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Werner SG, Backhaus M, Ohrndorf S. [Can rheuma be scanned? : Review of the current study situation on fluorescence optical imaging]. Z Rheumatol 2023; 82:627-637. [PMID: 37626223 DOI: 10.1007/s00393-023-01404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The novel technique of indocyanine green (ICG)-based fluorescence optical imaging (FOI) using the Xiralite® system (Rheumascan) has been the subject of many different studies worldwide since approval for clinical use in the European Union (2009), USA (2014) and Asia. The FOI depicts the disturbed microcirculation in the joints of both hands caused by inflammation. OBJECTIVE The aim of this article is to provide an overview of the current state of studies on ICG-based FOI in different rheumatologic indications. METHODS A narrative literature review of publications on ICG-based FOI in the diagnosis of various inflammatory rheumatic joint diseases since 2010 is presented, its use in treatment monitoring is explained, and its value in systemic sclerosis is outlined. RESULTS In summary, studies have extensively demonstrated the accuracy of FOI in inflammation detection. Therefore, it can be concluded that FOI is a good supplement to existing imaging modalities. Due to characteristic patterns of both skin and nails, FOI is an indicated procedure especially in psoriatic arthritis and can be very helpful in the diagnostic process in early undifferentiated arthritis. The FOI has shown its usefulness in children (juvenile idiopathic arthritis), for monitoring the course of treatment, and for demonstrating disturbed microcirculation in patients with systemic sclerosis. CONCLUSION The presented data imply that FOI should be considered as a valuable complementary imaging tool in the diagnostic algorithm of daily rheumatologic practice, both for diagnosis and for follow-up monitoring. In particular, the automated analyses should be able in the future to objectify measurements of inflammatory activity as well as monitoring the response to treatment.
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Affiliation(s)
- Stephanie Gabriele Werner
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO-Forschungsinstitut, Düsseldorf, Deutschland
| | - Marina Backhaus
- Abteilung für Rheumatologie und Klinische Immunologie, Parkklinik Weißensee, Berlin, Deutschland
| | - Sarah Ohrndorf
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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2
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Triantafyllias K, Marinoska T, Heller C, de Blasi M, Muthuraman M, Schwarting A. Optical spectral transmission to assess glucocorticoid therapy response in patients with arthritis: a longitudinal follow-up comparison with joint ultrasound. Arthritis Res Ther 2023; 25:47. [PMID: 36964628 PMCID: PMC10039502 DOI: 10.1186/s13075-023-03023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Optical spectral transmission (OST) is a modern diagnostic modality, able to assess the blood-specific absorption of light transmitted through a tissue, promising quantification of inflammation in the finger and wrist joints of patients with arthritis. To date, there are no adequate data regarding the diagnostic value of OST in the evaluation of inflammatory activity changes, during arthritis follow-up. Objectives of this study were therefore to examine the performance of OST in assessing response to anti-inflammatory therapy in patients with active arthritis and to explore OST associations with clinical, laboratory, and ultrasonographic (US) activity markers. METHODS 1173 joints of 54 patients with arthritides of the wrist and finger joints were examined by OST before and after oral administration of glucocorticoids (GC), during a disease flare. For the same time-points patients underwent clinical, laboratory, and joint US [grayscale (GSUS), power-Doppler (PDUS)] examinations. The distribution of ΔOST-values between the two time-points was compared with the respective distributions of ΔPDUS and ΔGSUS by Bayesian statistical analyses. Moreover, the diagnostic performance of OST compared to a control group (2508 joints of 114 subjects) was examined by receiver operating characteristics and associations of OST values with clinical, laboratory, and arthrosonographic parameters were evaluated by correlation analyses. RESULTS OST and US performed similarly in the assessment of inflammatory changes caused by GC (same value-change tendency in 83.2% of the cases). Bayesian statistics revealed no significant differences between ΔOST and ΔPDUS for all 3 examined joint categories (accuracy: metacarpophalangeal (MCP): 68.1%; proximal interphalangeal (PIP): 60.4%; wrists: 50.4%) and between ΔOST and ΔGSUS for MCP and PIP joints (accuracy: 51.1% and 78.7%, respectively). OST diagnostic performance (patients vs. controls) was excellent in both time-points [area under the curve (AUC) before GC=0.883(95%CI=0.83-0.94) and after GC=0.811(95%CI=0.74-0.881); p<0.001]. Furthermore, OST correlated significantly with all examined sonographic activity scores (all; p<0.001) and with swollen joint counts (p<0.01). CONCLUSIONS OST was able to assess response to therapy in a similar way to joint US and correlated significantly with arthritis activity markers. Therefore, OST has proved to be a valuable tool to assist disease activity monitoring in the examined cohort. TRIAL REGISTRATION German Registry of Clinical Trials, DRKS00016752.
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Affiliation(s)
- Konstantinos Triantafyllias
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany.
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Tatjana Marinoska
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
| | - Caroline Heller
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michele de Blasi
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
| | - Muthuraman Muthuraman
- Department of Biomedical Statistics and Multimodal Signal Processing, Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Schwarting
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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3
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Wang S, Hou Y, Li X, Meng X, Zhang Y, Wang X. Practical Implementation of Artificial Intelligence-Based Deep Learning and Cloud Computing on the Application of Traditional Medicine and Western Medicine in the Diagnosis and Treatment of Rheumatoid Arthritis. Front Pharmacol 2022; 12:765435. [PMID: 35002704 PMCID: PMC8733656 DOI: 10.3389/fphar.2021.765435] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/09/2021] [Indexed: 12/23/2022] Open
Abstract
Rheumatoid arthritis (RA), an autoimmune disease of unknown etiology, is a serious threat to the health of middle-aged and elderly people. Although western medicine, traditional medicine such as traditional Chinese medicine, Tibetan medicine and other ethnic medicine have shown certain advantages in the diagnosis and treatment of RA, there are still some practical shortcomings, such as delayed diagnosis, improper treatment scheme and unclear drug mechanism. At present, the applications of artificial intelligence (AI)-based deep learning and cloud computing has aroused wide attention in the medical and health field, especially in screening potential active ingredients, targets and action pathways of single drugs or prescriptions in traditional medicine and optimizing disease diagnosis and treatment models. Integrated information and analysis of RA patients based on AI and medical big data will unquestionably benefit more RA patients worldwide. In this review, we mainly elaborated the application status and prospect of AI-assisted deep learning and cloud computation-oriented western medicine and traditional medicine on the diagnosis and treatment of RA in different stages. It can be predicted that with the help of AI, more pharmacological mechanisms of effective ethnic drugs against RA will be elucidated and more accurate solutions will be provided for the treatment and diagnosis of RA in the future.
