Magnetic Resonance Imaging Edema Research Articles

W-DRAG: A joint framework of WGAN with data random augmentation optimized for generative networks for bone marrow edema detection in dual energy CT

Dual-energy computed tomography (CT) is an excellent substitute for identifying bone marrow edema in magnetic resonance imaging. However, it is rarely used in practice owing to its low contrast. To overcome this problem, we constructed a framework based on deep learning techniques to screen for diseases using axial bone images and to identify the local positions of bone lesions. To address the limited availability of labeled samples, we developed a new generative adversarial network (GAN) that extends expressions beyond conventional augmentation (CA) methods based on geometric transformations. We theoretically and experimentally determined that combining the concepts of data augmentation optimized for GAN training (DAG) and Wasserstein GAN yields a considerably stable generation of synthetic images and effectively aligns their distribution with that of real images, thereby achieving a high degree of similarity. The classification model was trained using real and synthetic samples. Consequently, the GAN technique used in the diagnostic test had an improved F1 score of approximately 7.8% compared with CA. The final F1 score was 80.24%, and the recall and precision were 84.3% and 88.7%, respectively. The results obtained using the augmented samples outperformed those obtained using pure real samples without augmentation. In addition, we adopted explainable AI techniques that leverage a class activation map (CAM) and principal component analysis to facilitate visual analysis of the network’s results. The framework was designed to suggest an attention map and scattering plot to visually explain the disease predictions of the network.

Does sacroiliitis is a mandatory criterion for enthesitis-related arthritis diagnosis?

Magnetic resonance imaging (MRI) sensitivity and specificity seem to be less studied in enthesitis-related arthritis (ERA). We aimed to determine the ability of sacroiliac MRI to diagnose ERA patients. We conducted a retrospective study including 44 patients with juvenile idiopathic arthritis (JIA). Each patient had a sacroiliac joint MRI. We divided patients into two groups: G1 patients with ERA and G2 patients with non-ERA subtype. ERA was noted in 61% of the cases. Sacroiliac joints were painful in 15 patients (34%). MRI was normal in 25 patients (57%) (G1:11 versus G2:14) and showed bone marrow edema in the sacroiliac joints in 19 patients (34%) (G1=16 versus G2=3, p=0.005). Sacroiliac joints MRI's sensitivity and specificity in the ERA diagnosis were 61.54% and 82.35%, respectively. Positive and negative predictive values were 84.21% and 58.33%, respectively. Furthermore, sacroiliac joint pain in the clinical examination was able to predict sacroiliac bone edema in MRI with an odds ratio of 6.8 (95% CI 1.68-28.09; p=0.006). Our study showed that sacroiliac joint MRI has good specificity and positive predictive value in the diagnosis of ERA patients among JIA patients. This underlines the usefulness of sacroiliac joint MRI in the early diagnosis of ERA patients.

Risk factors for developing calcinosis in juvenile dermatomyositis: subcutaneous and myofascial edema in initial magnetic resonance imaging.

Calcinosis is a sequela of Juvenile Dermatomyositis (JDM) with significant morbidity. A retrospective study observing risk factors for JDM calcinosis, including a possible association between higher intensity of subcutaneous and myofascial edema in initial magnetic resonance imaging (MRI) and development of calcinosis was performed at a tertiary pediatric medical center. Data from the past 20years on JDM patients with MRIs at the time of JDM diagnosis were obtained. MRIs were individually evaluated by two pediatric musculoskeletal radiologists who blindly graded the intensity of edema on a 0-4 Likert scale. Clinical data and edema scores were compared between patients who developed calcinosis and who did not. Forty-three patients (14 with calcinosis and 29 without calcinosis) were identified. The calcinosis group contained more racial and ethnic minorities, younger ages of JDM onset and longer time to reach JDM diagnosis. Muscle enzyme levels at JDM diagnosis were lower in the calcinosis group, especially Creatinine Kinase (CK) (p = 0.047) and Alanine Aminotransferase (ALT) (p = 0.015). The median score for edema in both groups was 3 (p = 0.39) with an inter-rater reliability of 95%. There was no association between increased subcutaneous and myofascial edema in MRIs at the time of JDM diagnosis and development of calcinosis. Earlier age of JDM onset, racial and ethnic minority, and delay in JDM diagnosis could be risks for developing calcinosis. The calcinosis group presented with lower muscle enzyme levels at the time of JDM diagnosis, especially CK and ALT with statistical significance. This could reflect delay in diagnosis and treatment.

