrasonography (US) and MRI. A less explored subject is the inflammatory and destructive potential of intra- and extra-articular fat tissue, which can also be evaluated in US and MRI. Finally, according to certain hypotheses, hyaline cartilage damage may trigger synovitis and lead to irreversible joint damage, and MRI may be used for preclinical detection of cartilage biochemical abnormalities. This review discusses the pathomechanisms that lead to articular cartilage and bone damage in RA, including erosion precursors such as synovitis and osteitis and panniculitis, as well as the role of imaging techniques employed to detect early cartilage damage and bone erosions.
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Affiliation(s)
- Monika Ostrowska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Włodzimierz Maśliński
- Department of Pathophysiology and Immunology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Monika Prochorec-Sobieszek
- Diagnostic Haematology Department, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
- Department of Pathomorphology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Michał Nieciecki
- Department of Diagnostic Imaging, Medical University of Warsaw, Poland
- Department of Nuclear Medicine, Medical University of Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Diagnostic Imaging, Medical University of Warsaw, Poland
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Schleich C, Miese F, Müller-Lutz A, Boos J, Aissa J, Nasca A, Zaucke F, Bostelmann T, Schimmöller L, Bittersohl B, Steiger HJ, Antoch G, Bostelmann R. Value of delayed gadolinium-enhanced magnetic resonance imaging of cartilage for the pre-operative assessment of cervical intervertebral discs. J Orthop Res 2017; 35:1824-1830. [PMID: 27699832 DOI: 10.1002/jor.23454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/29/2016] [Indexed: 02/04/2023]
Abstract
The study was performed to preoperatively assess the cartilage integrity of cervical intervertebral discs (IVDs) using Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC). Therefore, 53 cervical intervertebral discs of nine preoperative patients with neck and shoulder/arm pain scheduled for discectomy (five females, four males; mean age: 47.1 ± 8.4 years; range: 36-58 years) were included for biochemical analysis in this retrospective study. The patients underwent 3T magnetic resonance imaging (MRI) including biochemical imaging with dGEMRIC and morphological, sagittal T2 weighted (T2w) imaging. Cervical IVDs were rated using an MRI based grading system for cervical IVDs on T2w images. Region-of-interest measurements were performed in the nucleus pulposus (NP) and annulus fibrosus (AF) and a dGEMRIC index was calculated. Our results demonstrated that IVDs scheduled for discectomy showed significantly lower dGEMRIC index compared to IVDs that did not require surgical intervention in NP and AF (NP: 898.4 ± 191.9 ms vs. 1,150.3 ± 320.7 ms, p = 0.008; AF: 738.7 ± 183.8 ms vs. 984.6 ± 178.9 ms, p = 0.008). For Miyazaki score 3, the dGEMRIC indices were significantly lower in IVDs scheduled for surgery compared to non-operated discs for NP (p = 0.043) and AF (p = 0.018). In conclusion we could demonstrate that biochemical imaging with dGEMRIC is feasible in cervical IVDs. Significantly lower dGEMRIC index suggested GAG depletion in degenerated cervical IVD, scheduled for discectomy. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1824-1830, 2017.
