POS0129 TO CONTRAST OR NOT TO CONTRAST? ON THE ROLE OF CONTRAST ENHANCEMENT IN HAND MRI STUDIES OF PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Currently, clinical indications for application of gadolinium-based contrast agents (GBCA) in magnetic resonance imaging (MRI) are increasingly being questioned1. Rheumatoid arthritis is a disease which is characterised by joint inflammation and due to various existing therapies, early diagnosis and sensitive monitoring is beneficial for assessing disease progression, therapy response and optimizing the individual therapy.

Objectives

This study aimed to evaluate the necessity of contrast enhancement in MRI of the hand in patients with rheumatoid arthritis (RA).

Methods

31 patients with RA (mean age, 50±14 years [range, 18–72 years]) from the German ArthroMark cohort underwent morphologic high-field MRI scans on a clinical 3T scanner. MRI studies were analyzed based on (1) the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS2) and (2) the GBCA-free RAMRIS version, termed RAMRIS Sine-Gadolinium-For-Experts (RAMRIS-SAFE), in which synovitis and tenosynovitis were assessed using the short-tau-inversion-recovery (STIR) sequence instead of the post-contrast T1-weighted sequence.

Results

Correlation between RAMRIS and RAMRIS-SAFE in terms of Spearman’s ρ was almost perfect (ρ=0.976; p<0.001). The synovitis subscores, as based on RAMRIS and RAMRIS-SAFE, were equally strongly correlated (ρ=0.937; p<0.001), while the tenosynovitis subscores were less strongly correlated (ρ=0.380 p=0.035). Inter-rater reliability in terms of Cohen’s κ was high (0.963 ≤ κ ≤ 0.925).

Conclusion

In conclusion, RAMRIS-SAFE as the GBCA-free version of the well-established RAMRIS is a patient-friendly and resource-efficient alternative for assessing disease-related joint changes in RA. As patients with RA are subject to repetitive GBCA applications, non-contrast imaging protocols should be considered.

References

[1]Olchowy, C.; Cebulski, K.; Lasecki, M.; Chaber, R.; Olchowy, A.; Kalwak, K.; Zaleska-Dorobisz, U. The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review. PLoS One 2017, 12, e0171704, doi:10.1371/journal.pone.0171704.

[2]Ostergaard, M.; Peterfy, C.G.; Bird, P.; Gandjbakhch, F.; Glinatsi, D.; Eshed, I.; Haavardsholm, E.A.; Lillegraven, S.; Boyesen, P.; Ejbjerg, B.; et al. The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: Updated Recommendations by the OMERACT MRI in Arthritis Working Group. Journal of Rheumatology 2017, 44, 1706-1712, doi:10.3899/jrheum.161433.

Table 1.

Composition of both scores: RAMRIS-SAFE and RAMRIS

ImagingFeatureAnatomic LocationMRI Sequence:RAMRIS-SAFE(without contrast enhancement)RAMRIS(with contrastenhancement)Erosion•distal radius and distal ulnacoronal T1coronal T1•all carpal bones and metacarpal bases•MCP joints (II-V)Osteitis•distal radius and distal ulnacoronal STIRcoronal STIR•all carpal bones and metacarpal bases•MCP joints (II-V)Synovitis•Distal radio-ulnar jointcoronal STIR,coronal and axial•Radiocarpal jointaxial T1T1 + contrast•Intercarpal and carpometacarpal joints•MCP (II-V) jointsTenosynovitis•flexor tendons at the level of MCP jointscoronal STIR,axial T1coronal and axialT1 + contrastJoint spacenarrowing•all radiocarpal, intercarpal, carpometacarpal, . . and MCP joints (n=17)coronal T1coronal T1

Abbreviations are “RAMRIS” (rheumatoid arthritis MRI scoring system), “RAMRIS-SAFE” (RAMRIS sine gadolinium for experts), “MCP” (metacarpophalangeal), and “STIR” (Short-Tau-Inversion-Recovery).

Figure 1.

Exemplary imaging features (erosion, osteitis, synovitis, tenosynovitis, and joint space narrowing) that are scored semiquantitatively based on RAMRIS, shown in (i) unenhanced MRT T1-weighted sequence (left column), (ii) STIR sequence (middle column), and enhanced T1-weighted postcontrast sequence (right column).

Disclosure of Interests

Gesa Rübsam: None declared, Miriam Frenken: None declared, Alexaner Dieter Mewes: None declared, Karl Ludger Radke: None declared, Lien Le: None declared, Lena Wilms: None declared, Sven Nebelung: None declared, Daniel Abrar: None declared, Philipp Sewerin Speakers bureau: AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd./Chugai Europe, Deutscher Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly/Lilly Europe/Lilly Global, medi-login, Mediri GmbH, Novartis Pharma, Onkowissen

GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB Pharma, Consultant of: AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd./Chugai Europe, Deutscher

Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly/Lilly Europe/Lilly Global, medilogin, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB, Grant/research support from: Deutsche Forschungsgesellschaft (DFG), Bundesministerium für Bildung und Forschung (BMBF), AMGEN, AbbVie, BMS, Celgene, Chugai, Deutscher Psoriasis-Bund, Janssen-Cilag, Lilly, Novartis, Roche, Rheumazentrum Rhein-Ruhr, UCB Pharma

[Standardised measuring the health of infants and toddlers in community health services]

Standardised measures are needed in the general child health surveillance. A standardised record with manualised guidelines have been created for use in the existing services of community health nurses, to collect epidemiological data and improve the quality of regional child health surveillance. The record has been used since 2000, and currently one third of the Danish child population is included. Research findings suggest targets of intervention towards risk trajectories of overweight, weight faltering, eating problems and neuro-developmental disorders.