The relationship of T2 hypointensity and diffusion restriction of brain metastases with the presence and amount of vasogenic edema in MRI.

Brain metastases are seen in 15-40% of patients diagnosed with cancer. We aimed to search the relationship between the T2 hypointensity, diffusion-weighted imaging characteristics, and the presence and amount of vasogenic edema of brain metastasis in magnetic resonance imaging (MRI). A total of 292 patients with brain metastasis were included in the study. T2 signals of metastatic lesions, accompanying diffusion restriction and perilesional vasogenic edema findings, were investigated. In metastases accompanied by vasogenic edema, the largest dimension of the vasogenic edema-mass complex on T2-weighted sequences and the largest dimension of the mass in contrast-enhanced T1-weighted series were measured and the edema-mass ratio (EMR) was calculated by comparing these two values. The frequency of vasogenic edema was statistically significantly higher in T2 hypointense metastases (89.1% vs 58.8%, χ2 = 18.949, p = <.001) and metastases accompanied by diffusion restriction(81% vs 61.5%, χ2 = 6.971, p = .008). EMR values were found to be statistically significantly higher in T2 hypointense metastases (EMR→ Z = -4.507, p = <.001) and metastases with diffusion restriction(EMR→ Z = -3.819, p = .001). The frequency of vasogenic edema and EMR rates were higher in patients in T2 hypointense metastases and metastases accompanied by diffusion restriction in MRI.

Comparative study of diffuse midline glioma and glioblastoma: Magnetic Resonance Imaging (MRI) in the characteristics and demography

Introduction: Diffuse midline glioma and glioblastoma are classified as grade IV CNS tumors (WHO). The entity ‘diffuse midline glioma, H3 K27 mutant’ was introduced in the 4th revised edition of the 2016 WHO classification of brain tumors; however, there are only a few reports on Magnetic Resonance Imaging of these tumors. Thus, we conducted a retrospective study focused on Magnetic Resonance Imaging features of diffuse midline glioma compared to glioblastoma. This study aims to evaluate and compare the demographic characteristics, anatomic location of lesions, and MRI characteristics of diffuse midline glioma and glioblastoma. Methods: We histologically confirmed 30 patients with diffuse midline glioma and 70 patients with glioblastoma were enrolled in this retrospective study. Pretreatment MRI of each patient was reviewed by a neuroradiology issuing physician and neuroradiology reporting physician for MRI characteristics of tumors. Comparative analysis was performed of the imaging pattern to show differences between diffuse midline glioma and glioblastoma with the p-value. Results: The age of patients with diffuse midline glioma (mean age =24.7 ±10.4) was significantly lower than in those with glioblastoma (mean age =48.2 ±1). The majority of patients with diffuse midline glioma (56.7%) and glioblastoma (51.4%) were ≤ 25 and ≥ 50 years age group respectively. The most common location of diffuse midline glioma and glioblastoma were the thalamus (73.3%) and frontal lobe (37.1%) respectively. The presence of hydrocephalus, edema, and invasion were statistically significantly differences in patients with diffuse midline glioma (hydrocephalus = 46.7%, edema = 53.3%, and invasion =30%) than in those with glioblastoma (hydrocephalus = 12.9%, edema = 88.6%, and invasion =5.7%) (P &lt; 0.05 each). Conclusions: Despite having similar imaging features, diffuse midline glioma exhibited marked differences in age, edema, invasion, and hydrocephalus in MRI compared to Glioblastoma.

Possible Correlation Between Kyphosis of Lumbar Osteoporosis Fractures and the Spinal Signal Intensity Ratio (SSIR).

