MRI Synovitis Score Research Articles

T1\u03c1-mapping for assessing knee joint cartilage in children with juvenile idiopathic arthritis \u2014 feasibility and repeatability

BackgroundOngoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage.ObjectiveTo study the feasibility and repeatability of T1ρ for assessing knee cartilage in JIA and also to describe T1ρ values and study correlation between T1ρ and conventional MRI scores for disease activity.Materials and methodsThirteen children with JIA or suspected JIA underwent 3-tesla (T) knee MRI that included conventional sequences and a T1ρ sequence. Segmentation of knee cartilage was carried out on T1ρ images. We used intraclass correlation coefficient to study the repeatability of segmentation in a subset of five children. We used the juvenile arthritis MRI scoring system to discriminate inflamed from non-inflamed knees. The Mann-Whitney U and Spearman correlation compared T1ρ between children with and without arthritis on MRI and correlated T1ρ with the juvenile arthritis MRI score.ResultsAll children successfully completed the MRI examination. No images were excluded because of poor quality. Repeatability of T1ρ measurement had an intraclass correlation coefficient (ICC) of 0.99 (P<0.001). We observed no structural cartilage damage and found no differences in T1ρ between children with (n=7) and without (n=6) inflamed knees (37.8 ms vs. 31.7 ms, P=0.20). However, we observed a moderate correlation between T1ρ values and the juvenile arthritis MRI synovitis score (r=0.59, P=0.04).ConclusionThis pilot study suggests that T1ρ is a feasible and repeatable quantitative imaging technique in children. T1ρ values were associated with the juvenile arthritis MRI synovitis score.

Six-month prospective trial in early and long-standing rheumatoid arthritis: evaluating disease activity in the wrist through sequential synovial histopathological analysis, RAMRIS magnetic resonance score and EULAR-OMERACT ultrasound score

IntroductionStandardised scoring systems for rheumatoid arthritis (RA) joint disease activity include Larsen score for radiographs, rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for MRI and using the European League Against...

Frondlike Synovitis on MRI and Correlation With Polyethylene Surface Damage of Total Knee Arthroplasty

The purpose of this study is to determine the association between polyethylene surface damage and the severity of frondlike hypertrophied synovitis, joint distention, capsular thickness, and osteolysis on MRI compared with other patient factors. Another goal of this study is to ascertain the interobserver reliability in MRI evaluation of synovitis. MR images of 61 patients who had undergone revision total knee arthroplasty (TKA) were retrospectively reviewed. The two MRI reviewers were blinded to clinical and retrieval data. The retrieved polyethylene tibial inserts were graded to determine the severity of surface damage. The association of MRI features with surface damage was assessed using Spearman correlation coefficients and multiple linear regression. Interobserver reliability was assessed using the kappa statistic. Correlations were moderate between the surface damage score and MRI synovitis severity (r = 0.46; p < 0.001) and joint distention (r = 0.41; p = 0.001). Multiple linear regression showed that the MRI synovitis score (p = 0.045), male sex (p = 0.007), body mass index (p = 0.041), and the time since implantation (p < 0.0001) predicted the surface damage score. Substantial interobserver agreement was shown for MRI grading of synovitis (κ = 0.72; 95% CI, 0.65-0.80). The magnitude of frondlike hypertrophied synovitis on MRI is significantly associated with polyethylene surface damage in patients who undergo revision TKA. The finding of severe frondlike synovitis on MR images of patients with TKA should raise the possibility of polyethylene surface damage. However, time since implantation is a stronger predictor of surface damage.

Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique

ObjectivesIn rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive...

MRI assessment of early response to certolizumab pegol in rheumatoid arthritis: a randomised, double-blind, placebo-controlled phase IIIb study applying MRI at weeks 0, 1, 2, 4, 8 and 16

ObjectivesTo identify the first time point of an MRI-verified response to certolizumab pegol (CZP) therapy in patients with rheumatoid arthritis (RA).MethodsForty-one patients with active RA despite disease-modifying antirheumatic drug therapy...

