Reliability and responsiveness of dynamic contrast-enhanced magnetic resonance imaging in rheumatoid arthritis

• Published in: Scandinavian journal of rheumatology Vol. 42; no. 2; pp. 115 - 122
• Main Authors: Axelsen, MB, Poggenborg, RP, Stoltenberg, M, Kubassova, O, Boesen, M, Hørslev-Petersen, K, Bliddal, H, Hanson, LG, Østergaard, M
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01-01-2013; Taylor & Francis
• Subjects: Adult; Aged; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Cohort Studies; Follow-Up Studies; Gadolinium DTPA; Glucocorticoids - administration & dosage; Humans; Image Enhancement; Injections, Intra-Articular; Knee Joint - drug effects; Knee Joint - pathology; Longitudinal Studies; Magnetic Resonance Imaging - methods; Methylprednisolone - administration & dosage; Middle Aged; Recurrence; Remission Induction; Reproducibility of Results; Synovitis - diagnosis; Synovitis - drug therapy; Treatment Outcome; Young Adult
• ISSN: 0300-9742; 1502-7732
• DOI: 10.3109/03009742.2012.723745

Objectives: To investigate the responsiveness to treatment and the reliability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in rheumatoid arthritis (RA) knee joints.Methods: DCE-MRI was performed in 12 clinically active RA knee joints before and 1, 7, 30, and 180 days after intra-articular injection with 80 mg methylprednisolone. Using semi-automated image processing software, DCE-MRI parameters, including the initial rate of enhancement (IRE) and maximal enhancement (ME), were generated for three regions of interest (ROIs): 'Whole slice', 'Quick ROI', and 'Precise ROI'. The smallest detectable difference (SDD), the smallest detectable change (SDC), and intra- and inter-reader intraclass correlation coefficients (ICCs) were used to assess the reliability of DCE-MRI. Responsiveness to treatment was assessed by the standardized response mean (SRM).Results: In all patients clinical remission of the knee was achieved at day 7. All DCE-MRI parameters decreased from day 0 to day 7. Using the Quick and Precise ROI methods, respectively, IRE decreased by 63% and 69%, ME decreased by 11% and 11%, Nvoxel decreased by 55% and 57%, and IRE × Nvoxel decreased by 84% and 85%. The intra- and inter-reader ICCs were very high (0.96-1.00). The decrease in DCE-MRI parameters was larger than the SDC for all patients. SRM was large for all parameters, ranging from -1.04 to -2.40. When the Whole slice ROI method was used, no parameters were responsive to treatment.Conclusions: DCE-MRI analysed using semi-automatic software is a reliable and responsive tool for assessing treatment in RA knees joints. Rough manual delineation of the joint to omit enhancement artefacts is necessary.