The aim of this study was to examine the correlation between the risk of increasing kyphosis as well as collapse of the osteoporotic vertebral body fractures and the intensity of the bone edema in magnetic resonance imaging (MRI) scans. Inclusion criteria included the following: age >18 years and osteoporotic vertebral body fracture grade I-IV according to OF classification. Exclusion criteria included the following: other pathological fractures due to primary tumors or metastasis, OF grade V fractures, and AO type B or C fractures. This was a retrospective study from pseudonymized data of a tertiary spine center. No additional imaging were performed. Measurements of bisegmental kyphosis angle of the fracture for involvement of both endplates and monosegmental angle for involvement of 1 endplate, as well as vertebral body height loss in initial radiographs and at follow-ups after 3 and 6 months have been performed. Also, the initial signal intensity of the vertebral body edema was measured using integrated tool of the DICOM viewer (Impax V6.5 Agfa, Brentford, UK) in addition to the signal intensity of the cerebrospinal fluid (CSF) as reference for T1, T2, and separate target illumination radar (STIR) sequences of the MRI scans. A quotient from the signal intensity of the vertebral body edema and the reference (CSF) has been generated. Patients have been divided to 4 groups according to the ratio (<1, 1-2, 2-3, >3) and compared in regards to the results of the degree of kyphosis and vertebral collapse at follow-ups and final examination. The statistical analysis was performed using linear regression using statistic software SPSS version 26. Forty-four patients have been included: 9 males and 35 females with an average age of 71.5 years. The analysis showed a significant correlation between the increasing kyphosis at follow-ups and the quotient of the signal intensity for STIR and T2 weighing with P = .002 (SD ±2.664) for STIR and P = .001 (SD ±1.616) for T2 sequences. Furthermore, there was only a correlation between the intensity ratio and kyphosis for STIR weighting at last examination (P = .017; SD ±1.360). There was no correlation between the height loss and the signal intensity. Level 2.

Vertebral bone marrow edema in magnetic resonance imaging correlates with bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture.

BME on MRI has become the gold standard for the diagnosis of acute/subacute OVCF, but the correlation between the quantitative model of BME and histopathological manifestations of OVCF is rarely discussed in the literature. This study aimed to retrospectively investigate the relationship between bone marrow edema (BME) in magnetic resonance imaging (MRI) and bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture. According to the period since fracture, 125 patients were divided into four stages: stage I (0 to 15days), stage II (16 to 30days), stage III (31 to 60days) and stage IV (61 to 90days). Bone marrow edema was evaluated by the signal changes and intensity patterns on MRI sagittal images. Decalcified biopsy specimens were obtained from the cancellous bone core in the fractured vertebral body. The histomorphometry study results were analyzed by light microscopy using grid analysis and defined using bone histomorphometry criteria. There were 70 (56%) patients in stage I, 29 (23.2%) in stage II, 12 (9.6%) in stage III and 14 (11.2%) in stage IV. BME and histomorphometry characteristics differentiated from each other stage: The BME percentage had a significantly negative correlation with the ratio of osteoid volume/bone volume (r = - 0.539, p = 0.001) and the ratio of woven bone volume/tissue volume (r = - 0.584, p = 0.001). There was also a positive correlation between the BME percentage and the ratio of fibrous tissue volume/tissue volume (r = 0.488, p = 0.001). Bone marrow edema significantly correlates with bone morphology parameters after vertebral fracture. The characteristics of histomorphological changes during fracture healing process can be preliminarily determined by observing the edema signal.

Peritumoral edema in preoperative magnetic resonance imaging is an independent prognostic factor for hepatocellular carcinoma