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Affiliation(s)
- Christoph Schleich
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Falk Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Anja Müller-Lutz
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Johannes Boos
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Joel Aissa
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Adrian Nasca
- Neurosurgical Department, University Hospital, Dusseldorf, Germany
| | - Frank Zaucke
- Medical Faculty, Department of Orthopedics, University of Frankfurt/Main, Germany
| | | | - Lars Schimmöller
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Bernd Bittersohl
- Medical Faculty, Department of Orthopedics, University Duesseldorf, Germany
| | | | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
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Rehnitz C, Klaan B, Burkholder I, von Stillfried F, Kauczor HU, Weber MA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T 2 mapping at 3T MRI of the wrist: Feasibility and clinical application. J Magn Reson Imaging 2016; 45:381-389. [PMID: 27381489 DOI: 10.1002/jmri.25371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the feasibility of delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) and T2 mapping for biochemical imaging of the wrist at 3T. MATERIALS AND METHODS Seventeen patients with wrist pain (mean age, 41.4 ± 13.1 years) including a subgroup with chondromalacia (n = 11) and 15 healthy volunteers (26.0 ± 2.2 years) underwent dGEMRIC and T2 mapping at 3T. For dGEMRIC, the optimum time window after contrast-injection (gadopentetate dimeglumine) was defined as the plateau of the T1 curve of repeated measurements 15-90 minutes postinjection and assessed in all volunteers. Reference values of healthy-appearing cartilage from all individuals and values in areas of chondromalacia were assessed using region-of-interest analyses. Receiver-operating-characteristic analyses were applied to assess discriminatory ability between damaged and normal cartilage. RESULTS The optimum time window was 45-90 minutes, and the 60-minute timepoint was subsequently used. In chondromalacia, dGEMRIC values were lower (551 ± 84 msec, P < 0.001), and T2 values higher (63.9 ± 17.7, P = 0.001) compared to healthy-appearing cartilage of the same patient. Areas under the curve did not significantly differ between dGEMRIC (0.91) and T2 mapping (0.99; P = 0.17). In healthy-appearing cartilage of volunteers and patients, mean dGEMRIC values were 731.3 ± 47.1 msec and 674.6 ± 72.1 msec (P = 0.01), and mean T2 values were 36.5 ± 5 msec and 41.1 ± 3.2 msec (P = 0.009), respectively. CONCLUSION At 3T, dGEMRIC and T2 mapping are feasible for biochemical cartilage imaging of the wrist. Both techniques allow separation and biochemical assessment of thin opposing cartilage surfaces and can distinguish between healthy and damaged cartilage. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:381-389.
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Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Bastian Klaan
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Iris Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany
| | - Falko von Stillfried
- Department of Orthopedics and Trauma Surgery, University Hospital Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Hosny NM, Sherif YE. Anti-inflammatory activity of (2E,15E)-2-[1-(2-aminophenyl)ethylidineamino]-N′-[1-(2-aminophenyl)ethylidene]benzoic acid hydrazide (AEBH) and some of its nanoparticles rare earth complexes. MONATSHEFTE FUR CHEMIE 2016. [DOI: 10.1007/s00706-016-1709-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lakin BA, Ellis DJ, Shelofsky JS, Freedman JD, Grinstaff MW, Snyder BD. Contrast-enhanced CT facilitates rapid, non-destructive assessment of cartilage and bone properties of the human metacarpal. Osteoarthritis Cartilage 2015; 23:2158-2166. [PMID: 26067518 PMCID: PMC4841831 DOI: 10.1016/j.joca.2015.05.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this work is to establish the human metacarpal as a new whole joint surface early-stage osteoarthritis (OA) model that enables comparisons of articular cartilage and subchondral bone through high resolution contrast-enhanced CT (CECT) imaging, mechanical testing, and biochemical analysis. DESIGN The fourth metacarpal was obtained from 12 human cadaveric donors and baseline μCT imaging was followed by indentation testing. The samples were then immersed in anionic (Ioxaglate) and cationic (CA4+) iodinated contrast agent solutions followed by CECT. Cartilage GAG content and distribution was measured using the 1,9 dimethylmethylene blue (DMMB) assay and Safranin-O histology staining. Linear regression was performed to compare cartilage and subchondral bone properties. RESULTS Strong and significant positive correlations were observed between CA4+ CECT attenuation and both GAG content (R(2) = 0.86) and equilibrium modulus (R(2) = 0.84), while correlations using Ioxaglate were insignificant (R(2) ≤ 0.24, P > 0.05). Subchondral bone plate (SBP) thickness negatively and significantly correlated with SBP mineral density (R(2) = 0.49). Cartilage GAG content significantly correlated with several trabecular bone properties, including positive correlations with bone volume fraction (%BV/TV, R(2) = 0.67), trabecular number (Tb.N, R(2) = 0.60), and trabecular thickness (R(2) = 0.42), and negative relationships with structural model index (SMI, R(2) = 0.78) and trabecular spacing (Tb.Sp, R(2) = 0.56). Similarly, equilibrium modulus correlated positively with %BV/TV (R(2) = 0.50), Tb.N (R(2) = 0.59) and negatively with Tb.Sp (R(2) = 0.55) and SMI (R(2) = 0.60). CONCLUSION This study establishes the human metacarpal as a new early-stage OA model suitable for rapid, high resolution CECT imaging, mechanical testing, and biochemical analysis of the cartilage and subchondral bone, and for examining their inter-relationships.