SAT0046 Extensive MRI Osteitis is Associated with RAPID Radiographic Progression in Early but not Advanced Rheumatoid Arthritis

BackgroundPredictor for rapid radiographic progression (RRP) is still unknown. It has been reported that MRI osteitis is a strong independent predictor for radiographic joint damage (RJD) especially in early rheumatoid...

FRI0042 Validation of A Multi-Biomarker Disease Activity Score in Rheumatoid Arthritis in Relation to Imaging Inflammation and Damage

BackgroundA multi-biomarker disease activity (MBDA) score has been validated as a measure of disease activity in rheumatoid arthritis (RA).ObjectivesThis study aimed to further validate the MBDA score in relation to...

Degree of synovitis on MRI by comprehensive whole knee semi-quantitative scoring method correlates with histologic and macroscopic features of synovial tissue inflammation in knee osteoarthritis

To evaluate the association between synovitis on contrast enhanced (CE) MRI with microscopic and macroscopic features of synovial tissue inflammation. Forty-one patients (mean age 60 years, 61% women) with symptomatic radiographic knee OA were studied: twenty underwent arthroscopy (macroscopic features were scored (0-4), synovial biopsies obtained), twenty-one underwent arthroplasty (synovial tissues were collected). After haematoxylin and eosin staining, the lining cell layer, synovial stroma and inflammatory infiltrate of synovial tissues were scored (0-3). T1-weighted CE-MRI's (3 T) were used to semi-quantitatively score synovitis at 11 sites (0-22) according to Guermazi et al. Spearman's rank correlations were calculated. The mean (SD) MRI synovitis score was 8.0 (3.7) and the total histology grade was 2.5 (1.6). Median (range) scores of macroscopic features were 2 (1-3) for neovascularization, 1 (0-3) for hyperplasia, 2 (0-4) for villi and 2 (0-3) for fibrin deposits. The MRI synovitis score was significantly correlated with total histology grade [r = 0.6], as well as with lining cell layer [r = 0.4], stroma [r = 0.3] and inflammatory infiltrate [r = 0.5] grades. Moreover, MRI synovitis score was also significantly correlated with macroscopic neovascularization [r = 0.6], hyperplasia [r = 0.6] and villi [r = 0.6], but not with fibrin [r = 0.3]. Synovitis severity on CE-MRI assessed by a new whole knee scoring system by Guermazi et al. is a valid, non-invasive method to determine synovitis as it is significantly correlated with both macroscopic and microscopic features of synovitis in knee OA patients.

FRI0303 Degree of synovitis on MRI is correlated with histological and macroscopic features of synovial tissue inflammation in knee osteoarthritis

BackgroundSynovitis is often present on MRI of OA knees and is an important determinant of pain.ObjectivesTo evaluate the association between synovitis at contrast enhanced (CE) MRI with microscopic and macroscopic...

SAT0486 Early MRI Measures Independently Predict 1- and 2- Year X-Ray Progression: Results from a Large Clinical Trial

ObjectivesEarly predictors of progression in structural joint damage in RA are lacking. We evaluated if early MRI measures of inflammation & erosion at baseline (BL), 12 & 24wks could predict...

THU0083 NF-KB-Inducing Kinase (NIK) Expression in Synovial Blood Vessels Correlates with Systemic Markers of Inflammation and Local Disease Activity in Early Arthritis Patients, but is not Disease Specific

BackgroundThe NF-κB family of transcription factors is strongly involved in synovial inflammation. We have previously shown that NF-κB-inducing kinase (NIK) is a key regulator of inflammation-induced angiogenesis in rheumatoid arthritis...

Peripheral joint inflammation in early onset spondyloarthritis is not specifically related to enthesitis

ObjectivesA pivotal MRI study of knee arthritis indicated that enthesitis was more frequently observed in established spondyloartritis (SpA) than rheumatoid arthritis (RA). Subsequent MRI and ultrasound studies, however, failed to...