BackgroundPeritumoral edema is an independent prognostic risk factor for malignant tumors. Therefore, assessment of peritumoral edema in preoperative magnetic resonance imaging (MRI) may provide better prognostic information in patients with hepatocellular carcinoma (HCC). AimTo determine whether peritumoral edema in preoperative MRI is a prognostic factor for HCC. MethodsA retrospective analysis of 90 patients with HCC confirmed by surgical pathology was performed. All patients' peritumoral edema in preoperative MRI was reviewed by two radiologists. The association of disease recurrence with peritumoral edema and clinicopathological features was assessed using the Cox proportional hazards model. Interobserver agreement for evaluating peritumoral edema was determined using Cohen's κ coefficient. ResultsRecurrence and non-recurrence after an average 20.8 month follow-up was 25.6% (23/90) and 74.4% (67/90), respectively. The ratio of peritumoral edema of 90 patients with HCC in preoperative MRI was 35.6% (32/90). In univariate Cox regression analysis, peritumoral edema [hazard ratio (HR) 11.08, P < 0.001], tumor diameter (HR 4.12, P = 0.001), microvascular invasion (HR 2.78, P = 0.020), gender (HR 0.29, P = 0.006), cirrhosis (HR 2.45, P = 0.049), ascites syndrome (HR 2.83, P = 0.022), aspartate aminotransferase(AST)/alanine aminotransferase(ALT) (HR 5.07, P = 0.003) were indicators for HCC recurrence. In multivariate Cox regression analysis, the tumor diameter (HR 2.53, P = 0.032) and peritumoral edema (HR 8.71, P < 0.001) were independent prognostic factors of HCC. The sensitivity, specificity, positive predictive value and negative predictive value of peritumoral edema and tumor diameter were 82.6%&60.9%, 80.6%&77.6%, 59.4%&48.3%, and 93.1%&85.3%, respectively. ConclusionPeritumoral edema in preoperative MRI may be considered as a biomarker of prognostic information for patients with HCC.

Effect of methylprednisolone on experimental brain edema in magnetic resonance imaging.

Magnetic resonance imaging has been used for evaluating of a brain edema in experimental animals to assess cytotoxic and vasogenic edema by the apparent diffusion coefficient (ADC) and T2 imaging. This paper brings information about the effectiveness of methylprednisolone (MP) on experimental brain edema. A total of 24 rats were divided into three groups of 8 animals each. Rats with cytotoxic/intracellular brain edema induced by water intoxication were assigned to the group WI. These rats also served as the additional control group CG when measured before the induction of edema. A third group (WIMP) was intraperitoneally administered with methylprednisolone 100 mg/kg during water intoxication treatment. The group WI+MP was injected with methylprednisolone 50 mg/kg into the carotid artery within two hours after the water intoxication treatment. We evaluated the results in four groups. Two control groups (CG, WI) and two experimental groups (WIMP, WI+MP). Rats were subjected to MR scanning 24 h after edema induction. We observed significantly increased ADC values in group WI in both evaluated areas - cortex and hippocampus, which proved the occurrence of experimental vasogenic edema, while ADC values in groups WIMP and WI+MP were not increased, indicating that the experimental edema was not developed and thus confirming the protective effect of MP.

Benign bone tumors of hand and wrist: evaluation of diagnosis and treatment

Objectives This study aims to investigate the choice of graft or cement, the relationship between the graft types and union rates, functional results, and complications in hand and wrist benign bone lesions while also evaluating the diagnosis and treatment modalities of lesions with high recurrence potential like giant cell- containing lesions.Patients and methods Between September 2005 and May 2016, 48 benign osseous hand and wrist tumors of 48 patients (22 males, 26 females; mean age 33±13.1 years; range, 11 to 70 years) were reviewed retrospectively. Patients were evaluated according to demographic data, complaints at admission, radiological findings, surgical methods, graft type, pathological diagnosis, and complications.Results Although not statistically significant, there were differences between cement, allograft, and autograft according to union time and loss of range of motion. There was no statistical difference between cement, allograft, and autograft according to complications.ConclusionAutograft obtained percutaneously with a trephine needle may provide earlier union with minimal donor site morbidity. Wide resection and reconstruction options should be kept in mind in giant cell-containing tumors. Further investigations are needed about the relationship between soft tissue edema in magnetic resonance imaging and the recurrence risk in hand and wrist benign bone tumors.

