Contrast-Enhanced Magnetic Resonance Imaging Positively Impacts the Management of Some Patients With Rheumatoid Arthritis or Suspected RA

Fox, Michael G.; Stephens, Tausha; Jarjour, Wael; Anderson, Mark; Kimpel, Donald L.

doi:10.1097/rhu.0b013e31823e5ab3

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…Findings indicate that having knowledge of and access to the MBDA test result translated into better assessment and treatment decision-making by rheumatologists, evidenced by improved patient vignette scores in the intervention group compared with controls. These results, observed in a randomized controlled design, support the findings of earlier studies indicating that offering physicians a quantitative measure of disease activity improves their practice and may lead to better clinical outcomes [19], [30]. In RA in particular, the lack of more objective measures of disease activity can make it difficult for physicians to make the most appropriate treatment decisions.…”

Section: Discussionsupporting

confidence: 84%

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice

et al. 2013

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BackgroundVariability exists in the assessment of disease activity in rheumatoid arthritis (RA) patients that may affect quality of care.ObjectivesTo measure the impact on quality of care of a Multi-Biomarker Disease Activity (MBDA) test that quantitatively assesses RA disease activity.MethodsBoard-certified rheumatologists without prior experience with the MBDA test (N = 81) were randomized into an intervention or control group as part of a longitudinal randomized-control study. All physicians were asked to care for three simulated RA patients, using Clinical Performance and Value (CPV™) vignettes, in a before and after design. CPV™ vignettes have been validated to assess the quality of clinical practice and identify variation in care. The vignettes covered all domains of a regular patient visit; scores were determined as a percentage of explicit predefined criteria completed. Three vignettes, representing typical RA cases, were administered each round. In the first round, no physician received information about the MBDA test. In the second round, only physicians in the intervention group were given educational materials about the test and hypothetical test results for each of the simulated patients. The outcome measures were the overall quality of care, disease assessment and treatment.ResultsThe overall quality scores in the intervention group improved by 3 percent (p = 0.02) post-intervention compared with baseline, versus no change in the control group. The greatest benefit in the intervention group was to the quality of disease activity assessment and treatment decisions, which improved by 12 percent (p<0.01) compared with no significant change in the control group. The intervention was associated with more appropriate use of biologic and/or combination DMARDs in the co-morbidity case type (p<0.01).ConclusionsBased on these results, use of the MBDA test improved the assessment and treatment decisions for simulated cases of RA and may prove useful for rheumatologists in clinical practice.

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Section: Discussionsupporting

confidence: 84%

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice

et al. 2013

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“…Detection and quantification of synovial proliferation are vital for early diagnosis and therapy surveillance in RA, and has hitherto largely been conducted using contrast‐enhanced MRI. However, this methodology requires a costly contrast agent, the use of which may furthermore not be suitable for some patients with a history of allergic reaction or impaired renal function .…”

Section: Discussionmentioning

confidence: 99%

“…Our results indicate that IVIM parameter D values, and ADC values, were significantly different when compared between contrast enhancement grades indicative of synovial proliferation and those indicative of joint effusion. Detection and quantification of synovial proliferation are vital for early diagnosis and therapy surveillance in RA, 3,18 and has hitherto largely been conducted using contrastenhanced MRI. However, this methodology requires a costly contrast agent, the use of which may furthermore not be suitable for some patients with a history of allergic reaction or impaired renal function.…”

Section: Discussionmentioning

confidence: 99%

Intravoxel incoherent motion MRI for discrimination of synovial proliferation in the hand arthritis: A prospective proof‐of‐concept study

