Abstract
BackgroundTo assess diagnostic accuracy of quantitative double-echo in steady-state (qDESS) MRI for detecting synovitis in knee osteoarthritis (OA).MethodsPatients with different degrees of radiographic knee OA were included prospectively. All underwent MRI with both qDESS and contrast-enhanced T1-weighted magnetic resonance imaging (CE-MRI). A linear combination of the two qDESS images can be used to create an image that displays contrast between synovium and the synovial fluid. Synovitis on both qDESS and CE-MRI was assessed semi-quantitatively, using a whole-knee synovitis sum score, indicating no/equivocal, mild, moderate, and severe synovitis. The correlation between sum scores of qDESS and CE-MRI (reference standard) was determined using Spearman’s rank correlation coefficient and intraclass correlation coefficient for absolute agreement. Receiver operating characteristic analysis was performed to assess the diagnostic performance of qDESS for detecting different degrees of synovitis, with CE-MRI as reference standard.ResultsIn the 31 patients included, very strong correlation was found between synovitis sum scores on qDESS and CE-MRI (ρ = 0.96, p < 0.001), with high absolute agreement (0.84 (95%CI 0.14–0.95)). Mean sum score (SD) values on qDESS 5.16 (3.75) were lower than on CE-MRI 7.13 (4.66), indicating systematically underestimated synovitis severity on qDESS. For detecting mild synovitis or higher, high sensitivity and specificity were found for qDESS (1.00 (95%CI 0.80–1.00) and 0.909 (0.571–1.00), respectively). For detecting moderate synovitis or higher, sensitivity and specificity were good (0.727 (95%CI 0.393–0.927) and 1.00 (0.800–1.00), respectively).ConclusionqDESS MRI is able to, however with an underestimation, detect synovitis in patients with knee OA.
Highlights
To assess diagnostic accuracy of quantitative double-echo in steady-state Magnetic resonance imaging (MRI) for detecting synovitis in knee osteoarthritis (OA)
On quantitative double-echo in steady-state (qDESS) MRI, 10 out of 31 patients (32.3%) had no synovitis, 13 (41.9%) had mild synovitis, 8 (25.8%) had moderate synovitis, and none had severe synovitis, when the cutoff values of the whole-joint synovitis sum scores were used as defined by Guermazi et al [24]. qDESS MRI whole-knee sum score showed a mean (SD) of 5.16 (3.75) compared to 7.13 (4.66) for Contrast enhanced (CE)-MRI whole-knee
Representative qDESS and contrast-enhanced T1-weighted magnetic resonance imaging (CE-MRI) images are shown in Figs. 2 and 3
Summary
To assess diagnostic accuracy of quantitative double-echo in steady-state (qDESS) MRI for detecting synovitis in knee osteoarthritis (OA). Joint inflammation, characterized by swelling of the synovium and joint effusion, is believed to be a key process of knee OA in half of all OA patients [2]. Referred to as synovitis, already occurs in early OA [3] and plays an important role in OA symptom perception, with odds ratios (ORs) varying between 3.2 and 10.0 for effusion/synovitis [4, 5]. Synovitis is considered a potential tissue-specific target for novel anti-inflammatory treatments [7]; In addition, synovitis has been suggested as a predictive factor of knee OA progression in worsening of cartilage damage, with accompanying ORs up to 3.11 for progression of pain on a visual analog scale (VAS) after 1 year [8]. As the prominent role of synovitis in OA is increasingly recognized, there is growing interest in identifying OA patients with synovitis by means of imaging for the purpose of personalized prognostication and therapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