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Affiliation(s)
- Shaohui Wang
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ya Hou
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuanhao Li
- Chengdu Second People's Hospital, Chengdu, China
| | - Xianli Meng
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Zhang
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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4
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Tsen SWD, Springer LE, Sharmah Gautam K, Tang R, Liang K, Sudlow G, Kucharski A, Pham CTN, Achilefu S. Non-invasive monitoring of arthritis treatment response via targeting of tyrosine-phosphorylated annexin A2 in chondrocytes. Arthritis Res Ther 2021; 23:265. [PMID: 34696809 PMCID: PMC8543875 DOI: 10.1186/s13075-021-02643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The development and optimization of therapies for rheumatoid arthritis (RA) is currently hindered by a lack of methods for early non-invasive monitoring of treatment response. Annexin A2, an inflammation-associated protein whose presence and phosphorylation levels are upregulated in RA, represents a potential molecular target for tracking RA treatment response. METHODS LS301, a near-infrared dye-peptide conjugate that selectively targets tyrosine 23-phosphorylated annexin A2 (pANXA2), was evaluated for its utility in monitoring disease progression, remission, and early response to drug treatment in mouse models of RA by fluorescence imaging. The intraarticular distribution and localization of LS301 relative to pANXA2 was determined by histological and immunohistochemical methods. RESULTS In mouse models of spontaneous and serum transfer-induced inflammatory arthritis, intravenously administered LS301 showed selective accumulation in regions of joint pathology including paws, ankles, and knees with positive correlation between fluorescent signal and disease severity by clinical scoring. Whole-body near-infrared imaging with LS301 allowed tracking of spontaneous disease remission and the therapeutic response after dexamethasone treatment. Histological analysis showed preferential accumulation of LS301 within the chondrocytes and articular cartilage in arthritic mice, and colocalization was observed between LS301 and pANXA2 in the joint tissue. CONCLUSIONS We demonstrate that fluorescence imaging with LS301 can be used to monitor the progression, remission, and early response to drug treatment in mouse models of RA. Given the ease of detecting LS301 with portable optical imaging devices, the agent may become a useful early treatment response reporter for arthritis diagnosis and drug evaluation.
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Affiliation(s)
- Shaw-Wei D Tsen
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Luke E Springer
- Division of Rheumatology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Krishna Sharmah Gautam
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Rui Tang
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Kexian Liang
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Gail Sudlow
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Amir Kucharski
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christine T N Pham
- Division of Rheumatology, Washington University School of Medicine, St Louis, MO, 63110, USA.
| | - Samuel Achilefu
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA.
- Departments of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, MO, 63110, USA.
- Departments of Biomedical Engineering, Washington University School of Medicine, St Louis, MO, 63110, USA.
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5
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Roodenrijs NMT, Kedves M, Hamar A, Nagy G, van Laar JM, van der Heijde D, Welsing PMJ. Diagnostic issues in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open 2021; 7:rmdopen-2020-001511. [PMID: 33514671 PMCID: PMC7849901 DOI: 10.1136/rmdopen-2020-001511] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives To summarise the evidence on diagnostic issues in difficult-to-treat rheumatoid arthritis (D2T RA) informing the EULAR recommendations for the management of D2T RA. Methods A systematic literature review (SLR) was performed regarding the optimal confirmation of a diagnosis of rheumatoid arthritis (RA) and of mimicking diseases and the assessment of inflammatory disease activity. PubMed and Embase databases were searched up to December 2019. Relevant papers were selected and appraised. Results Eighty-two papers were selected for detailed assessment. The identified evidence had several limitations: (1) no studies were found including D2T RA patients specifically, and only the minority of studies included RA patients in whom there was explicit doubt about the diagnosis of RA or presence of inflammatory activity; (2) mostly only correlations were reported, not directly useful to evaluate the accuracy of detecting inflammatory activity in clinical practice; (3) heterogeneous, and often suboptimal, reference standards were used and (4) (thus) only very few studies had a low risk of bias. To ascertain a diagnosis of RA or relevant mimicking disease, no diagnostic test with sufficient validity and accuracy was identified. To ascertain inflammatory activity in patients with RA in general and in those with obesity and fibromyalgia, ultrasonography (US) was studied most extensively and was found to be the most promising diagnostic test. Conclusions This SLR highlights the scarcity of high-quality studies regarding diagnostic issues in D2T RA. No diagnostic tests with sufficient validity and accuracy were found to confirm nor exclude the diagnosis of RA nor its mimicking diseases in D2T RA patients. Despite the lack of high-quality direct evidence, US may have an additional value to assess the presence of inflammatory activity in D2T RA patients, including those with concomitant obesity or fibromyalgia.
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Affiliation(s)
- Nadia M T Roodenrijs
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Melinda Kedves
- Rheumatology, Bacs-Kiskun Megyei Korhaz, Kecskemet, Hungary
| | - Attila Hamar
- Rheumatology, University of Debrecen, Debrecen, Hungary
| | - György Nagy
- Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary.,Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Jacob M van Laar
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Paco M J Welsing
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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6
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Ohrndorf S, Glimm AM, Ammitzbøll-Danielsen M, Ostergaard M, Burmester GR. Fluorescence optical imaging: ready for prime time? RMD Open 2021; 7:e001497. [PMID: 34088778 PMCID: PMC8183208 DOI: 10.1136/rmdopen-2020-001497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Abstract
The novel technique of fluorescence optical imaging (FOI, Xiralite), which is approved in the European Union and the USA for clinical use, has been the object of studies since 2009. Indocyanine green-based FOI can demonstrate an impaired microcirculation caused by inflammation in both hands in one examination. Several studies have investigated FOI for detection of joint inflammation by comparing FOI to magnetic resonance imaging (MRI) and/or musculoskeletal ultrasound (MSUS). The results have shown a generally good agreement (>80%) between FOI and clinical examination, MRI and MSUS by power Doppler in inflammatory joint diseases. Moreover, characteristic enhancements in skin and nails are seen in PsA, which potentially can be useful in the diagnostic process of early undifferentiated arthritis. Furthermore, FOI has been investigated for the visualisation of a disturbed microcirculation in the hands and fingers of patients with systemic sclerosis (SSc), highlighting the potential of monitoring vascular changes in SSc and other vasculopathies. The available data indicate that it is time to consider FOI as a useful part of the imaging repertoire in rheumatology clinical practice, particularly where MSUS and MRI are not easily available.
