Quantitative assessment of the synovial membrane in the rheumatoid wrist: an easily obtained MRI score reflects the synovial volume (original) (raw)
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Journal of Magnetic Resonance Imaging, 1999
The purpose of this study was to assess the role of inflamed synovial volume (ISV) in defining a state of remission in rheumatoid arthritis (RA) with contrast-enhanced, fatsuppression, three-dimensional (3D) gradient-recalled acquisition in the steady state with radiofrequency spoiling (SPGR) magnetic resonance (MR) imaging. Sixteen patients with RA (5 remission and 11 non-remission patients) were enrolled in this study. Contrast-enhanced, fat-suppression, 3D-SPGR MR imaging was performed before (n ؍ 12) and after (n ؍ 16) a mean 17 months of disease-modifying antirheumatic drugs (DMARDs). ISV was calculated by using a segmentation method. Statistical analysis of changes in ISVs and residual ISVs between the remission and the non-remission groups was performed. Intra-and interobserver reproducibility was tested. Residual ISVs and relative changes in ISVs were 3.23 ؎ 1.84 cm 3 and 51.4% (range 47.6-55.2%) in the remission group and 6.26 ؎ 2.03 cm 3 and 31.4% (range -73.5-53.5%) in the non-remission group. Both values were significantly different between the two groups (P F 0.05 and 0.05, respectively). Volume measurement showed high reproducibility: Intra-and interobserver mean percentage errors were 5.04, 7.06, and 5.09%, respectively. Residual ISVs and relative changes in ISVs measured by MR imaging may provide objective and quantitative parameters in defining a state of remission in RA after therapy; however, the clinical utility of these measurements remains to be verified.
Arthritis Care & Research, 2012
ObjectiveTo introduce a novel automated method for the quantification of the inflamed synovial membrane volume (SV) using magnetic resonance imaging (MRI), and to investigate its feasibility and validity in patients with juvenile idiopathic arthritis (JIA).MethodsThe tool was tested on 58 patients with JIA and wrist involvement. Thirty‐six patients had a 1‐year MRI followup. MRI of the clinically more affected wrist was performed using a 1.5T scanner and a Flex small coil. An algorithmic approach, based on supervised voxel classification for automatic estimation of SV in a 3‐dimensional MRI, was developed. The SV was estimated as the number of positively classified voxels and then normalized by the patient's body surface (NSV). Validation procedures included the analysis of reliability, construct validity, responsiveness to change, discriminant validity, and the predictive value.ResultsThe agreement between the automated estimation of NSV and the manual measurements was excellen...
European Journal of Radiology, 2011
Objective: Traditional methods for assessment of synovial inflammation in rheumatoid arthritis such as clinical examination, immunohistology of bioptic samples, scintigraphy, and radiography have several limitations, including lack of sensitivity, need of invasive techniques, and administration of radioactive material. MRI lacks on standardisation and the data are often analysed using laborious, relatively rigid scoring methods. Materials and methods: This study introduces a standardized computer-aided method for quantitative analysis of MRI of the wrist on a dedicated scanner. Assessment of the synovial inflammation was performed using a semi-automated model-based method in conjunction with patient motion reduction algorithms. Further, the new method was compared with the traditional user-dependent ROI-based technique. Results: The computer-aided technique generated robust and reproducible results. Application of motion reduction algorithms allowed for significant improvements of the signal to noise ratio, which is especially important in the datasets acquired with low-field scanners. Conclusion: The use of the computer software can be beneficial for diagnostic decision in cross sectional as well as longitudinal MRI examinations of the wrist in rheumatoid arthritis.
The Egyptian Journal of Radiology and Nuclear Medicine, 2018
To compare the role of ultrasonography and MRI in the diagnosis of synovitis involving wrist and hand joints in Rheumatoid arthritis patients. Materials and methods: Fifty patients with rheumatoid arthritis involving the wrist were subjected to hand and wrist ultrasonography Doppler and MRI and the results are compared and correlated during the period from December 2015 to January 2017. Results: Ultrasound detected synovial hypertrophy (pannus) in 42 wrist joints while MRI detected it in 46. Power Doppler detected increased vascularity within 30 wrist joints (60%), MRI detected synovial enhancement within 38 (76%). Power Doppler detected synovial activity (vascularity) in MCP joints of 13 patients and MRI detected synovial activity (enhancement) in MCP joints of 9 patients. Ultrasound detected erosions in 35 wrist and 27 MCP joints and MRI detected erosions in 37 wrist and 25 MCP joints. Ultrasound detected tendinitis in 9 extensor tendons and MRI detected tendinitis in 8 tendons. Conclusion: We found a significant correlation between power Doppler ultrasonography and MRI in the detection of signs of inflammation and bone destruction in the wrist and hand joints in rheumatoid arthritis, which raise the potential importance of power Doppler study in the assessment and monitoring of disease activity as a reliable non-invasive method.
