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Dynamic contrast-enhanced magnetic resonance imaging of metacarpophalangeal joints reflects histological signs of synovitis in rheumatoid arthritis.

Vordenbäumen S, Schleich C, Lögters T, Sewerin P, Bleck E, Pauly T, Müller-Lutz A, Antoch G, Schneider M, Miese F, Ostendorf B - Arthritis Res. Ther. (2014)

Bottom Line: Correlations between MRI and histological data were calculated according to Spearman.Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation.According to our study, ME is the most closely associated parameter amongst the measures considered.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Synovial inflammation and joint destruction in rheumatoid arthritis (RA) may progress despite clinical remission. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly used to detect synovial inflammation in RA. Although small joints such as metacarpophalangeal (MCP) joints are mainly affected by RA, MRI findings have never been directly compared to histological synovitis in MCP synovial tissue. The objective of the current study was therefore to analyse if DCE-MRI relates to histological signs of synovitis small RA joints.

Methods: In 9 RA patients, DCE-MRI (3 Tesla, dynamic 2D T1 weighted turbo-flash sequence) of the hand was performed prior to arthroscopically-guided synovial biopsies from the second MCP of the imaged hand. Maximum enhancement (ME), rate of early enhancement, and maximum rate of enhancement were assessed in the MCP. Synovial biopsies were stained for determination of sublining CD68 and the Synovitis Score. Correlations between MRI and histological data were calculated according to Spearman.

Results: ME of the MCP significantly correlated to sublining CD68 staining (r = 0.750, P = 0.02), the Synovitis Score (r = 0.743, P = 0.02), and the subscores for lining layer hypertrophy (r = 0.789, P = 0.01) and cellular density (r = 0.842; P = 0.004).

Conclusions: Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation. According to our study, ME is the most closely associated parameter amongst the measures considered.

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Related in: MedlinePlus

Contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal (MCP) joints 2 and 3 and maximum synovial enhancement of MCP 2. Illustration of contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal joint 2 and joint 3 (CE-MRI T1), fusion image of CE-MRI T1 and maximum synovial enhancement of MCP 2 measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histological samples from the imaged joint stained with hematoxylin and eosion (HE) or immunohistochemical staining for macrophages (CD68). Patient with (A) a high degree of synovitis and (B) a low degree of synovitis. Red corresponds to a high maximum enhancement.
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Fig1: Contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal (MCP) joints 2 and 3 and maximum synovial enhancement of MCP 2. Illustration of contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal joint 2 and joint 3 (CE-MRI T1), fusion image of CE-MRI T1 and maximum synovial enhancement of MCP 2 measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histological samples from the imaged joint stained with hematoxylin and eosion (HE) or immunohistochemical staining for macrophages (CD68). Patient with (A) a high degree of synovitis and (B) a low degree of synovitis. Red corresponds to a high maximum enhancement.

Mentions: Finally, dynamic MRI parameters were compared with histological signs of synovitis by correlation analysis. As can be seen in Table 1 and is exemplified in Figure 1, strong correlations between ME and several histological measures of synovitis were present. No such correlations were found for either REE or MV.Table 1


Dynamic contrast-enhanced magnetic resonance imaging of metacarpophalangeal joints reflects histological signs of synovitis in rheumatoid arthritis.

Vordenbäumen S, Schleich C, Lögters T, Sewerin P, Bleck E, Pauly T, Müller-Lutz A, Antoch G, Schneider M, Miese F, Ostendorf B - Arthritis Res. Ther. (2014)

Contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal (MCP) joints 2 and 3 and maximum synovial enhancement of MCP 2. Illustration of contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal joint 2 and joint 3 (CE-MRI T1), fusion image of CE-MRI T1 and maximum synovial enhancement of MCP 2 measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histological samples from the imaged joint stained with hematoxylin and eosion (HE) or immunohistochemical staining for macrophages (CD68). Patient with (A) a high degree of synovitis and (B) a low degree of synovitis. Red corresponds to a high maximum enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4201730&req=5

Fig1: Contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal (MCP) joints 2 and 3 and maximum synovial enhancement of MCP 2. Illustration of contrast-enhanced T1-weighted magnetic resonance imaging of metacarpophalangeal joint 2 and joint 3 (CE-MRI T1), fusion image of CE-MRI T1 and maximum synovial enhancement of MCP 2 measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and histological samples from the imaged joint stained with hematoxylin and eosion (HE) or immunohistochemical staining for macrophages (CD68). Patient with (A) a high degree of synovitis and (B) a low degree of synovitis. Red corresponds to a high maximum enhancement.
Mentions: Finally, dynamic MRI parameters were compared with histological signs of synovitis by correlation analysis. As can be seen in Table 1 and is exemplified in Figure 1, strong correlations between ME and several histological measures of synovitis were present. No such correlations were found for either REE or MV.Table 1

Bottom Line: Correlations between MRI and histological data were calculated according to Spearman.Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation.According to our study, ME is the most closely associated parameter amongst the measures considered.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Synovial inflammation and joint destruction in rheumatoid arthritis (RA) may progress despite clinical remission. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly used to detect synovial inflammation in RA. Although small joints such as metacarpophalangeal (MCP) joints are mainly affected by RA, MRI findings have never been directly compared to histological synovitis in MCP synovial tissue. The objective of the current study was therefore to analyse if DCE-MRI relates to histological signs of synovitis small RA joints.

Methods: In 9 RA patients, DCE-MRI (3 Tesla, dynamic 2D T1 weighted turbo-flash sequence) of the hand was performed prior to arthroscopically-guided synovial biopsies from the second MCP of the imaged hand. Maximum enhancement (ME), rate of early enhancement, and maximum rate of enhancement were assessed in the MCP. Synovial biopsies were stained for determination of sublining CD68 and the Synovitis Score. Correlations between MRI and histological data were calculated according to Spearman.

Results: ME of the MCP significantly correlated to sublining CD68 staining (r = 0.750, P = 0.02), the Synovitis Score (r = 0.743, P = 0.02), and the subscores for lining layer hypertrophy (r = 0.789, P = 0.01) and cellular density (r = 0.842; P = 0.004).

Conclusions: Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation. According to our study, ME is the most closely associated parameter amongst the measures considered.

Show MeSH
Related in: MedlinePlus