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Affiliation(s)
- B A Lakin
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - D J Ellis
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - J S Shelofsky
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - J D Freedman
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Pharmacology and Experimental Therapeutics, Boston University, Boston, MA, USA
| | - M W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA, USA; Department of Chemistry, Boston University, Boston, MA, USA.
| | - B D Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
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Schleich C, Müller-Lutz A, Sewerin P, Ostendorf B, Buchbender C, Schneider M, Antoch G, Miese F. Intra-individual assessment of inflammatory severity and cartilage composition of finger joints in rheumatoid arthritis. Skeletal Radiol 2015; 44:513-8. [PMID: 25367672 DOI: 10.1007/s00256-014-2045-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/22/2014] [Accepted: 10/17/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To intra-individually assess the association of inflammation severity and cartilage composition measured by RAMRIS synovitis sub-score and delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC) of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA). METHODS Forty-three patients with RA according to ACR/EULAR classification criteria (age 52.9 ± 14.5 years, range, 18-77 years) were included in this study. All study participants received 3-T MRI scans of the metacarpophalangeal joints of the second and third finger (MCP 2 and 3). The severity of synovitis was scored according to the RAMRIS synovitis sub-score by two readers in consensus. In the cases with identical synovitis sub-scores, two radiologists decided in consensus on the joint with more severe synovitis. Cartilage composition was assessed with dGEMRIC. To test the association of inflammation severity and cartilage damage and in order to eliminate inter-patient confounders, each patient's MCP 2 and 3 were dichotomized into the joint with more severe synovitis versus the joint with less severe synovitis for a paired Wilcoxon test of dGEMRIC value. RESULTS There was a significant difference of dGEMRIC value (median of difference: 47.12, CI [16.6; 62.76]) between the dichotomized MCPs (p = 0.0001). There was a significant correlation between dGEMRIC value and RAMRIS synovitis grading of the joint with more severe synovitis (r = 0.5; p < 0.05) and the joint with less severe synovitis (r = 0.33; p < 0.05). CONCLUSIONS Our data concur with the concept that synovitis severity is associated with cartilage damage. The local inflammatory status on a joint level correlated significantly with the extent of cartilage degradation in biochemical MRI.
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Affiliation(s)
- C Schleich
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
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Comparison of quantitative and semiquantitative dynamic contrast-enhanced MRI with respect to their correlation to delayed gadolinium-enhanced MRI of the cartilage in patients with early rheumatoid arthritis. J Comput Assist Tomogr 2015; 39:64-9. [PMID: 25340588 DOI: 10.1097/rct.0000000000000164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the correlation between semiquantitative and quantitative dynamic contrast-enhanced (DCE) parameters with delayed gadolinium-enhanced magnetic resonance imaging (MRI) of the cartilage (dGEMRIC). METHODS Fifteen patients with early rheumatoid arthritis (RA) from the ArthroMark cohort were investigated at a 3-T MRI scanner. The metacarpophalangeal (MCP) joint of the index finger was examined with DCE-MRI and dGEMRIC. Semiquantitative and quantitative DCE perfusion parameters were calculated. The RA MRI score of the second MCP joint and the joint space width were measured. RESULTS Significant correlations were noted between both semiquantitative and quantitative DCE parameters and the RA MRI score of the second MCP joint. There was a significant negative correlation between DCE parameters and dGEMRIC. No association between joint space width and DCE parameters was observed. CONCLUSIONS Semiquantitative and quantitative analyses of perfusion are applicable to show that cartilage damage correlates with the inflammation activity despite the absence of joint space narrowing.