Prevalence of bone marrow edema in a study population with foot and/or ankle pain

Bone marrow edema (BME) is an imaging diagnosis defined by an abnormal accumulation of intraosseous interstitial fluid within a bone on magnetic resonance imaging (MRI) investigation. The aim of this study was to determine the prevalence of BME in patients with foot and/or ankle pain studied using MRI. This was a retrospective observational work on patient cases and controls studied through MRI of the foot and/or ankle at our Foot and Ankle Unit (FAU). An analytical statistical analysis and a multivariate analysis were performed to eliminate possible confounding factors. 1950 foot and/or ankle MRI cases were reviewed, of which 451 presented bone edema (23% prevalence). The average patient age was 51.8 (range, 7–87); the talus bone was most frequently affected: post-traumatic in 43.5% of cases, degenerative in 34.7% and there was no specific cause identified in 6.3% (these cases were termed ‘idiopathic’). With regards to risk factors, in the case of gender, the odds ratio (OR) of men suffering bone oedema was 1.5 times higher than that of women (P = 0.003); for immunosuppression the OR was 3.4 times higher (P = 0.001); while among those with a smoking habit it was 0.59 (P = 0.001), meaning that after ruling smoking out as a possible confounding factor, it was, in fact, revealed to be a protective factor. The prevalence of bone edema in MRI in patients with foot and/or ankle pain was 23%. The average patient was male, aged approximately 50, with traumatic or degenerative origin talus bone oedema.Level of Evidence: Level IV, revision observational study.

Hamstring Injuries in Professional Soccer Players: Extent of MRI-Detected Edema and the Time to Return to Play.

Background:Discrepancies exist in the literature regarding the association of the extent of injuries assessed on magnetic resonance imaging (MRI) with recovery times.Hypothesis:MRI-detected edema in grade 1 hamstring injuries does not affect the return to play (RTP).Study Design:Retrospective cohort study.Level of Evidence:Level 4.Methods:Grade 1 hamstring injuries from 22 professional soccer players were retrospectively reviewed. The extent of edema-like changes on fluid-sensitive sequences from 1.5-T MRI were evaluated using craniocaudal length, percentage of cross-sectional area, and volume. The time needed to RTP was the outcome. Negative binomial regression analysis tested the measurements of MRI-detected edema-like changes as prognostic factors.Results:The mean craniocaudal length was 7.6 cm (SD, 4.9 cm; range, 0.9-19.1 cm), the mean percentage of cross-sectional area was 23.6% (SD, 20%; range, 4.4%-89.6%), and the mean volume was 33.1 cm3 (SD, 42.6 cm3; range, 1.1-161.3 cm3). The mean time needed to RTP was 13.6 days (SD, 8.9 days; range, 3-32 days). None of the parameters of extent was associated with RTP.Conclusion:The extent of MRI edema in hamstring injuries does not have prognostic value.Clinical Relevance:Measuring the extent of edema in hamstring injuries using MRI does not add prognostic value in clinical practice.

Pulmonary edema measured by MRI correlates with late-phase response to allergen challenge

ABSTRACTPurpose: Asthma is associated with reversible airway obstruction, leucocyte infiltration, airways hyperresponsiveness (AHR), and airways remodeling. Fluid accumulation causes pulmonary edema contributing to airways obstruction. We examined the temporal relationship between the late asthmatic response (LAR) following allergen challenge of sensitized guinea-pigs and pulmonary edema measured by magnetic resonance imaging (MRI). Materials and Methods: Ovalbumin (OVA) sensitized guinea-pigs received either a single OVA inhalation (acute) or nine OVA inhalations at 48 h intervals (chronic). Airways obstruction was measured as specific airways conductance (sGaw) by whole body plethysmography. AHR to inhaled histamine and bronchoalveolar lavage for leucocyte counts were measured 24 h after a single or the final chronic ovalbumin challenges. MRI was performed at intervals after OVA challenge and high-intensity edemic signals were quantified. Results: Ovalbumin caused early bronchoconstriction, followed at 7 h by an LAR and at 24 h AHR and leucocyte influx. The bright-intensity MRI edema signal, peaking at 7 h, was significantly (P < .05) greater after chronic (9.0 ± 0.7 × 103 mm3) than acute OVA (7.6 ± 0.2 × 103 mm3). Dexamethasone treatment before acute OVA abolished the AHR and LAR and significantly reduced eosinophils and the bright-intensity MRI edema from 9.1 ± 1.0 to 6.4 ± 0.3 × 103 mm3. Conclusion: We show a temporal relationship between edema and the LAR and their parallel reduction, along with eosinophils and AHR, by dexamethasone. This suggests a close causative association between pulmonary edema and impaired airways function.

