Objective: Fluorescence optical imaging (FOI) demonstrates enhanced microcirculation in finger joints as a sign of inflammation. We wanted to assess the validity and diagnostic performance of FOI measuring synovitis in persons with hand OA, comparing it with magnetic resonance imaging (MRI)-and ultrasound-detected synovitis. Methods: Two hundred and twenty-one participants with hand OA underwent FOI and ultrasound (gray-scale synovitis and power Doppler activity) of the bilateral hands and contrast-enhanced MRI examination of the dominant hand. Fifteen joints in each hand were scored on semi-quantitative scales (grade 0-3) for all modalities. Four FOI images were evaluated: one composite image (Prima Vista Mode (PVM)) and three images representing phases of fluorescent dye distribution. Spearman's correlation coefficients were calculated between sum scores of FOI, MRI, and ultrasound. Sensitivity, specificity, and area under the curve (AUC) were calculated for FOI using MRI or ultrasound as reference. Results: FOI did not demonstrate enhancement in the thumb base, and the joint was excluded from further analyses. FOI sum scores showed poor to fair correlations with MRI (rho 0.01-0.24) and GS synovitis sum scores (rho 0.12-0.25). None of the FOI images demonstrated both good sensitivity and specificity, and the AUC ranged from 0.50-0.61 and 0.51-0.63 with MRI and GS synovitis as reference, respectively. FOI demonstrated similar diagnostic performance with PD activity and GS synovitis as reference. Conclusion: FOI enhancement correlated poorly with synovitis assessed by more established imaging modalities, questioning the value of FOI for the evaluation of synovitis in hand OA.

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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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Background:Fluorescence Optical Imaging (FOI) demonstrates enhanced microcirculation in finger joints as a sign of inflammation.Objectives:We wanted to assess the validity and diagnostic performance of FOI measuring synovitis, comparing it with Magnetic Resonance Imaging (MRI)- and ultrasound-detected synovitis in persons with hand osteoarthritis (OA).Methods:Two hundred and twenty-one participants (88% female, age (SD) 60.6 (6.2) years) with hand OA from the Nor-Hand study underwent FOI and grey scale (GS) and power Doppler (PD) ultrasound of the bilateral hands and contrast-enhanced MRI of the dominant hand. The FOI scan was performed after the administration of an intravenous fluorescence dye (indocyanine green, ICG) and 360 images (1/second) were produced in 6 minutes. One reader scored the bilateral distal interphalangeal (DIP), proximal interphalangeal (PIP), metacarpophalangeal (MCP) and first carpometacarpal (CMC-1) joints for FOI enhancement, blinded for clinical information and other imaging data. Images were scored according to the ‘FOI activity score’ (FOIAS) where four out of 360 images are assessed, defined as phase 1, 2, and 3, based on the inflow and washing out of the fluorescence dye, and a composite image (Prima Vista Mode; PVM) of the 240 first images. Two readers evaluated separately the severity of MRI-defined synovitis (grade 0-3) in the DIP, PIP, MCP and CMC-1 joints of the dominant hand and the severity of GS synovitis (grade 0-3) and PD activity (grade 0-3) in the same joints of the hands bilaterally. Spearman’s rho was calculated for correlations between sum scores of all joints for FOI, MRI and ultrasound and sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and area under the curve (AUC) for FOI using MRI and ultrasound as reference.Results:Despite frequent MRI and ultrasound findings in the CMC-1 joint, no FOI enhancement was detected in the thumb base, and CMC-1 was excluded from the analyses. FOI had poor to fair correlations with MRI and GS synovitis and PD activity. The strongest correlation with MRI was found for PVM in the PIP joints with Spearman’s rho of 0.32, while the DIP joints had consistently the weakest correlations ranging from 0 to 0.14 (Figure 1). None of the FOI phases or PVM demonstrated both good sensitivity and specificity, and AUC remained low with both MRI and GS synovitis as a reference (table 1). The NPVs of FOI were consistently higher when GS synovitis was used as reference rather than MRI, due to higher frequency of low degree MRI-defined synovitis. However, when changing cut-off for MRI synovitis as reference from grade 1 to grade 2 the diagnostic performance of FOI increased to the level of GS synovitis. The diagnostic performance for FOI was similar with both GS synovitis and PD activity as reference.Table 1.Diagnostic performance of FOI measuring synovitis in hand OA using MRI and GS synovitis as referenceFOIReferenceSensitivitySpecifisityPPVNPVAUCPVMMRI0.480.720.610.610.61Phase 10.020.990.610.530.50Phase 20.580.620.580.620.60Phase 30.240.900.670.570.57PVMGS0.590.640.170.930.62Phase 10.020.990.280.890.51Phase 20.690.560.170.940.63Phase 30.230.860.170.900.56FOI; Fluorescence optical imaging, PVM; Prima Vista Mode, GS; Grey scale, PVM; Prima Vista Mode, PPV; Positive Predictive Value, NPV; Negative Predictive Value, AUC; Area under the curveConclusion:FOI sum scores showed poor to fair correlations with MRI- and ultrasound-detected synovitis in persons with hand OA. These findings might be explained by the low-grade inflammation with minor vascularization in the majority of inflamed joints. None of the FOI phases or PVM demonstrated both good sensitivity and specificity and the method was not able to detect CMC-1 synovitis.Disclosure of Interests:Øystein Maugesten: None declared, Alexander Mathiessen: None declared, Hilde Berner Hammer Consultant of: Has received fees as consultant from Roche, AbbVie and Novartis., Speakers bureau: Has received fees for speaking from AbbVie, BMS, Pfizer, UCB, Roche, MSD and Novartis, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Sigrid Valen Hestetun: None declared, Till Uhlig: None declared, Sarah Ohrndorf: None declared, Ida K. Haugen: None declared

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