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Herz B, Albrecht A, Englbrecht M, Welsch GH, Uder M, Renner N, Schlechtweg P, Paul D, Lauer L, Engelke K, Janka R, Rech J, Schett G, Finzel S. Osteitis and synovitis, but not bone erosion, is associated with proteoglycan loss and microstructure damage in the cartilage of patients with rheumatoid arthritis. Ann Rheum Dis 2013; 73:1101-6. [PMID: 23625980 DOI: 10.1136/annrheumdis-2012-202850] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the relation between anatomic changes of the synovium, the bone, the bone marrow and the cartilage to biochemical properties of the cartilage in patients with rheumatoid arthritis (RA). METHODS 33 patients with RA received 3-T MRI scans of the metacarpophalangeal joints. Two independent methods, (A) the delayed gadolinium enhanced MRI of the cartilage (dGEMRIC, T2-mapping), which was used to assess the biochemical properties of the cartilage; (B) synovitis, osteitis and bone erosions were quantified according to the RA MRI scoring (RAMRIS) method and cartilage thickness (CT), interbone joint space (IBJS, distance between proximal and distal bone surface) and intercartilage joint space (ICJS, distance between proximal and distal cartilage surface) were measured. RESULTS Biochemical changes of the cartilage, corresponding to low dGEMRIC and high T2 values, were more likely to be seen in joints with decreased IBJS and ICJS as well as decreased CT. For instance, dGEMRIC was directly correlated to the IBJS (p=0.001) and ICJS (p=0.001), whereas T2 mapping was inversely correlated to IBJS and ICJS (both p=0.017). Moreover, the degree of osteitis, and to some extent synovitis, was correlated to biochemical cartilage changes as measured by dGEMRIC (p=0.003) or the T2 mapping (p=0.013). By contrast, bone erosions did not correlate to the degree of biochemical cartilage changes. DISCUSSION These data support the concept that synovitis and osteitis may be two main triggers for cartilage damage. Thus, the actual inflammatory state of a joint, but not so much the degree of bone erosion, appears to influence cartilage properties in RA.
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Affiliation(s)
- Barbara Herz
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, , Erlangen, Germany
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18
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Buchbender C, Schneider M, Ostendorf B. Magnetresonanztomographie und Hybridbildgebung in der Rheumatologie. Z Rheumatol 2013; 72:137-44. [DOI: 10.1007/s00393-012-1068-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Cartilage assessment of the metacarpophalangeal joints: cadaveric study with magnetic resonance arthrography and finger traction. Clin Imaging 2013; 37:718-22. [PMID: 23395553 DOI: 10.1016/j.clinimag.2012.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022]
Abstract
We investigated the efficacy of axial traction of the fingers combined with magnetic resonance (MR) arthrography in assessing the metacarpophalangeal (MCP) joint cartilage in cadavers. Cartilage was imaged and graded before/after MR arthrography, with/without traction, then correlated with cadaveric sectioning. The application of traction with MR arthrography is a promising technique for improved visualization of the articular cartilage of the MCP joints compared with similar imaging without traction and/or without arthrography, but its true benefit requires further study.