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Affiliation(s)
- Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Mads Ammitzbøll-Danielsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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7
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Zhu Y, Sui P, Wang C, Wang H, Wen Z. Evaluation of contrast-enhanced ultrasound for activity of rheumatoid arthritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24417. [PMID: 33592889 PMCID: PMC7870237 DOI: 10.1097/md.0000000000024417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) refers to a technique that uses contrast medium to strengthen the echo of backscatter, which can significantly improve the resolution, sensitivity and specificity of ultrasound diagnosis. As a quantitative imaging examination of blood flow signals, CEUS has allowed detection of synovial microvascularization in the joints of patients with rheumatoid arthritis (RA). However, the results of these studies have been contradictory. Therefore, the purpose of this study is to evaluate the value of CEUS in the activity of RA disease. METHODS We will search PubMed, Embase, Cochrane Library, and CNKI from their inception to the December 20, 2020, without restrictions of language and publication status. Two investigators will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. This study will only include high quality clinical cohort or case control studies. Statistical analysis was performed by using the Review Manager version 5.3 and the STATA version 14.0 (Stata Corp, College Station, TX, USA) softwares. RESULTS This systematic review will determine the value of CEUS in RA activity scores. CONCLUSION The results of this study will provide a useful basis for high-quality CEUS to evaluate RA activity score. SYSTEMATIC REVIEW REGISTRATION INPLASY2020120125.
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Affiliation(s)
- Yunpei Zhu
- Ultrasound Department of The First Affiliated Hospital of Dalian Medical University
| | - Ping Sui
- Ultrasound Department of The First Affiliated Hospital of Dalian Medical University
| | - Cong Wang
- Ultrasound Department of The First Affiliated Hospital of Dalian Medical University
| | - Hui Wang
- Ultrasound Department of The First Affiliated Hospital of Dalian Medical University
| | - Zhihong Wen
- Radiology Department of Dalian Fifth People's Hospital
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8
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Maugesten Ø, Ohrndorf S, Slatkowsky-Christensen B, Kvien PTK, Uhlig PT, Haugen IK. Associations between Fluorescence Optical Imaging and Magnetic Resonance Imaging and symptoms in hand osteoarthritis. Rheumatology (Oxford) 2021; 61:764-769. [PMID: 33521807 DOI: 10.1093/rheumatology/keab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate whether Fluorescence Optical Imaging (FOI) enhancement and Magnetic Resonance Imaging (MRI)-defined synovitis are associated with pain and physical function in hand osteoarthritis (OA) patients. METHODS Bilateral FOI scans and MRI of the dominant hand were available for 221 patients. Finger joints were examined for tenderness on palpation. Pain in individual finger joints during the last 24 h and last 6 weeks and hand pain intensity by the Australian/Canadian hand index and Numeric Rating Scale were self-reported. On joint level, we applied logistic regression with generalized estimating equations to examine whether FOI enhancement and MRI-defined synovitis were associated with pain in the same joint. On subject level, we applied linear regression to assess whether FOI and MRI sum scores were associated with pain intensity and physical function. RESULTS Metacarpophalangeal and thumb base joints were excluded from analyses due to little/no FOI enhancement. Finger joints with FOI enhancement on the composite image had higher odds (95% confidence interval) of pain during the last 6 weeks (grade 1: 1.4 (1.2-1.6), grade 2-3: 2.1 (1.7-2.6)). Similar results were found for joint pain during the last 24 h and joint tenderness in fingers. Numerically stronger associations were found between MRI-defined synovitis and finger joint pain/tenderness. FOI and MRI sum scores demonstrated no/weak associations with hand pain and physical function. CONCLUSION FOI enhancement and MRI-defined synovitis were associated with pain in the same finger joint. None of the imaging modalities demonstrated consistent associations with pain, stiffness and physical function on subject level.
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Affiliation(s)
- Øystein Maugesten
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Prof Tore K Kvien
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Prof Till Uhlig
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida Kristin Haugen
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway
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9
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Zhao J, Chen X, Ho KH, Cai C, Li CW, Yang M, Yi C. Nanotechnology for diagnosis and therapy of rheumatoid arthritis: Evolution towards theranostic approaches. CHINESE CHEM LETT 2021. [DOI: 10.1016/j.cclet.2020.11.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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10
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Kawashiri SY, Nishino A, Shimizu T, Takatani A, Umeda M, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Maeda T, Kawakami A. Fluorescence optical imaging in patients with active rheumatoid arthritis: a comparison with ultrasound and an association with biomarkers. Scand J Rheumatol 2020; 50:95-103. [PMID: 33084461 DOI: 10.1080/03009742.2020.1794028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: This study compared indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) and musculoskeletal ultrasound (MSUS), and explored the significance of the FOI findings based on the association between the FOI and MSUS findings and serum biomarkers in patients with rheumatoid arthritis (RA). The study also explored the association between the FOI findings and patients' joint destruction at the joint-area level.Method: We enrolled 50 consecutive patients with active RA from among the patients hospitalized from May 2014 to March 2016 at Nagasaki University Hospital, Japan. FOI images were acquired with the Xiralite® fluorescence imaging system and compared with the patients' clinical examination results and MSUS findings. On the same day, the patients' clinical disease activity and levels of serum biomarkers (including vascular endothelial growth factor) were obtained.Results: Although the FOI detected synovitis with high sensitivity, the frequency of positive findings and the diagnostic performance with MSUS as the reference standard for FOI differed considerably among the phases of FOI as well as among the affected joint regions. The FOI scores were positively correlated with clinical disease activity, MSUS scores, and serum biomarkers. The severity of FOI-proven synovitis was associated with the presence of MSUS-proven bone erosion.Conclusion: FOI is effective for detecting joint inflammation in RA patients, with high accuracy. The severity of the FOI score was closely associated with the joint destruction at the joint-area level. However, the significance of positive FOI findings differed depending on not only the phase of FOI but also the affected joint regions.
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Affiliation(s)
- S-Y Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Nishino
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Shimizu
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Takatani
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Umeda
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Koga
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Iwamoto
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - K Ichinose
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Nakamura
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Origuchi
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Kawakami
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Lee JH, Jung SY, Park GK, Bao K, Hyun H, El Fakhri G, Choi HS. Fluorometric Imaging for Early Diagnosis and Prognosis of Rheumatoid Arthritis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:1902267. [PMID: 31921569 PMCID: PMC6947695 DOI: 10.1002/advs.201902267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Indexed: 05/19/2023]
Abstract
Early diagnosis and monitoring of disease progress are of significant importance in the effective treatment of rheumatoid arthritis (RA), because the continuing inflammation can lead to irreversible joint damage and systemic complications. However, applying imaging modalities for the prognosis of RA remains challenging, because no tissue-specific guidelines are available to monitor the progressive course of RA. In this study, fluorometric imaging of RA is reported using bioengineered targeted agents of the blood vessel, bone, and cartilage in combination with the customized optical fluorescence imaging system. Separate but simultaneous tissue-specific images of synovitis, cartilage destruction, and bone resorption are obtained from a mouse model of RA, which allows quantification of the prognosis of diseases at each stage. Thus, the fluorometric imaging of RA by using tissue-specific contrast agents plays a key role in the systemic treatment of RA by monitoring structural damage and disease progression.