European Radiology, 2007
High-resolution MRI of the wrist and finger joints in patients with rheumatoid arthritis: comparison of 1.5 Tesla and 3.0 Tesla Abstract The goal of this study was to compare magnetic resonance (MR) image quality at different field strengths for evaluating lesions in wrist and finger joints of patients with rheumatoid arthritis (RA) in order to determine whether the higher field strength provides diagnostic gain. The hand mainly affected in 17 RA patients was examined at 1.5 Tesla (T) and 3.0 T with comparable MR imaging (MRI) protocols. MR images were reviewed twice by two experienced radiologists using the Rheumatoid Arthritis MRI Scoring System (RAMRIS) of the OMERACT (Outcome Measures in Rheumatoid Arthritis Clinical Trials) group. Image quality was rated on a five-point scale using Friedmann's test and Kendall's W-test for statistical analysis. Image comparison revealed better image quality at higher field strength. Image quality of T1-weighted images was rated 14-22% better at 3.0 T compared with 1.5 T by both readers. Moreover, the rating for the T2weighted-images acquired at 3.0 T was one point better in the five-point scale used. Inter-reader correlation for image quality, bone erosions/defects, edema and synovitis ranged between 0.6 and 0.9 at 3.0 T and between 0.6 and 0.8 at 1.5 T. Intra-reader correlation for these parameters was high at 0.8-1.0. MRI image quality of RA hands is superior at 3.0 T, while an acceptable image quality is achieved at 1.5 T, which improves the evaluation of extent of bone edema, synovitis and identification of small bone erosions.
Rheumatology, 2011
Objective. To test the correlation between assessment of inflammation using dynamic contrast-enhanced MRI (DCE-MRI) analysed by a novel computer-aided approach and semi-quantitative scores of synovitis and bone marrow oedema (BME) using the OMERACT-RA MRI Scoring (RAMRIS) system, in the wrist of patients with RA. Methods. Fifty-four RA patients had conventional and DCE-MRI of a symptomatic wrist using a low-field 0.2T extremity scanner. RAMRIS synovitis and BME of the wrist joint were done. DCE-MRI data were analysed in three ways: (i) in all images (fully automated approach), (ii) within a large extended region of interest (ROI) placed around the wrist joint (semi-automated approach) and (iii) within a small ROI placed in the area with most visual enhancement (semi-automated approach). Time spent on each procedure was noted. Spearman's rank correlation test was applied to assess the correlation between RAMRIS and the computer-generated dynamic parameters. Results. RAMRIS synovitis (range 29), BME (range 039) and the dynamic parameters reflecting the number of enhancing voxels were significantly correlated, especially when an extended ROI around the wrist was used (= 0.74; P < 0.01 for synovitis and = 0.82; P < 0.01 for BME). The observer spent on average 20 min (range 1225 min) to perform RAMRIS, including acquisition of the results in the database, and 8 min (range 710 min) to perform all above-mentioned computer-aided analyses. Conclusion. Computer-aided analysis of DCE-MRI data correlated with RAMRIS synovitis and BME and was twice as fast to perform. This technique may be useful for quick semi-automated assessment of joint inflammation, but needs further validation.
The Journal of rheumatology, 2001
To study magnetic resonance imaging (MRI) features in the wrist and metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints in 4 patient groups: early rheumatoid arthritis (RA) (< 3 yrs); established RA (> 3 yrs); other arthritis; arthralgia. MRI was obtained before and after contrast (gadodiamide) injection of the wrist and finger joints in 103 patients and 7 controls. The study included: (1) 28 patients with disease duration < 3 yrs who fulfilled the American College of Rheumatology (ACR) criteria for RA; (2) 25 patients with RA disease duration > 3 yrs who fulfilled the ACR criteria. (3) 25 patients with reactive arthritis, psoriatic arthritis, or mixed connective tissue disease; and (4) 25 patients with arthralgia. The following MRI variables were assessed: number of joints with enhancement after contrast injection, number of joints with joint fluid, and number of bones with edema in the wrist and fingers. The volume of the ...
ULTRASOUND VERSUS MAGNETIC RESONANCE IMAGING IN RHEUMATOID ARTHRITIS IN WRIST JOINTS AND HAND
ARTICLE INFO ABSTRACT Purpose: the assessment of the extent of damage of hand and wrist joints in rheumatoid arthritis. Material and methods: this prospective study included 25 patients, 20 females 43.48 years±13.64SD. Initial clinical assessment was carried out and Disease Activity Score (DAS28) was used for grading the disease activity; followed by ultrasound and MRI evaluation. Results: assessment of tenosynovitis with 100% sensitivity and specificity as well as synovial effusion (100 % sensitivity, 90% specificity). The least sensitivity was encountered in the detection of bony erosions (sensitivity 21.05%, specificity 100%). Significant correlations were found between US parameters for synovial thickening & bone erosions by MRI and DAS28 score. Yet, no significant correlation was found between synovial thickening by MRI and DAS28 score. Conclusion: changes and disease follow up. MRI is superior in the estimation of the severity of structural bony changes and recommended as the baseline study for proper treatment outcome.