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Miese F, Buchbender C, Scherer A, Wittsack HJ, Specker C, Schneider M, Antoch G, Ostendorf B. Molecular imaging of cartilage damage of finger joints in early rheumatoid arthritis with delayed gadolinium-enhanced magnetic resonance imaging. ACTA ACUST UNITED AC 2012; 64:394-9. [PMID: 21952736 DOI: 10.1002/art.33352] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess cartilage glycosaminoglycan content and cartilage thickness in the metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis (RA) and healthy volunteers. METHODS After review board approval and informed consent were obtained, 22 subjects were prospectively enrolled (9 patients with early RA [7 women and 2 men with a mean ± SD age of 49 ± 13 years; range 25-68 years] and 13 healthy volunteers [10 women and 3 men with a mean ± SD age of 51 ± 12 years; range 25-66 years). In a total of 44 MCP joints of the index and middle fingers, measurements of cartilage thickness and delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index (T1 [msec]) were obtained using the variable flip-angle method and a 3T MR scanner. MRIs were evaluated for bone edema, erosions, and synovitis (using the RA MRI Scoring criteria). Student's t-test was used to test the significance of differences between groups. RESULTS The mean ± SD dGEMRIC index was 497 ± 86 msec in healthy volunteers and was significantly lower in the early RA group (421 ± 76 msec) (P = 0.042). There was no joint space narrowing seen on standard radiographs. No significant difference was found between cartilage thickness in patients with early RA and that in controls (index finger mean ± SD 1.27 ± 0.23 mm in RA patients versus 1.46 ± 0.34 mm in controls [P = 0.16] and middle finger 1.26 ± 0.23 mm in RA patients versus 0.97 ± 0.47 mm in controls [P = 0.10]). No significant correlation was noted between cartilage thickness and dGEMRIC index (R = 0.36, P = 0.88 in RA patients; R = 0.156, P = 0.445 in controls). CONCLUSION Our findings indicate that cartilage damage is present in the MCP joints of patients with early RA despite the absence of joint space narrowing on standard radiographs and MRI. Cartilage damage in RA can be imaged with dGEMRIC.
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Affiliation(s)
- Falk Miese
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
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Cartilage quality in rheumatoid arthritis: comparison of T2* mapping, native T1 mapping, dGEMRIC, ΔR1 and value of pre-contrast imaging. Skeletal Radiol 2012; 41:685-92. [PMID: 21932053 DOI: 10.1007/s00256-011-1276-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/01/2011] [Accepted: 09/05/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively evaluate four non-invasive markers of cartilage quality--T2* mapping, native T1 mapping, dGEMRIC and ΔR1--in healthy volunteers and rheumatoid arthritis (RA) patients. MATERIALS AND METHODS Cartilage of metacarpophalangeal (MCP) joints II were imaged in 28 consecutive subjects: 12 healthy volunteers [9 women, mean (SD) age 52.67 (9.75) years, range 30-66] and 16 RA patients with MCP II involvement [12 women, mean (SD) age 58.06 (12.88) years, range 35-76]. Sagittal T2* mapping was performed with a multi-echo gradient-echo on a 3 T MRI scanner. For T1 mapping the dual flip angle method was applied prior to native T1 mapping and 40 min after gadolinium application (delayed gadolinium-enhanced MRI of cartilage, dGEMRIC, T1(Gd)). The difference in the longitudinal relaxation rate induced by gadolinium (ΔR1) was calculated. The area under the receiver operating characteristic curve (AROC) was used to test for differentiation of RA patients from healthy volunteers. RESULTS dGEMRIC (AUC 0.81) and ΔR1 (AUC 0.75) significantly differentiated RA patients from controls. T2* mapping (AUC 0.66) and native T1 mapping (AUC 0.66) were not significantly different in RA patients compared to controls. CONCLUSIONS The data support the use of dGEMRIC for the assessment of MCP joint cartilage quality in RA. T2* and native T1 mapping are of low diagnostic value. Pre-contrast T1 mapping for the calculation of ΔR1 does not increase the diagnostic value of dGEMRIC.