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Affiliation(s)
- Jeong Heon Lee
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Sang Youn Jung
- Division of RheumatologyDepartment of Internal MedicineCHA Bundang Medical CenterCHA UniversitySeongnam13496South Korea
| | - G. Kate Park
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Kai Bao
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Hoon Hyun
- Department of Biomedical SciencesChonnam National University Medical SchoolGwangju501‐746South Korea
| | - Georges El Fakhri
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
| | - Hak Soo Choi
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA02114USA
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Abstract
Optical imaging offers a high potential for noninvasive detection and therapy of cancer in humans. Recent advances in instrumentation for diffuse optical imaging have led to new capabilities for the detection of cancer in highly scattering tissue such as the female breast. In particular, fluorescence imaging was made applicable as a sensitive technique to image molecular probes in vivo. We review recent developments in the detection of breast cancer and fluorescence-guided surgery of the breast by contrast agents available for application on humans. Detection of cancer has been investigated with the unspecific contrast agents "indocyanine green" and "omocianine" so far. Hereby, indocyanine green was found to offer high potential for the differentiation of malignant and benign lesions by exploiting vessel permeability for macromolecules as a cancer-specific feature. Tumor-specific molecular targeting and activatable probes have been investigated in clinical trials for fluorescence-guided tumor margin detection. In this application, high spatial resolution can be achieved, since tumor regions are visualized mainly at the tissue surface. As another example of superficial tumor tissue, imaging of lesions in the gastrointestinal tract is discussed. Promising results have been obtained on high-risk patients with Barrett´s esophagus and with ulcerative colitis by administering 5-aminolevulinic acid which induces accumulation of protoporphyrin IX serving as a tumor-specific fluorescent marker. Time-gated fluorescence imaging and spectroscopy are effective ways to suppress underlying background from tissue autofluorescence. Furthermore, recently developed tumor-specific molecular probes have been demonstrated to be superior to white-light endoscopy offering new ways for early detection of malignancies in the gastrointestinal tract.
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Ioussoufovitch S, Morrison LB, Desjardins L, Hadway JA, Lawrence KS, Lee TY, Beier F, Diop M. Quantification of joint blood flow by dynamic contrast-enhanced near-infrared spectroscopy: application to monitoring disease activity in a rat model of rheumatoid arthritis. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-10. [PMID: 31939225 PMCID: PMC6983648 DOI: 10.1117/1.jbo.25.1.015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/06/2019] [Indexed: 05/11/2023]
Abstract
Significance Current guidelines for rheumatoid arthritis (RA) management recommend early treatment with disease modifying antirheumatic drugs (DMARDs). However, DMARD treatment fails in 30% of patients and current monitoring methods can only detect failure after 3 to 6 months of therapy. Aim We investigated whether joint blood flow (BF), quantified using dynamic contrast-enhanced time-resolved near-infrared spectroscopy, can monitor disease activity and treatment response in a rat model of RA. Approach Ankle joint BF was measured every 5 days in eight rats with adjuvant-induced arthritis (AIA) and four healthy controls. Arthritis was allowed to progress for 20 days before rats with AIA were treated with a DMARD once every 5 days until day 40. Results Time and group had separate significant main effects on joint BF; however, there was no significant interaction between time and group despite a notable difference in average joint BF on day 5. Comparison of individual blood flow measures between rats with AIA and control group animals did not reveal a clear response to treatment. Conclusions Joint BF time courses could not distinguish between rats with AIA and study controls. Heterogeneous disease response and low temporal frequency of BF measurements may have been important study limitations.
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Affiliation(s)
- Seva Ioussoufovitch
- Western University, Bone and Joint Institute, School of Biomedical Engineering, Faculty of Engineering, London, Ontario, Canada
| | - Laura B. Morrison
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Lise Desjardins
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Jennifer A. Hadway
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
| | - Ting-Yim Lee
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
- Robarts Research Institute, Imaging Program, London, Ontario, Canada
| | - Frank Beier
- Western University, Schulich School of Medicine and Dentistry, Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Mamadou Diop
- Western University, Bone and Joint Institute, School of Biomedical Engineering, Faculty of Engineering, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Schulich School of Medicine and Dentistry, Department of Medical Biophysics, London, Ontario, Canada
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14
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Glimm AM, Sprenger LI, Haugen IK, Mansmann U, Hermann S, Häupl T, Hoff P, Burmester GR, Backhaus M, Le L, Ohrndorf S. Fluorescence optical imaging for treatment monitoring in patients with early and active rheumatoid arthritis in a 1-year follow-up period. Arthritis Res Ther 2019; 21:209. [PMID: 31533820 PMCID: PMC6749637 DOI: 10.1186/s13075-019-1989-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Fluorescence optical imaging (FOI) enables visualization of inflammation in the hands in rheumatic joint diseases with currently a lack of long-term follow-up studies. Objective To investigate FOI for treatment monitoring in a homogenous cohort of patients with early (disease duration < 2 years) and active (DAS28 > 3.2) RA over a period of 12 months. Methods Thirty-five RA patients (24 (68.6%) females, mean age 53.3 years (SD 13.6)) were investigated clinically by DAS28, tender joint count (TJC) and swollen joint count (SJC) and by FOI in phases 1–3 and PrimaVistaMode (PVM) before therapy change and after 12 months. The FOI activity score (FOIAS) was calculated based on individual joint scores from 0 to 3 in 30 joints per patient, adding up to a sum score (0–90). Results We found a statistically significant reduction of FOIAS in phase 1 from baseline (median 5.0, IQR 24.96) to follow-up (median 1.0, IQR 4.0) in all patients (p = 0.0045), both in responders and non-responders according to EULAR response criteria by DAS28. Statistically significant reductions over 12 months were found for median DAS28(ESR) 5.61 to 3.31, TJC 7.0 to 1.0, and SJC 5.0 to 1.0 (each p < 0.001). No statistically significant correlations were detected between the FOIAS change in phase 1 and DAS28(ESR), TJC, or SJC. Correlations between the other phases and clinical outcomes were weak to moderate. Conclusion Reduced early enhancement in FOI phase 1 can be observed in clinically responding and non-responding early RA patients under treatment. Regarding potential marker performance, FOI probably shows a reduction of inflammation more objectively.
