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

Fei Gao,Shun Yu,Mingui Lin,Mingping Ma,Xianyuan Chen

doi:10.1186/s12880-021-00646-9

Fei Gao, Shun Yu + Show 3 more

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https://doi.org/10.1186/s12880-021-00646-9

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Abstract

BackgroundSpA 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.MethodsThis 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.Results1. 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.ConclusionThis 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.

Highlights

SpA (Ankylosing spondylarthritis), belonging to serumnegative spondyloarthritis, is a chronic inflammatory disease which typically affects the sacroiliac joints and the spine
T1 mapping is superior to T2* mapping and T2 mapping in the diagnosis of subchondral Bone marrow edema (BME) of SpA
As the Ankylosing spondylitis disease activity score (ASDAS)-CRP score increased, the degree of sacroiliac joint BME increased and PDWI-fs showed that the signal of bone marrow under sacroiliac joint surface increased in different degrees (Figs. 1a, 2a, 3a)

Summary

Introduction

SpA (Ankylosing spondylarthritis), belonging to serumnegative spondyloarthritis, is a chronic inflammatory disease which typically affects the sacroiliac joints and the spine. BME (Bone marrow edema) of the sacroiliac joint is considered the main imaging marker of this inflammation Such disease is characterized by younger age of onset, high prevalence rate, long course of disease and recurrent disease. In severe cases, it can cause ankylosis of sacroiliac joint and axial spine, which greatly affects living quality and working ability of patients. MR Relaxometry technique was used to quantitatively evaluate the changes of subchondral BME of sacroiliac joint in SpA to provide scientific and effective quantitative indexes for clinical diagnosis, activity staging, curative effect evaluation and monitoring of SpA. 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

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