Fujimori

Murakami

Sugimori

et al. 2019

Magnetic Resonance Imaging

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Background Postcontrast‐enhanced MRI is currently the reference standard for synovial proliferation in rheumatoid arthritis (RA). However, the technique is somewhat invasive due to the use of gadolinium contrast agents, which may cause severe adverse/side effects. Intravoxel incoherent motion (IVIM) simultaneously permits quantification of perfusion as well as diffusion using a single imaging scan. Purpose/Hypothesis To test the capability of IVIM MRI for noninvasive discrimination of synovial proliferation in hand arthritis. Study Type Prospective. Subjects Seven suspected RA patients (three women and four men; mean age, 61 years; range, 26–74 years). Field Strength/Sequence 3 T/short tau inversion recovery (STIR), IVIM, postcontrast‐enhanced MRI. Assessment Region of interest (ROI) was identified based on STIR. Contrast‐enhanced MRI was evaluated using a 5‐point grading scale of 0 (water) to 4 (synovial proliferation) according to the degree of contrast enhancement within the ROI. For each ROI, we calculated the apparent diffusion coefficient (ADC) and IVIM parameters (molecular diffusion coefficient [D], perfusion fraction [f], and perfusion‐related diffusion coefficient [D*]). These parameters were subsequently compared with ROI contrast enhancement grades. Statistical Tests Spearman's rank correlation test and a receiver operating characteristic (ROC) curve. Results A total of 90 ROIs of suspected synovial proliferation and/or joint effusion were identified. ROI grades were correlated with ADC and D values (r S = –0.385, P < 0.001, r S = –0.458, P < 0.0001, respectively), but not with the f and D* values (r S = –0.010, P = 0.936, r S = –0.084, P = 0.505, respectively). The area under the curves (AUCs) of D values (0.708–0.888, P = 0.002–0.0002) were slightly larger than those of ADC values (0.692–0.791, P = 0.013–0.001) when comparing low‐ vs. high‐contrast enhancement grades. Data Conclusion The IVIM parameter D and ADC may be useful for the noninvasive identification of synovial proliferation in hand arthritis. Level of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:1199–1206.

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“…Soft-tissue involvement can be detected with increased sensitivity by intravenous contrast administration, either in contrast-enhanced MDCT or in CEMR imaging. 6,11,18 Although only affected bone tissue was quantified, our results showed significantly larger disease extent in CEMR imaging compared with the widely used reference CBCT and clinical examination. This finding corroborates the notion of the additive value of intravenous contrast for disease quantification.…”

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confidence: 85%

“…9 Dynamic CEMR imaging is less specific for the assessment of bone viability 10 but does allow assessment of pathologies affecting bone, notably the medullary cavity, and adjacent soft tissues. 11 Our hypothesis was that CEMR imaging and [ 18 F] fluoride PET/CT best quantify the preoperative extent of BONJ and add value to clinical examinations and standard radiologic imaging with panoramic views of the jaw from CBCT. Thus, the purpose of this study was to compare the extent of changes compatible with BONJ on CEMR imaging, [ 18 F] fluoride PET/CT, and panoramic views derived from standard CBCT of the jaw with clinical preoperative and intraoperative examinations.…”

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confidence: 99%

Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [¹⁸F] Fluoride PET/CT, and Conebeam CT imaging

Guggenberger

Fischer

Metzler

et al. 2012

AJNR Am J Neuroradiol

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Contrast-Enhanced Magnetic Resonance Imaging Positively Impacts the Management of Some Patients With Rheumatoid Arthritis or Suspected RA

Abstract: Enhanced MRI significantly altered clinical management in 50% of these patients with RA or suspected RA. Therefore, when the clinical picture in a patient with RA or suspected RA is unclear, enhanced MRI can provide useful guidance for treatment modifications.

Cited by 11 publications

References 23 publications

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice

Intravoxel incoherent motion MRI for discrimination of synovial proliferation in the hand arthritis: A prospective proof‐of‐concept study

Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [¹⁸F] Fluoride PET/CT, and Conebeam CT imaging

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Contrast-Enhanced Magnetic Resonance Imaging Positively Impacts the Management of Some Patients With Rheumatoid Arthritis or Suspected RA

Abstract: Enhanced MRI significantly altered clinical management in 50% of these patients with RA or suspected RA. Therefore, when the clinical picture in a patient with RA or suspected RA is unclear, enhanced MRI can provide useful guidance for treatment modifications.

Cited by 11 publications

References 23 publications

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice

Impact of Rheumatoid Arthritis Disease Activity Test on Clinical Practice

Intravoxel incoherent motion MRI for discrimination of synovial proliferation in the hand arthritis: A prospective proof‐of‐concept study

Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [18F] Fluoride PET/CT, and Conebeam CT imaging

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Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [¹⁸F] Fluoride PET/CT, and Conebeam CT imaging