Vasoactive Intestinal Peptide in Early Spondyloarthritis: Low Serum Levels as a Potential Biomarker for Disease Severity.

Spondyloarthritis (SpA) is a family of inflammatory diseases sharing clinical, genetic, and radiological features. While crucial for tailoring early interventions, validated prognostic biomarkers are scarce in SpA. We analyze the correlation between serum levels of vasoactive intestinal peptide (VIP) and disease activity/severity in patients with early chronic inflammatory back pain. The study population comprised 54 patients enrolled in our early chronic inflammatory back pain register. We collected demographic information, clinical data, laboratory data, and imaging findings. VIP levels were measured by enzyme immunoassay in serum samples from 162 visits. The association between independent variables and VIP levels was analyzed using longitudinal multivariate analysis nested by patient and visit. No significant differences were observed in VIP levels between these two groups. Lower levels of VIP were significantly associated with a higher Bath Ankylosing Spondylitis Disease Activity Index (BASFI) score, presence of bone edema in magnetic resonance imaging (MRI) scan, and lower hemoglobin levels. Coexistence of cutaneous psoriasis was independently associated with lower VIP levels, and similar trend was observed for enthesitis. We conclude that SpA patients with low serum VIP levels had worse 2-year disease outcome, suggesting that serum VIP levels could be a valid prognostic biomarker.

The assessment of edema in magnetic resonance imaging in patients with acute myocardial infarction

Purpose: The assessment of myocardial edema provides diagnostic and prognostic information in patients with acute myocardial infarction. The presence of myocardial edema can be visualized in magnetic resonance imaging (MRI) by commonly used T2-weighted sequences - Turbo Inversion Recovery with Magnitude Display (T2-TIRM). Diffusion Weighted Imaging (DWI) is a new sequence used in myocardial imaging with a potential clinical utility. The aim of this study was to compare two methods of myocardial edema imaging: DWI and T2-TIRM. Methods: The study group consist of 91 patients, aged 35-84 years (77% men): 71 patients with ST-segment elevation myocardial infarction (STEMI), and control group 20 patients with chronic myocardial infarction. MRI was performed within 7 days in patients with STEMI and in control group six months after STEMI with use of standard protocol. Based on the frequency of an increased signal detection associated with an edema in STEMI group and control group, the sensitivity and specificity of T2-TIRM and DWI was determined. The presence of edema in STEMI group was correlated with infarct related artery (LAD, LCX, RCA). Results: The edema was visualized in STEMI group in 83,1% patients when DWI sequence was used compare to 60,6% patients in T2-TIRM. A statistically significant difference in visualization of the edema was observed between both methods in inferior-STEMI patients (85% vs 46%, p=0,0002). Tab.1. View this table: Table 1. The presence of the edema Conclusion: Diffusion Weighted Imaging is a new method of myocardial edema imaging. DWI shows a higher sensitivity in the detection of myocardial edema than commonly used T2-TIRM. In contrast to the T2-TIRM, the sensitivity of the DWI sequence does not depend on the infarct location.

Correlation of MRI Edema and Clinical Outcomes Following Microfracture of Osteochondral Lesions of the Talus

Magnetic resonance imaging (MRI) is an accurate, noninvasive method used to assess healing of osteochondral lesions postoperatively. The purpose of the current study was to evaluate the presence of postoperative edema on MRI following osteochondral lesion of the talus (OLT) drilling and to correlate MRI findings with clinical outcome. A retrospective chart and MRI review was performed on all OLTs treated by arthroscopic drilling or microfracture. A musculoskeletal radiologist reviewed MRIs performed at a minimum of 9 months postoperatively and the amount of edema present at OLT drilling site was graded. MRI findings were correlated with clinical outcome. A total of 29 patients with 30 OLTs were included. The average patient age at the time of surgery was 31.9 years (range = 13-52 years, SD = 11.87). The average time from arthroscopic drilling to MRI was 81.47 weeks (range 36-242 weeks, SD = 51.31). The intensity of edema was classified as none, mild, moderate, or severe based on MRI findings. Those patients with a moderate or severe edema intensity had inferior clinical outcomes (P = .011). The presence of edema on MRI following drilling of OLTs may be a valuable predictor of clinical outcome, with those patients with greater edema intensity having inferior clinical outcomes.

