BackgroundValid detection of arthritis is essential in differential diagnosis of joint pain. Indocyanin green (ICG)-enhanced fluorescence optical imaging (FOI) is a new imaging method that visualizes inflammation in wrist and finger joints. Objectives of this study were to compare FOI with ultrasonography (US, by gray-scale (GS) and power Doppler (PD)) and clinical examination (CE) and to estimate the predictive power of FOI for discrimination between inflammatory and non-inflammatory juvenile joint diseases.MethodsFOI and GSUS/PDUS were performed in both hands of 76 patients with joint pain (53 with juvenile idiopathic arthritis (JIA), 23 with non-inflammatory joint diseases). Inflammation was graded by a semiquantitative score (grades 0–3) for each imaging method. Joints were defined clinically active if swollen or tender with limited range of motion. Sensitivity and specificity of FOI in three phases dependent on ICG enhancement (P1–P3) were analyzed with CE and GSUS/PDUS as reference.ResultsFor JIA patients, FOI had an overall sensitivity of 67.3%/72.0% and a specificity of 65.0%/58.8% with GSUS/PDUS as reference; specificity was highest in P3 (GSUS 94.3%/PDUS 91.7%). FOI was more sensitive for detecting clinically active joints than GSUS/PDUS (75.2% vs 57.3%/32.5%). In patients with non-inflammatory joint diseases both FOI and US showed positive (i.e., pathological) findings (25% and 14% of joints). The predictive value for discrimination between inflammatory and non-inflammatory joint diseases was 0.79 for FOI and 0.80/0.85 for GSUS/PDUS.ConclusionsDependent on the phase evaluated, FOI had moderate to good agreement with CE and US. Both imaging methods revealed limitations and should be interpreted cautiously. FOI may provide an additional diagnostic method in pediatric rheumatology.Trial registrationDeutsches Register Klinischer Studien DRKS00012572. Registered 31 July 2017.
BackgroundImaging techniques play an important role in making a diagnosis and in the evaluation of treatment effectiveness as well as in the outcome assessment of juvenile idiopathic arthritis (JIA). Fluorescence optical imaging (FOI) has been shown to visualize inflammation in arthritis of wrist and finger joints. FOI is a simple and cost-effectively imaging technique that is well tolerated by the patients.ObjectivesFirstly, to determine the association and agreement of FOI with ultrasonography (US) and physician's assessment of swollen and active joints. Secondly, to estimate the predictive power of FOI to distinguish between patients with and without inflammatory pediatric rheumatic joint diseases.MethodsA total of 95 patients were enrolled in three pediatric rheumatology centers in Berlin, Germany. FOI and US (in greyscale (GS) and power Doppler (PD)) were performed in each patient. The FOI software automatically generated the PrimaVista mode (PVM). Furthermore, three phases (P1, P2, P3) were defined dependent on the signal intensity in the fingertips. Each joint was scored semiquantitatively (0=no signal up to 3=strong signal, more than 50% of affected joint area) in each of the three phases and PVM. US was additionally graded by a semiquantitative score of each joint for synovitis (synovial thickening and joint effusions) in GS and hyperperfusion in PD mode. The joints were defined as active if the FOI or US reached a score of at least 1, respectively. We report the results on 27 patients in this interim analysis.ResultsThe mean disease duration was 3.5 years (SD=3.2), the mean cJADAS-10 was 11.0 (SD=12.3), the mean number of active joints in the hand was 3.4 (SD=5.8). Half of the patients had polyarthritis (51.8%) and one third had a non-inflammatory rheumatic disease. A total of 810 joints in 27 patients could be analyzed. Among those, 140 (17.3%) had a positive US synovitis score, 87 (10.7%) a positive US power Doppler signal, 93 (11.5%) a clinically active joint and 133 (16.4%) a positive FOI PVM. Taking the US synovitis score as reference, the FOI PVM had a sensitivity of 40%, a specificity of 86% and an overall agreement of 79%. Taking the active joint count as reference, the FOI PVM had a sensitivity of 46%, a specificity of 88% and an overall agreement of 83%. The area under curve was 0.91 for US power Doppler, 0.84 for US GS synovitis, 0.76 and 0.93 for FOI PVM and P2 for the ability to distinguish between patients with and without inflammatory rheumatic diseases. FOI and US scores correlated highly with the cJADAS-10 and the physicians global. In contrast, the patient-reported outcomes pain and fatigue did not show any correlation with FOI and US scores.ConclusionsFOI and US had a comparable predictive power to distinguish between patients with and without inflammatory rheumatic diseases in pediatric/ juvenile patients. The agreement between active joint count, US and FOI was high. FOI may provide a cost-effective method to evaluate inflammation in finger and hand joints.AcknowledgementsThe study w...
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