Evidence of mitochondrial dysfunction in obese adolescents

AIM

Although obesity and weight gain generally are anticipated to be caused by an imbalance between energy intake and energy expenditure, the significance of thyroid hormones (TH) remains unclear. Examination of mitochondrial function may reflect intracellular thyroid hormone effect and elucidate whether a lower metabolic rate is present.

METHODS

In a group of 34 obese adolescents (age <16 years and body mass index above the age-related 95th percentile), and an age- and gender-matched group of 32 lean adolescent, thyroid stimulating hormone (TSH) and basal oxygen consumption were measured and mitochondrial function in peripheral blood monocytes was determined by flow cytometry.

RESULTS

Significant increase in TSH (3.06 +/- 1.56 mU/L vs. 2.33 +/- 0.91 mU/L, p < 0.05) and a decrease in VO2 (129 +/- 16 mL O2/m(2)*min vs. 146 +/- 15 mL O2/m(2)*min, p < 0.05) were observed in obese adolescents compared with lean adolescents. Flow cytometry analysis demonstrated a lower mitochondrial mass (6385 +/- 1962 a.u. vs. 7608 +/- 2328 a.u., p < 0.05) and mitochondrial membrane potential (11426 +/- 3861 a.u. vs. 14017 +/- 5536 a.u., p < 0.05) in obese adolescents compared with lean adolescents. These results are even more pronounced in adolescents with obese mothers.

CONCLUSION

In obese adolescents, the increased TSH and lowered VO2 propose a lowered basal metabolic rate and the impaired mitochondrial function suggests a decreased thyroid hormone stimulation of mitochondrial energy production. The maternal in-heritage is suggestive of a basal metabolic defect or mitochondrial resistance for TH.

Subclinical hypothyroidism affects mitochondrial function

The aim of the present study was to examine mitochondrial function in cells from persons with subclinical hypothyroidism and euthyroid controls. The participating persons were examined clinically and had basal oxygen consumption (VO(2)) determined. The concentrations of thyroid hormones and thyrotropine stimulating hormone were determined, and mitochondrial function in isolated mononuclear blood cells was examined by enzymatic methods [citrate synthase activity (CS)] and by flow cytometry (mitochondrial membrane potential by TMRM fluorescence and mitochondrial mass by MTG fluorescence). The ratio of T(4)/T(3) was lowered in subclinical hypothyroidism patients compared to controls (2.5+/-0.5 vs. 2.9+/-0.4, p=0.005). VO(2) was increased in persons with subclinical hypothyroidism compared to controls (adolescents: 134+/-27 ml O(2)/min*m(2) vs. 119+/-27 ml O(2)/min*m(2), p=0.006, adults: 139+/-14 ml O(2)/min*m(2) vs. 121+/-17 ml O(2)/min*m(2), p=0.001). The mitochondrial function, represented by citrate synthase activity, MTG, and TMRM fluorescence were all increased (CS in subclinical hypothyroidism vs. controls: 0.074+/-0.044 nmol/mg*min vs. 0.056+/-0.021 nmol/mg*min, p=0.005; MTG fluorescence in subclinical hypothyroidism vs. controls: 7,482+/-1,733 a.u. vs. 6,391+/-2,171 a.u., p=0.027; TMRM fluorescence in subclinical hypothyroidism vs. controls: 13,449+/-3,807 a.u. vs. 11,733+/-4,473 a.u, p=0.04). Our results indicate an increased mitochondrial stimulation, eventually caused by increased deiodination of T(4) to intracellular bioactive iodothyronines in adults and adolescents with subclinical hypothyroidism.

Overall and meal-specific macronutrient intake in Belgian primary school children

In the fall of 1991, dietary intake of 1,321 primary school children aged 6-12 years was studied in 79 schools in an area called 'South Campine' in Flanders-the Dutch-speaking part of Belgium. Assessment of dietary intake was done using the '24-hour estimated food record method'. The energy distribution over the macronutrients showed no significant difference between boys and girls. On average 37.2% (SD 7.88%) of energy came from total fat and 15.4% (SD 3.70%) from saturated fatty acids; 49.0% (SD 7.87%) from total carbohydrates with 21.8% (SD 5.84%) from complex carbohydrates and 27.7% (SD 7.79%) from free sugars. Snacks accounted for on average 19.5% (SD 10.83%) of total energy intake; on average 55.7% (SD 21.22%) of the energy in these snacks was represented by free sugars. Lunch and dinner had very high fat contents (around 40% of energy). Already at this young age, the dietary pattern is deviating strongly from the recommended population nutrient goals.