Cartilage Oligomeric Matrix Protein Associates Differentially with Erosions and Synovitis and Has a Different Temporal Course in Cyclic Citrullinated Peptide Antibody (Anti-CCP)-positive versus Anti-CCP-negative Early Rheumatoid Arthritis

Cyclic citrullinated peptide antibody (anti-CCP)-positive and anti-CCP-negative rheumatoid arthritis (RA) have been suggested as 2 distinctive disease subsets with respect to disease activity and prognosis. Previously, we proposed that anti-CCP antibodies might have a chondrocyte-suppressive effect. We aimed to compare circulating cartilage oligomeric matrix protein (COMP), a marker of cartilage turnover, in untreated anti-CCP-positive and anti-CCP-negative RA, and to study the temporal pattern of COMP through 4 years of treatment, including the relationship to imaging and clinical findings. A total of 160 patients with newly diagnosed RA who were naive to disease-modifying antirheumatic drugs were included in the CIMESTRA trial. Ninety healthy blood donors served as controls. Demographic and disease measures including Disease Activity Score in 28 joints, IgM rheumatoid factor, anti-CCP, Health Assessment Questionnaire, visual analog scale scores for pain and global and physician assessment, and magnetic resonance imaging (MRI) of the nondominant hand were recorded at baseline. COMP in serum was measured by ELISA at inclusion and serially through 4 years. Median baseline COMP was higher in patients with RA [9.8 U/l (interquartile range 8.96, 10.5)] compared with controls [8.3 U/l (IQR 7.84, 8.9); p < 0.001] and remained elevated at 4 years [10.8 U/l (IQR 10.2, 11.7); p < 0.001]. At baseline, anti-CCP-positive patients had lower COMP than anti-CCP-negative patients (p = 0.048). In anti-CCP-positive patients, COMP exhibited a parabolic course over 4 years, while COMP in anti-CCP-negative patients had an almost linear course. In anti-CCP-positive patients, COMP was associated with MRI edema and erosion score, while COMP was correlated with synovitis score in anti-CCP-negative individuals. Our study provides additional evidence for the existence of different disease pathways in anti-CCP-positive and anti-CCP-negative subsets of RA, and evidence that anti-CCP antibodies may be implicated in the disease process by modifying cartilage metabolism.

Significance of Clinical Evaluation of the Metacarpophalangeal Joint in Relation to Synovial/Bone Pathology in Rheumatoid and Psoriatic Arthritis Detected by Magnetic Resonance Imaging

Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard. MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher's exact tests (p < 0.05 considered statistically significant). Interrater agreement was highest for visual assessment of swelling (kappa = 0.55-0.63), slight-fair for assessment of swelling by palpation (kappa = 0.19-0.41), and moderate (kappa = 0.41-0.58) for assessment of joint tenderness. In patients with RA, TJC, stress pain, and visual swelling assessment were strongly associated with MRI evaluation of synovitis. Visual swelling assessment demonstrated high specificity (> 0.8) and positive predictive value (= 0.8). For PsA, significant associations exist between TJC and MRI synovitis scores (p < 0.01) and stress pain and MRI edema scores (p < 0.04). Assessment of swelling by palpation was not significantly associated with synovitis or edema as determined by MRI in RA or PsA (p = 0.54-1.0). In inflammatory arthritis, disease activity in MCP joints can be reliably assessed at the bedside by examining for joint-line tenderness (TJC) and visual inspection for swelling. Clinical assessment may have to be complemented by other methods for evaluating disease activity in the joint, such as MRI, particularly in patients with PsA.