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Affiliation(s)
- Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Ines Sprenger
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Ulrich Mansmann
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Paula Hoff
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Innere Medizin - Bereich Rheumatologie und Klinische Immunologie, Park-Klinik Weißensee, Berlin, Germany
| | - Lien Le
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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15
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Go DJ, Lee SJ, Joo SH, Cheon GJ, Hong SH, Song YW. Potential clinical utility of a novel optical tomographic imaging for the quantitative assessment of hand rheumatoid arthritis. Rheumatol Int 2019; 39:2103-2110. [PMID: 31435753 DOI: 10.1007/s00296-019-04424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/10/2019] [Indexed: 11/30/2022]
Abstract
Optical tomographic imaging (OTI) was reported to be a novel technique for the early diagnosis and disease activity assessment of rheumatoid arthritis (RA). This study aimed to evaluate the clinical utility of OTI for the detection of hand synovitis of RA patients. Manu-scan was used to perform imaging targeting the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints in 12 RA patients and three controls. The enrolled RA patients also underwent magnetic resonance imaging (MRI) and bone scintigraphy (BS) to provide reference images. Of the 181 joints feasible for OTI analysis, 140 joints (111 in RA patients and 29 in controls, 77.3%) in which the difference of the OTI indices in the two measurements was within 20% were evaluated. The OTI indices in RA joints were significantly lower than those in control joints (p < 0.001). Overall, the OTI indices in RA joints decreased as the synovitis grades on MRI or BS increased. Moreover, OTI was able to discriminate between RA and control joints (AUC = 0.815, 95% CI 0.739-0.891), even if RA joints were normal on physical examination (AUC = 0.714, 95% CI 0.594-0.834). OTI was in good agreement (kappa = 0.60) with MRI for evaluating synovitis in RA patients and showed positive results in 11.4% of clinically asymptomatic joints. OTI in this study showed the potential to be a supplementary imaging modality for the quantification of synovial inflammation in PIP and MCP joints of RA patients. Further large-scale trials are needed to confirm these findings.
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Affiliation(s)
- Dong Jin Go
- Division of Rheumatology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
| | - Sang Jin Lee
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Hyun Joo
- Department of Internal Medicine, Bethesda Hospital, Yangsan, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea. .,Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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16
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The rheumatoid hand in the light of fluorescence: a diagnostic technique of the future? Reumatologia 2019; 57:45-49. [PMID: 30858630 PMCID: PMC6409828 DOI: 10.5114/reum.2019.83239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
Fluorescence spectroscopy is usually applied in physics, chemistry and related sciences. However, in recent years we can observe a growing interest in fluorescence spectroscopy for medical diagnostics. Currently, it is beginning to be used in the monitoring of rheumatoid arthritis (RA) activity. As the knowledge on RA increases, growing importance is being placed on the evaluation of synovitis. Today, it is difficult to imagine contemporary rheumatology without ultrasound (US) and magnetic resonance imaging (MRI). However, it turns out that these are not the only methods allowing one to visualise subclinical lesions, particularly synovitis. Fluorescence optical imaging (FOI) is also useful for the evaluation of inflammatory lesions in the joints. In the future, FOI may become competitive with "traditional" imaging studies. It is characterised by low cost, short duration and similar sensitivity to US.
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17
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Bhatnagar S, Khera E, Liao J, Eniola V, Hu Y, Smith DE, Thurber GM. Oral and Subcutaneous Administration of a Near-Infrared Fluorescent Molecular Imaging Agent Detects Inflammation in a Mouse Model of Rheumatoid Arthritis. Sci Rep 2019; 9:4661. [PMID: 30858419 PMCID: PMC6411963 DOI: 10.1038/s41598-019-38548-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022] Open
Abstract
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that causes irreversible damage to the joints. However, effective drugs exist that can stop disease progression, leading to intense interest in early detection and treatment monitoring to improve patient outcomes. Imaging approaches have the potential for early detection, but current methods lack sensitivity and/or are time-consuming and expensive. We examined potential routes for self-administration of molecular imaging agents in the form of subcutaneous and oral delivery of an integrin binding near-infrared (NIR) fluorescent imaging agent in an animal model of RA with the long-term goal of increasing safety and patient compliance for screening. NIR imaging has relatively low cost, uses non-ionizing radiation, and provides minimally invasive spatial and molecular information. This proof-of-principle study shows significant uptake of an IRDye800CW agent in inflamed joints of a collagen antibody induced arthritis (CAIA) mouse model compared to healthy joints, irrespective of the method of administration. The imaging results were extrapolated to clinical depths in silico using a 3D COMSOL model of NIR fluorescence imaging in a human hand to examine imaging feasability. With target to background concentration ratios greater than 5.5, which are achieved in the mouse model, these probes have the potential to identify arthritic joints following oral delivery at clinically relevant depths.
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Affiliation(s)
- Sumit Bhatnagar
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Eshita Khera
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Jianshan Liao
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Victoria Eniola
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Yongjun Hu
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, United States
| | - David E Smith
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Greg M Thurber
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States.
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Wiemann O, Werner SG, Langer HE, Backhaus M, Chatelain R. Phänomen „grüner Nagel“ in der ICG-gestützten fluoreszenzoptischen Bildgebung - ein möglicher differenzialdiagnostischer Hinweis auf Psoriasisarthritis. J Dtsch Dermatol Ges 2019; 17:138-148. [DOI: 10.1111/ddg.13747_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Oliver Wiemann
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO Forschungsinstitut; Düsseldorf
| | | | - Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO Forschungsinstitut; Düsseldorf
| | - Marina Backhaus
- Abteilung für Innere Medizin - Rheumatologie und Klinische Immunologie Park-Klinik Weißensee; Berlin
| | - René Chatelain
- Klinik für Dermatologie und Allergologie; Evangelisches Krankenhaus Düsseldorf und Fakultät für Gesundheit; Department für Humanmedizin; Universität Witten/Herdecke
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19
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Wiemann O, Werner SG, Langer HE, Backhaus M, Chatelain R. The "green nail" phenomenon in ICG-enhanced fluorescence optical imaging - a potential tool for the differential diagnosis of psoriatic arthritis. J Dtsch Dermatol Ges 2019; 17:138-147. [PMID: 30702804 DOI: 10.1111/ddg.13747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of psoriatic arthritis poses a particular challenge. A novel fluorescence optical imaging technique, the Xiralite® system is very useful in this regard as it allows for visualization of microvasculature and perfusion. The present study is the first to systematically examine fluorescence optical signals in a large psoriatic arthritis cohort. PATIENTS AND METHODS In the primary study, we reviewed and analyzed extra-articular fluorescence optical signal patterns in 241 imaging sequences obtained from 187 psoriatic arthritis patients; 36 fluorescence optical sequences from 31 patients with rheumatoid arthritis served as controls. In a follow-up study, 203 consecutive fluorescence optical sequences from 54 psoriatic arthritis patients and 149 control subjects with various inflammatory rheumatic disorders were retrospectively evaluated in order to validate the primary study results in terms of the patterns previously identified. RESULTS Psoriatic arthritis patients exhibited three different fluorescence optical signal patterns in projection of the nails that have not been previously described. One of these patterns was the "green nail" sign, which was highly specific (97 %) for psoriatic arthritis. In the follow-up study, the specificity of this phenomenon in psoriatic arthritis was 87 % in comparison to the control cohort. CONCLUSIONS In the present study, fluorescence optical signals in the nail region proved to be highly specific for psoriatic arthritis. The "green nail" phenomenon seems to be of particular diagnostic interest as a potential sign of impaired microcirculation of the nail bed.
