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Teruel JR, Burghardt AJ, Rivoire J, Srikhum W, Noworolski SM, Link TM, Imboden JB, Li X. Bone structure and perfusion quantification of bone marrow edema pattern in the wrist of patients with rheumatoid arthritis: a multimodality study. J Rheumatol 2014; 41:1766-73. [PMID: 25086074 DOI: 10.3899/jrheum.131564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify bone structure and perfusion parameters in regions of bone marrow edema pattern (BMEP), non-edematous bone marrow (NBM), and pannus tissue areas in the wrists of patients with rheumatoid arthritis (RA) using 3-Tesla (3T) magnetic resonance imaging (MRI), and high resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Sixteen subjects fulfilling American College of Rheumatology classification were imaged using a HR-pQCT system and a 3T MRI scanner with an 8-channel wrist coil. Coronal T2-weighted and dynamic contrast-enhanced (DCE-MRI) images were acquired. BMEP and pannus tissue areas were segmented semiautomatically in T2-weighted images. NBM areas were placed at a similar distance from the joint space as BMEP regions. MR and HR-pQCT images were registered, and bone variables were calculated within the BMEP and NBM regions. Perfusion parameters in BMEP, pannus tissue, and NBM regions were calculated based on the signal-time curve obtained from DCE-MRI. RESULTS Eighteen BMEP areas were segmented, 15 of them presented proximal to pannus-filled erosions. Significant increases in bone density and trabecular thickness and number were observed in all BMEP regions compared to NMB (p < 0.05). Significantly elevated perfusion measures were observed in both BMEP and pannus tissue regions compared to NBM (p < 0.05). CONCLUSION BMEP regions showed significantly increased bone density and structures as well as perfusion measures, suggesting bone remodeling and active inflammation. Combining MRI and HR-pQCT provides a powerful multimodality approach for understanding BMEP and erosions, and for potentially identifying novel imaging markers for disease progression in RA.
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Affiliation(s)
- Jose R Teruel
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Andrew J Burghardt
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Julien Rivoire
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Waraporn Srikhum
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Susan M Noworolski
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Thomas M Link
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - John B Imboden
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Xiaojuan Li
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
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Diamanti AP, Argento G, Podestà E, Germano V, Fazi S, Migliore A, David V, D'Amelio R, Laganà B. Can the Association of Ciclosporine a and Methotrexate Maintain Remission/Low Disease Activity Induced by Etanercept in Early Rheumatoid Arthritis Patients? Evaluation by Magnetic Resonance Imaging. Int J Immunopathol Pharmacol 2012; 25:301-5. [DOI: 10.1177/039463201202500136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The opportunity to induce remission/low disease activity in Rheumatoid Arthritis (RA) patients has been achieved in recent years by the adoption of more sensitive diagnostic methods [Magnetic Resonance Imaging (MRI), ultrasonography] and early aggressive treatments (combination of biologics and synthetic DMARDs). On the other hand, data are still scarce and contrasting about the management of long-term remission. The aim of this preliminary study is to evaluate whether the association of Methotrexate + Ciclosporine A (MTX + CSA) therapy in early RA (eRA) patients is able to maintain remission/low disease activity and avoid structural progression, evaluated by MRI. Etanercept was suspended in patients who reached remission/low disease activity and CSA+MTX therapy was introduced (TO), all patients continued to receive MTX; at this time MRI showed mild/moderate synovitis and erosions in all the patients; 1-year after (T1), a slight reduction in mean synovitis, bone edema and total score was observed, whereas the erosion score was unchanged. The mean DAS44 remained stable from T0 to T1 and 6/7 patients maintained a low disease activity score. No side effects were reported. These results confirm the good clinical efficacy and safety of the combination therapy CSA+MTX in eRA patients and demonstrate a parallel arrest of structural damage evaluated by MRI 1-year after etanercept suspension.
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Affiliation(s)
- A. Picchianti Diamanti
- Division of Allergy, Clinical Immunology and Rheumatology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - G. Argento
- Division of Radiology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - E. Podestà
- Division of Allergy, Clinical Immunology and Rheumatology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - V. Germano
- Division of Allergy, Clinical Immunology and Rheumatology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - S. Fazi
- Division of Allergy, Clinical Immunology and Rheumatology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - A. Migliore
- Unit of Rheumatology “S. Peter Hospital FBF”, Research Center “S. Pietro AfaR”, Rome, Italy
| | - V. David
- Division of Radiology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - R. D'Amelio
- Division of Allergy, Clinical Immunology and Rheumatology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
| | - B. Laganà
- Division of Allergy, Clinical Immunology and Rheumatology, “Sapienza” University of Rome, School of Medicine and Psychology, S. Andrea University Hospital, Rome, Italy
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