The T- and L-Type Calcium Channel Blocker (CCB) Mibefradil Attenuates Leg Edema Induced by the L-Type CCB Nifedipine in the Spontaneously Hypertensive Rat: A Novel Differentiating Assay

Among the L-type calcium channel blockers (CCBs), particularly dihydropyridines like nifedipine [1,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinedicarboxylic acid dimethyl ester], a common adverse effect is vasodilatory edema. Newer CCBs, such as the T- and L-type CCB, mibefradil [(1S,2S)-2-[2[[3-(2-benzimidazolylpropyl]methylamino]ethyl]-6-fluoro-1,2,3,4-tetrahydro-1-isopropyl-2-naphthyl methoxyacetate dihydrochloride hydrate], demonstrate antihypertensive efficacy similar to that of their predecessors but seem to have a reduced propensity to cause edema. Using a magnetic resonance imaging (MRI) T(2) mapping technique, we investigated the ability of mibefradil to reduce extracellular water accumulation caused by the L-type CCB, nifedipine, in the hindleg skeletal muscle of the spontaneously hypertensive rat. Mibefradil (10 mg/kg i.v.) and nifedipine (1 mg/kg i.v.) lowered mean arterial blood pressure by 97 +/- 5 and 77 +/- 4 mm Hg, respectively. MRI edema index (expressed as percentage increase of integral T(2) over predrug control) was significantly higher with nifedipine (2606 +/- 86%; p < 0.05) than with mibefradil (981 +/- 171%) measured 30 to 60 min after the start of drug infusion. The hindleg edema caused by nifedipine was dose dependently decreased by coadministration of mibefradil (0, 0.3, or 3 mg/kg). The hindleg edema formation was not due to albumin leakage into the interstitial space based on immunostaining. However, a 4.2-fold increase in the arterial L-/T-type CC mRNA expression ratio was observed compared with the venous L/T ratio as shown by quantitative reverse transcription polymerase chain reaction. These results demonstrate the novel utility of MRI to measure extravascular water after acute exposure to CCBs and indicate that T-type CCB activity may reduce L-type CCB-induced vasodilatory edema in the skeletal muscle vasculature, possibly by a differential effect on arteriole and venule dilatation.

Pubic Magnetic Resonance Imaging Findings in Surgically and Conservatively Treated Athletes with Osteitis Pubis Compared to Asymptomatic Athletes during Heavy Training

Background Osteitis pubis is characterized by diffuse pain, inflammation, and bony changes in the pubic symphysis. Bone marrow edema in magnetic resonance imaging is associated with stress injury and osteitis of the pubic bone. Hypothesis Laparoscopic mesh repair decreases inflammation and pain in the pubic periosteum. The presence of extensive bone marrow edema may correlate with the severity of symptoms and may guide the surgical treatment of osteitis pubis. Study Design Case control study; Level of evidence, 4. Methods Surgery (n = 8) was performed by placement of totally extraperitoneal endoscopic mesh behind the symphysis. Nonoperative treatment (n = 8) included physical therapy and corticosteroids. Preoperative and postoperative pain was measured by the visual analog scale. Athletes were followed up from 1 to 6 years (mean, 2.7 years). All magnetic resonance imaging scans were analyzed blindly by 2 radiologists. Twenty asymptomatic ice hockey or soccer players served as controls in magnetic resonance imaging. Results The patients treated surgically had higher preoperative pain scores than did the patients treated conservatively. Seven of 8 athletes (88%) treated surgically returned to sport activities after 2 months of convalescence. No complications were associated with surgery. In the nonoperative group, 4 patients (50%) still had disabling symptoms after 1 year of follow-up, and they stopped their elite sports during 3 years of follow-up. The presence of bone marrow edema was distributed in the surgical (100%), nonoperative (88%), and asymptomatic athletes (65%) with no statistical difference between the groups. Conclusion This study indicated that the placement of retropubic mesh was an efficient method for the treatment of severe pubic enthesopathy in athletes. Abnormal magnetic resonance imaging findings were also common in asymptomatic athletes, which decreases the value of magnetic resonance imaging in surgical decision-making.