Abstract
ObjectiveTo evaluate the performance of dynamic contrast-enhanced CT (DCE-CT) in detecting and quantitatively assessing perfusion parameters in patients with arthritis of the hand compared with dynamic contrast-enhanced MRI (DCE-MRI) as a standard of reference.Materials and methodsIn this IRB-approved randomized prospective single-centre study, 36 consecutive patients with suspected rheumatoid arthritis underwent DCE-CT (320-row, tube voltage 80 kVp, tube current 8.25 mAs) and DCE-MRI (1.5 T) of the hand. Perfusion maps were calculated separately for mean transit time (MTT), time to peak (TTP), relative blood volume (rBV), and relative blood flow (rBF) using four different decomposition techniques. Region of interest (ROI) analysis was performed in metacarpophalangeal joints II–V and in the wrist. Pairs of perfusion parameters in DCE-CT and DCE-MRI were compared using a two-tailed t test for paired samples and interpreted for effect size (Cohen’s d). According to the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) scoring results, differentiation of synovitis-positive and synovitis-negative joints with both modalities was assessed with the independent t test.ResultsThe two modalities yielded similar perfusion parameters. Identified differences had small effects (d 0.01–0.4). DCE-CT additionally differentiates inflamed and noninflamed joints based on rBF and rBV but tends to underestimate these parameters in severe inflammation. The total dose-length product (DLP) was 48 mGy*cm with an estimated effective dose of 0.038 mSv.ConclusionDCE-CT is a promising imaging technique in arthritis. In patients with a contraindication to MRI or when MRI is not available, DCE-CT is a suitable alternative to detect and assess arthritis.
Highlights
The early detection of inflammatory changes such as synovitis is crucial to prevent the development of structural changes and bone destruction such as erosions [1]
The total dose-length product (DLP) was 48 mGy*cm, resulting in an estimated effective dose of 0.038 mSv. This is the first study investigating the innovative technique of low-dose Dynamic contrast-enhanced computed tomography (DCE-computed tomography (CT)) for the assessment of synovitis of the hand in patients with active arthritis using four different decomposition techniques
We show that DCE-CT is able to differentiate between inflamed and noninflamed joints and between the different grades of the semi-quantitative Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) synovitis scores with no major differences between the four decomposition techniques studied
Summary
The early detection of inflammatory changes such as synovitis is crucial to prevent the development of structural changes and bone destruction such as erosions [1]. A comprehensive evaluation of inflammatory activity in rheumatic joint diseases is possible [6,7,8]. With dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), it has become possible to evaluate synovitis and disease activity with sufficient accuracy [9] to Skeletal Radiol quantify the response to therapy in research studies. Dynamic contrast-enhanced computed tomography (DCE-CT) has the potential to provide a differentiated estimation of inflammatory joint lesions through the assessment of perfusion parameters. It offers the superior detection of structural changes intrinsic to CT [14,15,16]. The use of DCE-CT in clinical practice has become feasible due to dose reduction with low-kVp scanning protocols and the introduction of iterative reconstruction algorithms in recent years [17, 18]
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