MRI versus conventional measures of disease activity and structural damage in evaluating treatment efficacy in juvenile idiopathic arthritis

ObjectiveTo compare the American College of Rheumatology paediatric (ACRp) response criteria and conventional radiography with MRI findings in a cohort of patients with juvenile idiopathic arthritis.MethodsForty consecutive patients (30 girls,...

Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis: impact of joint area, repeated injections, MRI findings, anti-CCP, IgM-RF and CRP

ObjectiveTo investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor...

Comparing non-enhanced and enhanced sequences in the assessment of effusion and synovitis in knee OA: associations with clinical, macroscopic and microscopic features

The purpose of this study was to evaluate synovial membrane (SM) inflammation and joint effusion scores by semiquantitative magnetic resonance imaging (MRI) assessment with and without enhanced sequences. Gold standards used for comparison were microscopic examination of SM biopsies for SM inflammation and joint volume measurement (JVM) after arthrocentesis for effusion. Patients (n=30) fulfilling ACR criteria for knee osteoarthritis (OA) and requiring joint lavage, were evaluated with MRI: (1) SM inflammation was assessed by Whole-Organ Magnetic Resonance Imaging Score (WORMS) on T2 weighted sequences (T2w) a composite score assessing together synovitis and effusion, and the MRI-synovitis score (based on synovitis thickening in five regions of interest) on a T1-weighted fat sat sequence after contrast agent injection (T1wCE). (2) Joint effusion was evaluated by MRI-effusion score (T1wCE) and the WORMS (T2w). JVM was measured after arthrocentesis, and microscopic SM inflammation was determined in SM samples (n=86). Correlations between MRI scores and clinical, biologic and histologic parameters were studied. Both scores for effusion were well correlated [r=0.82 (0.65-0.91); P<0.001] and presented excellent intraclass correlation coefficient (ICC) for intra- and inter-observer reproducibility. MRI scores for effusion were well correlated with JVM (r=0.60 for WORMS and r=0.59 for MRI-effusion score). Synovitis scores were highly reproducible but moderately correlated (r=0.63; P<0.001). Only MRI-synovitis total score (T1wCE) was correlated with SM microscopic inflammation (r=0.46; P=0.01) and most strongly infiltration (r=0.45; P<0.005). T2w sequences are adequate in assessing effusion volume in compare to joint volume by arthrocentesis but only T1wCE sequences are able to detect synovitis according to the reference of synovial biopsy.

Change in CD3 positive T-cell expression in psoriatic arthritis synovium correlates with change in DAS28 and magnetic resonance imaging synovitis scores following initiation of biologic therapy - a single centre, open-label study

IntroductionWith the development of increasing numbers of potential therapeutic agents in inflammatory disease comes the need for effective biomarkers to help screen for drug efficacy and optimal dosing regimens early in the clinical trial process. This need has been recognized by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group, which has established guidelines for biomarker validation. To seek a candidate synovial biomarker of treatment response in psoriatic arthritis (PsA), we determined whether changes in immunohistochemical markers of synovial inflammation correlate with changes in disease activity scores assessing 28 joints (ΔDAS28) or magnetic resonance imaging synovitis scores (ΔMRI) in patients with PsA treated with a biologic agent.MethodsTwenty-five consecutive patients with PsA underwent arthroscopic synovial biopsies and MRI scans of an inflamed knee joint at baseline and 12 weeks after starting treatment with either anakinra (first 10 patients) or etanercept (subsequent 15 patients) in two sequential studies of identical design. DAS28 scores were measured at both time points. Immunohistochemical staining for CD3, CD68 and Factor VIII (FVIII) was performed on synovial samples and scored by digital image analysis (DIA). MRI scans performed at baseline and at 12 weeks were scored for synovitis semi-quantitatively. The ΔDAS28 of the European League Against Rheumatism good response definition (>1.2) was chosen to divide patients into responder and non-responder groups. Differences between groups (Mann Whitney U test) and correlations between ΔDAS28 with change in immunohistochemical and MRI synovitis scores (Spearman's rho test) were calculated.ResultsPaired synovial samples and MRI scans were available for 21 patients (8 anakinra, 13 etanercept) and 23 patients (8 anakinra, 15 etanercept) respectively. Change in CD3 (ΔCD3) and CD68 expression in the synovial sublining layer (ΔCD68sl) was significantly greater in the disease responders compared to non-responders following treatment (P = 0.005 and 0.013 respectively). ΔCD3, but not ΔCD68 or ΔFVIII, correlated with both ΔDAS28 (r = 0.49, P = 0.025) and ΔMRI (r = 0.58, P = 0.009).ConclusionsThe correlation of ΔCD3 with ΔDAS28 and ΔMRI following biologic treatment in this cohort contributes to the validation of ΔCD3 as a synovial biomarker of disease response in PsA, and supports the further evaluation of ΔCD3 for predictive properties of future clinical outcomes.

Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients

ObjectivesTo examine the associations between modern imaging modalities and joint damage measured as 1-year MRI erosive progression, in early rheumatoid arthritis (RA) patients.Methods84 RA patients with disease duration of less...

Dynamic contrast-enhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis

To determine the capability and reliability of dynamic contrast-enhanced MRI (DCE-MRI) in the assessment of disease activity in juvenile idiopathic arthritis (JIA). DCE-MRI of the clinically more affected wrist or hip joints was undertaken in 21 patients, coupled with standard clinical assessment and biochemical analysis. Synovial inflammation was assessed by computing the maximum level of synovial enhancement (ME), the maximum rate of enhancement (MV) and the rate of early enhancement (REE) from the enhancement curves generated from region of interest independently delineated by two readers in the area of the ME. Correlations between dynamic parameters and clinical measures of disease activity, and static MRI synovitis score were investigated. In patients with wrist arthritis, REE correlated with the wrist swelling score (r(s) = 0.72), ESR (r(s) = 0.69), pain assessment scale (r(s) = 0.63) and childhood HAQ (r(s) = 0.60). In patients with hip arthritis, ME correlated with the hip limitation of motion (r(s) = 0.69). Static MRI synovitis score based on post-gadolinium enhancement correlated with MV (r(s) = 0.63) in patients with wrist arthritis and with ME (r = 0.68) in those with hip arthritis. The inter-reader agreement assessed by intra-class correlation coefficient (ICC) for ME, MV and REE (ICC = 0.98, 0.97 and 0.84, respectively) was excellent. DCE-MRI represents a promising method for the assessment of disease activity in JIA, especially in patients with wrist arthritis. As far as we know, this study is the first to demonstrate the feasibility, reliability and construct validity of DCE-MRI in JIA. These results should be confirmed in large-scale longitudinal studies in view of its further application in therapeutic decision making and in clinical trials.

The impact of T-cell co-stimulation modulation in patients with undifferentiated inflammatory arthritis or very early rheumatoid arthritis: a clinical and imaging study of abatacept

Background: Several agents provide treatment for established RA, but a crucial therapeutic goal is to delay/prevent progression of undifferentiated arthritis (UA) or very early RA.Methods: In this double-blind, Phase II,...

Quantitative assessment of synovitis in juvenile idiopathic arthritis using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Methods In 22 JIA patients 12 wrists and 10 hips were studied with DCE-MRI. A 3D FFE Dynamic sequence was acquired after contrast injection. Two readers delineated independently a region of interest (ROI) in the area of maximal synovial enhancement. Enhancement curves were obtained plotting pixel intensity against time from the ROIs. Maximum level of synovial enhancement (ME), maximum rate of enhancement (MV) and rate of early enhancement (REE) were obtained from the curves. Correlations with clinical parameters of disease activity and with static MRI synovitis score were investigated.