Dynamic gadolinium‐enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease

Abstract

Objective. To determine the efficacy of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of the wrist in the evaluation of disease activity in patients with rheumatoid arthritis (RA).Methods. Thirty-six patients with RA (with different degrees of disease activity) and 5 healthy controls were studied. MRI was performed with a low-field (0.2T), extremity-dedicated machine. After an intravenous bolus injection of gadolinium-diethylenetriamine pentaacetic acid, 20 consecutive fast spin-echo images of 3 slices of the wrist were obtained every 18 seconds.Results. The curves of synovial membrane enhancement identified the following 2 groups: controls and RA patients in remission, and RA patients with active or intermediately active disease. Both the rate of early enhancement (REE) and relative enhancement (RE) were significantly higher in patients with active RA than in those with inactive RA and controls. The REE and RE were significantly correlated with the number of swollen joints (P < 0.00001 and P ‫؍‬ 0.003, respectively), the number of tender joints (P < 0.00001 and P ‫؍‬ 0.004, respectively), the Ritchie index (P ‫؍‬ 0.0002 for both REE and RE), the Disease Activity Score (P ‫؍‬ 0.0004 and P ‫؍‬ 0.0008, respectively), the Health Assessment Questionnaire (HAQ) (P ‫؍‬ 0.0002 and P ‫؍‬ 0.0007, respectively), early morning stiffness (P ‫؍‬ 0.001 and P ‫؍‬ 0.009, respectively), the C-reactive protein level (P ‫؍‬ 0.015 and P ‫؍‬ 0.03, respectively), the erythrocyte sedimentation rate (P ‫؍‬ 0.03, RE only), and ␣2 globulins (P ‫؍‬ 0.036 and P ‫؍‬ 0.028, respectively).Conclusion. Our data support use of dynamic MRI for discriminating active from inactive RA. Enhancement curves are associated not only with laboratory and clinical indicators of inflammation, but also with the HAQ, a relevant predictor of RA functional outcome. This technique can be repeated frequently and is an excellent candidate for the ideal method for the followup of patients with RA.

Extremity magnetic resonance imaging in rheumatoid arthritis: Report of the american college of rheumatology extremity magnetic resonance imaging task force

“…Cimmino et al studied a group of 36 patients with RA who had a mean disease duration of 66 months (and a median age of 62.5 years) and compared these patients with a healthy control group (with a mean age of 39 years) (30). The patient group was divided into those with active RA, those with intermediate-level RA, and those whose RA was in remission.…”

Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Using Pharmacokinetic Modeling: Initial Experience in Patients With Early Arthritis

“…An arterial concentration-time curve, the C blood (t), was obtained using Equation 1, and using a T 10 Blood value of 1,540 msec (38). Plasma concentrations in the capillary (C p ) were estimated using the equation C p 5C blood /(12Hct), where Hct represents the hematocrit constant (assigned a value of 0.45) (38).…”

“…With a quantitative approach, it is also possible to obtain physiology-related parameters by converting the time-intensity curves to concentration-time curves, and subsequently fitting these data with pharmacokinetic models (PKMs) such as the Tofts model (9). In patients with rheumatoid arthritis (RA), descriptive DCE-MRI parameters are correlated with clinical disease activity parameters such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level (10)(11)(12), as well as with histologic measures of inflammation such as vascularity and perivascular edema (11,(13)(14)(15)(16). Furthermore, these descriptive parameters have been shown to be predictive of the progression of erosive disease (17), and have been found to decrease after successful treatment (18)(19)(20)(21)(22).…”

Automatic Segmentation of Blood Vessels from Dynamic MRI Datasets

“…Measurement of this enhancement, which is specific for voxels representing particular tissue types, allows assessment of the patient's condition [2,3].…”

“…The enhancement is reflected by the shape of signal intensity vs. time curves derived on the voxel-by-voxel basis from the temporal slices and can be measured by computing various heuristics such as maximum rate of enhancement (M E), initial rate of enhancement (IRE), and time of onset of enhancement (T onset ) [4,3,5]. Positioning of the imaging volume for acquisition of the data from the 2nd-5th metacarpophalangeal joints (MCPJs) and structure of the DCE-MRI experiment are shown in Fig.…”