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Mo YQ, Yang ZH, He HN, Ma JD, Liang JJ, Zeng WK, Shi GZ, Shen J, Dai L. Magnetic Resonance Imaging of Bilateral Hands Is More Optimal Than MRI of Unilateral Hands for Rheumatoid Arthritis. J Rheumatol 2018; 45:895-904. [PMID: 29717034 DOI: 10.3899/jrheum.171044] [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] [Accepted: 01/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the advantages of magnetic resonance imaging (MRI) of bilateral hands in rheumatoid arthritis (RA). METHODS Consecutive patients with active RA were recruited for clinical assessments, radiographs, and MRI of bilateral hands. Bilateral hands were scanned simultaneously on 3.0 T whole-body MRI system and were scored on synovitis, osteitis, and bone erosion according to the RA MRI scoring (RAMRIS) system. RESULTS Among 120 patients included, wrist bones and metacarpophalangeal joint (MCPJ) 2 proximal showed bone erosion in early RA. The second to fifth metacarpal bases and the second to fourth MCPJ distal showed more bone erosion in mid-stage or late-stage RA. When MRI of dominant unilateral hand was analyzed, MRI synovitis and osteitis in 5% of wrists and 3 MRI features in 5-14% of MCPJ were misdiagnosed (McNemar test, all p < 0.05). There were 46% wrist synovitis, 29-52% MCPJ2-5 synovitis, 45% wrist osteitis, and 20%-34% MCPJ2-5 osteitis not detected by joint tenderness and/or swelling. When the clinically more severe hand was selected for MRI of unilateral hand according to physical examination, MRI synovitis in 5% of wrists and 3 MRI features in 7-15% of MCPJ were misdiagnosed (all p < 0.05). Scatter plots and linear regression analyses were used to illustrate RAMRIS between dominant or selected hand (Y values) and nondominant or nonselected hand (X values). All linear models were markedly different from a Y = X linear model, indicating the dominant or clinically more severe hand could not represent the contralateral hand to evaluate RAMRIS. CONCLUSION MRI of bilateral hands is more optimal than MRI of the unilateral hand in RA.
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Affiliation(s)
- Ying-Qian Mo
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Ze-Hong Yang
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Hai-Ning He
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Jian-Da Ma
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Jin-Jian Liang
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Wei-Ke Zeng
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Guang-Zi Shi
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Jun Shen
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work
| | - Lie Dai
- From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China. .,Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work.
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Agten CA, Rosskopf AB, Jonczy M, Brunner F, Pfirrmann CWA, Buck FM. Frequency of inflammatory-like MR imaging findings in asymptomatic fingers of healthy volunteers. Skeletal Radiol 2018; 47:279-287. [PMID: 29110050 DOI: 10.1007/s00256-017-2808-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the frequency of inflammatory-like findings on MR imaging in asymptomatic volunteers and compare them with patients with known rheumatoid arthritis and psoriatic arthritis. MATERIALS AND METHODS MR images of fingers in 42 asymptomatic volunteers and 33 patients with rheumatoid/psoriatic arthritis were analyzed. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid/Psoriatic Arthritis MRI Scoring System (RAMRIS/PsAMRIS) and tenosynovitis scoring system were used to assess: bone marrow edema (BME), erosions, tendon sheath fluid/tenosynovitis, joint effusion, and soft-tissue edema. Findings and scores were compared between volunteers and patients. Inter-reader agreement was calculated (intraclass correlation coefficients, ICC). RESULTS In volunteers, tendon sheath fluid was very common in at least one location (42/42 volunteers for reader 1, 34/42 volunteers for reader 2). BME, erosions, joint effusion, and soft-tissue edema were absent (except one BME in the 3rd proximal phalanx for reader 1). Tendon sheath fluid scores in volunteers and tenosynovitis scores in patients were high (reader 1, 7.17 and 5.39; reader 2, 2.31 and 5.45). Overall, inter-reader agreement was substantial (ICC = 0.696-0.844), except for tendon sheath fluid (ICC = 0.258). CONCLUSION Fluid in the finger flexor tendon sheaths may be a normal finding and without gadolinium administration should not be interpreted as tenosynovitis. Bone marrow edema, erosions, joint effusion, and soft-tissue edema in the fingers most likely reflect pathology if present.
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Affiliation(s)
- Christoph A Agten
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland. .,University of Zurich, Faculty of Medicine, Zurich, Switzerland.
| | - Andrea B Rosskopf
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Maciej Jonczy
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Florian Brunner
- University of Zurich, Faculty of Medicine, Zurich, Switzerland.,Department of Physical Medicine and Rheumatology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Florian M Buck
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
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Bouta EM, Ju Y, Rahimi H, de Mesy-Bentley KL, Wood RW, Xing L, Schwarz EM. Power Doppler ultrasound phenotyping of expanding versus collapsed popliteal lymph nodes in murine inflammatory arthritis. PLoS One 2013; 8:e73766. [PMID: 24040061 PMCID: PMC3767819 DOI: 10.1371/journal.pone.0073766] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis is a chronic inflammatory disease manifested by episodic flares in affected joints that are challenging to predict and treat. Longitudinal contrast enhanced-MRI (CE-MRI) of inflammatory arthritis in tumor necrosis factor-transgenic (TNF-Tg) mice has demonstrated that popliteal lymph nodes (PLN) increase in volume and contrast enhancement during the pre-arthritic “expanding” phase of the disease, and then suddenly “collapse” during knee flare. Given the potential of this biomarker of arthritic flare, we aimed to develop a more cost-effective means of phenotyping PLN using ultrasound (US) imaging. Initially we attempted to recapitulate CE-MRI of PLN with subcutaneous footpad injection of US microbubbles (DEFINITY®). While this approach allowed for phenotyping via quantification of lymphatic sinuses in PLN, which showed a dramatic decrease in collapsed PLN versus expanding or wild-type (WT) PLN, electron microscopy demonstrated that DEFINITY® injection also resulted in destruction of the lymphatic vessels afferent to the PLN. In contrast, Power Doppler (PD) US is innocuous to and efficiently quantifies blood flow within PLN of WT and TNF-Tg mice. PD-US demonstrated that expanding PLN have a significantly higher normalized PD volume (NPDV) versus collapsed PLN (0.553±0.007 vs. 0.008±0.003; p<0.05). Moreover, we define the upper (>0.030) and lower (<0.016) quartile NPDVs in this cohort of mice, which serve as conservative thresholds to phenotype PLN as expanding and collapsed, respectively. Interestingly, of the 12 PLN phenotyped by the two methods, there was disagreement in 4 cases in which they were determined to be expanding by CE-MRI and collapsed by PD-US. Since the adjacent knee had evidence of synovitis in all 4 cases, we concluded that the PD-US phenotyping was correct, and that this approach is currently the safest and most cost-effective in vivo approach to phenotype murine PLN as a biomarker of arthritic flare.
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Affiliation(s)
- Echoe M. Bouta
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Yawen Ju
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Homaira Rahimi
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Karen L. de Mesy-Bentley
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Ronald W. Wood
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Lianping Xing
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
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