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Affiliation(s)
- Oliver Wiemann
- RHIO (Rheumatology, Immunology, Osteology) Düsseldorf and RHIO Research Institute, Düsseldorf, Germany
| | - Stephanie G Werner
- Department of Medicine III, Rheumatology, Helios St. Johannes Medical Center, Duisburg, Germany
| | - Hans-Eckhard Langer
- RHIO (Rheumatology, Immunology, Osteology) Düsseldorf and RHIO Research Institute, Düsseldorf, Germany
| | - Marina Backhaus
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Weißensee Medical Center, Berlin, Germany
| | - René Chatelain
- Department of Dermatology and Allergology, Evangelical Hospital, Düsseldorf, and Faculty of Health, Department of Medicine, University of Witten/Herdecke, Germany
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20
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Hirano F, Yokoyama-Kokuryo W, Yamazaki H, Tsutsumino M, Sakai R, Satoh S, Kimura T, Tojo N, Kohsaka H, Harigai M. Comparison of fluorescence optical imaging, ultrasonography and clinical examination with magnetic resonance imaging as a reference in active rheumatoid arthritis patients. Immunol Med 2018; 41:75-81. [PMID: 30938268 DOI: 10.1080/13497413.2018.1481578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Fluorescence optical imaging with indocyanine-green enhancement (FOI) is a new imaging modality for the assessment of hand arthritis. The objective of this study was to compare performance profiles of clinical examination (CE), US and FOI using MRI as a reference in the same active rheumatoid arthritis (RA) patients. METHODS CE, US, FOI and MRI were performed on six subjects with active RA. Each sequence of FOI was divided into three phases based on indocyanine-green dynamics and the joints were graded semi-quantitatively. Sensitivities and specificities of CE, US and FOI were calculated using the RAMRIS synovitis score >0 as a reference in a total of 30 joints (the second to fifth metacarpophalangeal (MCP) joints and the wrist of the clinically dominant hand). RESULTS FOI showed sensitivities and specificities, respectively, of 85% and of 94% for Phase-1 and 69% and 94% for Phase-2. Sensitivities and specificities were 100% and 35% for CE (tender or swollen), 92% and 41% for gray scale US, and 77% and 100% for color-Doppler US. CONCLUSIONS The performance characteristics of FOI in detection of synovitis in patients with active RA are comparable to those of US and more specific than CE. FOI has a potential as an assessment modality of RA.
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Affiliation(s)
- Fumio Hirano
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Waka Yokoyama-Kokuryo
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hayato Yamazaki
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Michi Tsutsumino
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Ryoko Sakai
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Shiro Satoh
- c Department of Diagnostic Imaging , Ochanomizu Surugadai Clinic , Tokyo , Japan
| | - Tomo Kimura
- c Department of Diagnostic Imaging , Ochanomizu Surugadai Clinic , Tokyo , Japan
| | - Naoko Tojo
- d Department of Clinical Laboratory , Medical Hospital, Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hitoshi Kohsaka
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Masayoshi Harigai
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
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Wu H, Wu H, He Y, Gan Z, Xu Z, Zhou M, Liu S, Liu H. Synovitis in mice with inflammatory arthritis monitored with quantitative analysis of dynamic contrast-enhanced NIR fluorescence imaging using iRGD-targeted liposomes as fluorescence probes. Int J Nanomedicine 2018; 13:1841-1850. [PMID: 29615837 PMCID: PMC5870656 DOI: 10.2147/ijn.s155475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a common inflammatory disorder characterized primarily by synovitis and pannus formation in multiple joints, causing joints destruction and irreversible disability in most cases. Early diagnosis and effective therapy monitoring of RA are of importance for achieving the favorable prognosis. METHODS We first prepared the targeted fluorescence probes, and then explored the feasibility of near-infrared (NIR) fluorescence molecular imaging to detect and evaluate the RA via the targeted fluorescence probes by quantitative analysis in this study. RESULTS The targeted fluorescence probes (indocyanine green-liposomes decorated with iRGD peptide [iLPs]) was successfully prepared. The quantitative analysis found that strong fluorescence signal was detected in inflamed paws and the fluorescence signal in iLPs group was 3.03-fold higher than that in non-targeted (indocyanine green-liposomes decorated without iRGD peptide [LPs]) group (P<0.01) at 15 min after injection, whereas the fluorescence signal from iLPs signal can almost not be observed in the non-inflamed paws, showing the high sensitivity and accuracy for arthritis by the NIR fluorescence imaging based on iLPs. CONCLUSION The NIR fluorescence imaging by iLPs may facilitate improved arthritis diagnosis and early assessment of the disease progression by providing an in vivo characterization of angiogenesis in inflammatory joint diseases.
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Affiliation(s)
- Hao Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haohan Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yanni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Zhen Gan
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhili Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Meijun Zhou
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Sai Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongmei Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
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22
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van den Berg PJ, Daoudi K, Bernelot Moens HJ, Steenbergen W. Feasibility of photoacoustic/ultrasound imaging of synovitis in finger joints using a point-of-care system. PHOTOACOUSTICS 2017; 8:8-14. [PMID: 28913168 PMCID: PMC5587869 DOI: 10.1016/j.pacs.2017.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/21/2017] [Accepted: 08/28/2017] [Indexed: 05/05/2023]
Abstract
We evaluate a portable ultrasound and photoacoustic imaging (PAI) system for the feasibility of a point-of-care assessment of clinically evident synovitis. Inflamed and non-inflamed proximal interphalangeal joints of 10 patients were examined and compared with joints from 7 healthy volunteers. PAI scans, ultrasound power Doppler (US-PD), and clinical examination were performed. We quantified the amount of photoacoustic (PA) signal using a region of interest (ROI) drawn over the hypertrophic joint space. PAI response was increased 4 to 10 fold when comparing inflamed with contralateral non-inflamed joints and with joints from healthy volunteers (p < 0.001 for both). US-PD and PAI were strongly correlated (Spearman's ρ = 0.64, with 95% CI: 0.42, 0.79). Hence, PAI using a compact handheld probe is capable of detecting clinically evident synovitis. This motivates further investigation into the predictive value of PAI, including multispectral PAI, with other established modalities such as US-PD or MRI.