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Tsushima H, Okazaki K, Takayama Y, Hatakenaka M, Honda H, Izawa T, Nakashima Y, Yamada H, Iwamoto Y. Evaluation of cartilage degradation in arthritis using T1ρ magnetic resonance imaging mapping. Rheumatol Int 2011; 32:2867-75. [PMID: 21881979 DOI: 10.1007/s00296-011-2140-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/22/2011] [Indexed: 12/16/2022]
Abstract
T1ρ magnetic resonance imaging (MRI) can be used to map proteoglycan (PG) loss in cartilage. Here, we used T1ρ MRI to map cartilage degradation in osteoarthritis (OA) and rheumatoid arthritis (RA). Tissue samples were obtained from five RA patients and 14 OA patients following total knee arthroplasty (TKA). Three parameters were measured: First, macroscopic grading of cartilage sample tissues was performed on a 5-grade scale (G0: normal, G1: swelling, G2: superficial fibrillation, G3: deep fibrillation, G4: subchondral bone exposure). Second, semi-quantitative values of PG were assessed by measuring the optical density of Safranin-O-stained paraffin sections that had been digitally photographed. Third, cartilage was divided into superficial and deep layers and the T1ρ values were quantified. T1ρ values of OA and RA in the superficial layers showed significant differences between groups (G0/1 and G0/2 for OA; G0/2 and G1/2 for RA). In the deep layers, T1ρ values of OA and RA also differed significantly between groups. In both the superficial and deep layers, there was a significant correlation between the mean T1ρ values and macroscopic grading (P < 0.01 for OA, P < 0.001 for RA). We found a negative correlation between the score of Safranin-O staining and T1ρ values (r = -0.61 for OA, r = -0.79 for RA). In addition, RA subjects had significantly higher T1ρ values than OA subjects of similar morphologic grade. In conclusion, T1ρ MRI is able to detect and map the early stages of cartilage degradation in OA and RA. This method is reliable and useful for the evaluation of macromolecular changes in arthritic cartilage.
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Affiliation(s)
- Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Abstract
Juvenile idiopathic arthritis is a heterogeneous group of diseases characterised by arthritis of unknown origin with onset before age of 16 years. Pivotal studies in the past 5 years have led to substantial progress in various areas, ranging from disease classification to new treatments. Gene expression profiling studies have identified different immune mechanisms in distinct subtypes of the disease, and can help to redefine disease classification criteria. Moreover, immunological studies have shown that systemic juvenile idiopathic arthritis is an acquired autoinflammatory disease, and have led to successful studies of both interleukin-1 and interleukin-6 blockade. In other forms of the disease, synovial inflammation is the consequence of a disturbed balance between proinflammatory effector cells (such as T-helper-17 cells), and anti-inflammatory regulatory cells (such as FOXP3-positive regulatory T cells). Moreover, specific soluble biomarkers (S100 proteins) can guide individual treatment. Altogether these new developments in genetics, immunology, and imaging are instrumental to better define, classify, and treat patients with juvenile idiopathic arthritis.
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Affiliation(s)
- Berent Prakken
- Centre for Molecular and Cellular Intervention, Department of Paediatrics, University Medical Centre Utrecht, Netherlands
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Gompels LL, Paleolog EM. A window on disease pathogenesis and potential therapeutic strategies: molecular imaging for arthritis. Arthritis Res Ther 2011; 13:201. [PMID: 21345267 PMCID: PMC3157632 DOI: 10.1186/ar3197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Novel molecular imaging techniques are at the forefront of both preclinical and clinical imaging strategies. They have significant potential to offer visualisation and quantification of molecular and cellular changes in health and disease. This will help to shed light on pathobiology and underlying disease processes and provide further information about the mechanisms of action of novel therapeutic strategies. This review explores currently available molecular imaging techniques that are available for preclinical studies with a focus on optical imaging techniques and discusses how current and future advances will enable translation into the clinic for patients with arthritis.
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Affiliation(s)
- Luke L Gompels
- Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College, Charing Cross Hospital Campus, 65 Aspenlea Road, London W68LH, UK.
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