Monitoring the efficacy of tumor necrosis factor alpha antagonists in the treatment of Ankylosing spondylarthritis: a pilot study based on MR relaxometry technique

Abstract

Background SpA is a disease that seriously affects the quality of life and working ability of patients. At present, there is a lack of scientific and effective quantitative indicators to evaluate the activity of sacroilitis and the efficacy of tumor necrosis factor-α antagonists in the treatment of active sacroilitis. MRI STIR sequence is the most commonly used method for the diagnosis of sacroiliac joint inflammation, but its response to the disease still lags behind the pathological changes and cannot provide quantitative indicators. This study aimed to evaluate the feasibility of using MRI Relaxometry technique to monitor the efficacy of TNF-α antagonists in the treatment of SpA, so as to provide an effective quantitative index for monitoring the efficacy. Methods This is a prospective study, 114 patients with sacroiliac joint were enrolled, including 15 patients as a control group, 99 patients as the case group, and 20 patients in the case group as the treatment group. The differences of T1 mapping, T2 mapping, T2* mapping of subchondral bone marrow of sacroiliac joint were compared among different groups. The diagnostic efficacy was analyzed by ROC, and the best quantitative index of diagnostic efficiency was used to monitor curative effects of different treatment cycles in the treatment group. Results 1. Compared with the control group, values of three different relaxation times in the subchondral bone marrow region of the sacroiliac joint in the case group increased in varying degrees, and T1 mapping showed the best diagnostic efficacy. 2. The decreasing rate of T1 mapping in different treatment periods benefits the monitoring of curative effects. Conclusion This study indicates that T1 mapping technique is preferred in quantitative diagnosis. T1 mapping is superior to T2* mapping and T2 mapping in the diagnosis of subchondral BME of SpA. It can quantitatively monitor edema changes during treatment, benefiting clinical individualized treatment and timely adjustment of the treatment plan.

Characterization of bone marrow lesions in axial spondyloarthritis using quantitative T1 mapping MRI

“…Dixon sequences can be performed with high spatial resolution, however, are less sensitive to the properties of the bone marrow compared to the other sequences that were discussed above [ 16 ]. Another investigation compared different mapping techniques and found that T1 mapping also allowed quantification of bone marrow oedema to assess the severity of inflammation and the treatment response [ 17 ]. Surprisingly, they proved T1 mapping to be superior, for that matter, to the other quantitative MRI techniques.…”

Quantitative magnetic resonance imaging (qMRI) in axial spondyloarthritis

“…A recent pilot study by Lin et al 41 compared different MR relaxometry techniques (T 1 mapping, T 2 mapping, T 2 * mapping) for mapping the subchondral bone marrow and demonstrated that these could be used to monitor response to TNF inhibitor treatment. Lin et al 41 found T 1 mapping had better diagnostic efficacy than T 2 mapping which was susceptible to confounding effects of the external environment including age, bone marrow composition, fat deposition and changes in the structure of bone trabeculae.…”

Inflammatory activity evaluation in patients with axial spondyloarthritis using MRI relaxometry and mucosal-associated invariant T cells

“…Magnetic relaxometry technique, detecting subtle changes of water content of the tissue, can quantitatively assess the extent of BME ( 15 , 16 ). Previous study showed that T1 mapping and T2* mapping values were effective quantitative indicators for clinical diagnosis, disease activity assessment and treatment monitoring in axSpA ( 17 ). However, due to the heterogeneity and the fluctuating nature of inflammatory activity in axSpA, relying solely on quantitative detection of BME is insufficient to evaluate the overall inflammatory activity level in axSpA patients ( 18 , 19 ).…”