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Affiliation(s)
- Pim J. van den Berg
- Biomedical Photonic Imaging, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Khalid Daoudi
- Medical Ultrasound Imaging Center, department of Radiology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hein J. Bernelot Moens
- Ziekenhuisgroep Twente, Department of Rheumatology, Postbus 546, 7550 AM Hengelo, The Netherlands
| | - Wiendelt Steenbergen
- Biomedical Photonic Imaging, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
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23
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Fluorescence optical imaging and 3T-MRI for detection of synovitis in patients with rheumatoid arthritis in comparison to a composite standard of reference. Eur J Radiol 2017; 90:6-13. [DOI: 10.1016/j.ejrad.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/16/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022]
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Jung C, Drummer K, Oelzner P, Figulla HR, Boettcher J, Franz M, Betge S, Foerster M, Wolf G, Pfeil A. The association between endothelial microparticles and inflammation in patients with systemic sclerosis and Raynaud's phenomenon as detected by functional imaging. Clin Hemorheol Microcirc 2016; 61:549-57. [PMID: 26410864 DOI: 10.3233/ch-151956] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED Systemic sclerosis (SSc) is a systemic, autoimmune connective tissue disease characterized by vasculopathy and microvascular changes. Fluorescence Optical Imaging (FOI) is a technique used to assess inflammation in patients with arthritis; in this study FOI is used to quantify inflammation in the hand. Endothelial Microparticle (EMP) can reflect damage or activation of the endothelium but also actively modulate processes of inflammation, coagulation and vascular function. The aim of the present study was to quantify EMP and FOI, to determine an association between these microparticles and inflammation and to endothelial function. METHODS EMP were quantified in plasma samples of 25 patients (24 female, 1 male, age: 41 ± 9 years) with SSc using flow cytometry. EMP was defined as CD31+/CD42- MP, and CD62+ MP. Perivascular inflammation was assessed using fluorescence optical imaging (FOI) of the hand. Macrovascular endothelial function was non-invasively estimated using the Endopat system. RESULTS Plasma levels of CD31+/CD42- EMP and CD62+ EMP were lower in patients with SSc compared to controls (both p < 0.05). An impaired endothelial function with an increased hyperemia index was observed. A strong association could be demonstrated between CD62+ EMP and perivascular soft tissue inflammation as assessed by the FOI global score (Spearman, p = 0.002, r = 0.61). CONCLUSIONS EMP indicate molecular vascular damage in SSc; in this study a strong association between EMP and perivascular inflammation as quantified by FOI is demonstrated. Consequently EMP, using FOI, may be a potential marker benefitting the diagnosis and therapy monitoring of patients with SSc with associated Raynaud's phenomenon.
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Affiliation(s)
- Christian Jung
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Karl Drummer
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
| | - Peter Oelzner
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
| | - Hans R Figulla
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Joachim Boettcher
- Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera gGmbH, Straße des Friedens, Gera, Germany
| | - Marcus Franz
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Stefan Betge
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Martin Foerster
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Gunter Wolf
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
| | - Alexander Pfeil
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
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Rajaram A, Ioussoufovitch S, Morrison LB, St Lawrence K, Lee TY, Bureau Y, Diop M. Joint blood flow is more sensitive to inflammatory arthritis than oxyhemoglobin, deoxyhemoglobin, and oxygen saturation. BIOMEDICAL OPTICS EXPRESS 2016; 7:3843-3854. [PMID: 27867697 PMCID: PMC5102556 DOI: 10.1364/boe.7.003843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 05/11/2023]
Abstract
Joint hypoxia plays a central role in the progression and perpetuation of rheumatoid arthritis (RA). Thus, optical techniques that can measure surrogate markers of hypoxia such as blood flow, oxyhemoglobin, deoxyhemoglobin, and oxygen saturation are being developed to monitor RA. The purpose of the current study was to compare the sensitivity of these physiological parameters to arthritis. Experiments were conducted in a rabbit model of RA and the results revealed that joint blood flow was the most sensitive to arthritis and could detect a statistically significant difference (p<0.05, power = 0.8) between inflamed and healthy joints with a sample size of only four subjects. Considering that this a quantitative technique, the high sensitivity to arthritis suggests that joint perfusion has the potential to become a potent tool for monitoring disease progression and treatment response in RA.
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Affiliation(s)
- Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Seva Ioussoufovitch
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Laura B. Morrison
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Keith St Lawrence
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
- Imaging Program, Robarts Research Institute, 100 Perth Drive, London, Ontario N6A 5K8, Canada
| | - Yves Bureau
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
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26
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Haugen IK, Hammer HB. A need for new imaging modality to detect inflammation in rheumatoid arthritis and osteoarthritis? Ann Rheum Dis 2015; 75:479-80. [PMID: 26698851 DOI: 10.1136/annrheumdis-2015-208661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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27
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Scales HE, Ierna M, Smith KM, Ross K, Meiklejohn GR, Patterson-Kane JC, McInnes IB, Brewer JM, Garside P, Maffia P. Assessment of murine collagen-induced arthritis by longitudinal non-invasive duplexed molecular optical imaging. Rheumatology (Oxford) 2015; 55:564-72. [PMID: 26475798 DOI: 10.1093/rheumatology/kev361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the present study we evaluated the use of four commercially available fluorescent probes to monitor disease activity in murine CIA and its suppression during glucocorticoid therapy. METHODS Arthritis was induced in male DBA/1 mice by immunization with type II collagen in Complete Freund's Adjuvant, followed by a boost of collagen in PBS. Four fluorescent probes from PerkinElmer in combination [ProSense 750 fluorescent activatable sensor technology (FAST) with Neutrophil Elastase 680 FAST and MMPSense 750 FAST with CatK 680 FAST] were used to monitor disease development from day 5 through to day 40 post-immunization. Fluorescence generated in vivo by the probes was correlated with clinical and histological score and paw measurements. RESULTS The fluorescence intensity emitted by each probe was shown to correlate with the conventional measurements of disease. The highest degree of correlation was observed with ProSense 750 FAST in combination with Neutrophil Elastase 680 FAST; these probes were then used to successfully assess CIA suppression during dexamethasone treatment. CONCLUSION We have demonstrated that longitudinal non-invasive duplexed optical fluorescence imaging provides a simple assessment of arthritic disease activity within the joints of mice following the induction of CIA and may represent a powerful tool to monitor the efficacy of drug treatments in preclinical studies.
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Affiliation(s)
- Hannah E Scales
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, MD Biosciences
| | | | | | - Kirsty Ross
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK and
| | | | - Janet C Patterson-Kane
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Iain B McInnes
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - James M Brewer
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Paul Garside
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Department of Pharmacy, University of Naples Federico II, Naples, Italy
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28
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van Onna M, Ten Cate DF, Tsoi KL, Meier AJL, Jacobs JWG, Westgeest AAA, Meijer PBL, van Beek MC, Rensen WHJ, Bijlsma JWJ. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2015; 75:511-8. [PMID: 26452538 PMCID: PMC4789697 DOI: 10.1136/annrheumdis-2015-207315] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/20/2015] [Indexed: 01/30/2023]
Abstract
Objectives In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA.
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Affiliation(s)
- M van Onna
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D F Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K L Tsoi
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J L Meier
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | - J W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A A A Westgeest
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | | | | | | | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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29
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The Application of Fluorescence Optical Imaging in Systemic Sclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:658710. [PMID: 26357658 PMCID: PMC4555360 DOI: 10.1155/2015/658710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/03/2015] [Indexed: 01/30/2023]
Abstract
Objective. The aim of this study was to visualize soft tissue inflammation using FOI on patients with Systemic Sclerosis (SSc) characterized by SSc-related Raynaud's phenomenon and to detect the therapeutic response to treatment with iloprost or alprostadil. Methods. Twenty-one patients with SSc and Raynaud's phenomenon and twenty-six healthy controls were prospectively included. The SSc patients were intravenously treated with iloprost or alprostadil over seven days. FOI was performed at baseline and after seven days using an intravenous application of indocyanine green (ICG). The hands were divided into nineteen segments per hand. All segments were quantitatively evaluated to determine changes in ICG. Results. The sensitivity and specificity of FOI in the detection of ICG enhancement in patients with SSc were 95% versus 96%. At baseline, 31.5% hand segments showed ICG enhancement. After seven days of either iloprost or alprostadil therapy a significant reduction in the ICG was observed which ranged from 40.9% to 24.7%. Conclusion. The study demonstrates that the FOI technique is able to visualize soft-tissue inflammation with both high sensitivity and specificity. The anti-inflammatory therapeutic effects of iloprost were slightly stronger than alprostadil. FOI offers promising benefits in the diagnosis and therapy of patients with SSc-associated Raynaud's phenomenon.
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30
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Krohn M, Ohrndorf S, Werner SG, Schicke B, Burmester GR, Hamm B, Backhaus M, Hermann KGA. Near-infrared Fluorescence Optical Imaging in Early Rheumatoid Arthritis: A Comparison to Magnetic Resonance Imaging and Ultrasonography. J Rheumatol 2015; 42:1112-8. [PMID: 25934821 DOI: 10.3899/jrheum.141244] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Near-infrared fluorescence optical imaging (FOI) is a novel imaging technology in the detection and evaluation of different arthritides. FOI was validated in comparison to magnetic resonance imaging (MRI), greyscale ultrasonography (GSUS), and power Doppler ultrasonography (PDUS) in patients with early rheumatoid arthritis (RA). METHODS Hands of 31 patients with early RA were examined by FOI, MRI, and US. In each modality, synovitis of the wrist, metacarpophalangeal joints (MCP) 2-5, and proximal interphalangeal joints (PIP) 2-5 were scored on a 4-point scale (0-3). Sensitivity and specificity of FOI were analyzed in comparison to MRI and US as reference methods, differentiating between 3 phases of FOI enhancement (P1-3). Intraclass correlation coefficients (ICC) were calculated to evaluate the agreement of FOI with MRI and US. RESULTS A total of 279 joints (31 wrists, 124 MCP and 124 PIP joints) were evaluated. With MRI as the reference method, overall sensitivity/specificity of FOI was 0.81/0.00, 0.49/0.84, and 0.86/0.38 for wrist, MCP, and PIP joints, respectively. Under application of PDUS as reference, sensitivity was even higher, while specificity turned out to be low, except for MCP joints (0.88/0.15, 0.81/0.76, and 1.00/0.27, respectively). P2 appears to be the most sensitive FOI phase, while P1 showed the highest specificity. The best agreement of FOI was shown for PDUS, especially with regard to MCP and PIP joints (ICC of 0.57 and 0.53, respectively), while correlation with MRI was slightly lower. CONCLUSION FOI remains an interesting diagnostic tool for patients with early RA, although this study revealed limitations concerning the detection of synovitis. Further research is needed to evaluate its full diagnostic potential in rheumatic diseases.
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Affiliation(s)
- Michaela Krohn
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Sarah Ohrndorf
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Stephanie G Werner
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Bernd Schicke
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Gerd-Rüdiger Burmester
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Bernd Hamm
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Marina Backhaus
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Kay-Geert A Hermann
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
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Slooter MD, Bierau K, Chan AB, Löwik CWGM. Near infrared fluorescence imaging for early detection, monitoring and improved intervention of diseases involving the joint. Connect Tissue Res 2015; 56:153-60. [PMID: 25689091 DOI: 10.3109/03008207.2015.1012586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Joints consist of different tissues, such as bone, cartilage and synovium, which are at risk for multiple diseases. The current imaging modalities, such as magnetic resonance imaging, Doppler ultrasound, X-ray, computed tomography and arthroscopy, lack the ability to detect disease activity before the onset of anatomical and significant irreversible damage. Optical in vivo imaging has recently been introduced as a novel imaging tool to study the joint and has the potential to image all kinds of biological processes. This tool is already exploited in (pre)clinical studies of rheumatoid arthritis, osteoarthritis and cancer. The technique uses fluorescent dyes conjugated to targeting moieties that recognize biomarkers of the disease. This review will focus on these new imaging techniques and especially where Near Infrared (NIR) fluorescence imaging has been used to visualize diseases of the joint. NIR fluorescent imaging is a promising technique which will soon complement established radiological, ultrasound and MRI imaging in the clinical management of patients with respect to early disease detection, monitoring and improved intervention.
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Abstract
Magnetic resonance imaging (MRI) is ideal for imaging the joints of rheumatoid arthritis (RA) patients. It produces anatomically detailed images of bone, cartilage, tendons and synovial membrane. It can reveal structural damage, in the form of bone erosion, cartilage thinning and/or tendon rupture, and regions of inflammation, using sequences that reveal water content and vascularity. MRI synovitis, tenosynovitis and bone oedema/osteitis all have prognostic significance, and MRI studies of RA have helped elucidate the mechanisms whereby bone and synovial inflammation lead to joint damage. Bone oedema/osteitis has become an important imaging biomarker, and can be used to help predict progression from undifferentiated arthritis to definite RA. Recent MRI studies have confirmed that subclinical inflammation is often present in patients in clinical remission, and these data may affect disease management. Finally, recent clinical trials are reviewed, in which MRI outcome measures are being established as sensitive response markers.
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Affiliation(s)
- Fiona M McQueen
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand,
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