Detection of synovitis in the hands of patients with rheumatologic disorders: Diagnostic performance of optical imaging in comparison with magnetic resonance imaging

Meier, Reinhard; Thürmel, Klaus; Moog, Philipp; Noël, Peter B.; Ahari, Carmen; Sievert, Matti; Dorn, Franziska; Waldt, Simone; Schaeffeler, Christoph; Golovko, Daniel; Haller, Bernhard; Ganter, Carl; Weckbach, Sabine; Woertler, Klaus; Rummeny, Ernst J.

doi:10.1002/art.34467

Cited by 42 publications

(50 citation statements)

References 69 publications

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“…In a recent study by Meier et al [19], FOI was compared with CE and three T-weighted MRI. Using MRI as standard of reference, FOI displayed a sensitivity of 39.6% and a specificity of 85.2%.…”

Section: Discussionmentioning

confidence: 99%

“…Electronically generated composite images (CI) were calculated from the mean fluorescence signal intensities of an image stack of sequential subsets of acquired images. In line with two previous publications, we defined CI for three sequential phases with a duration of 120 seconds each (1 to 120 seconds, 121 to 240 seconds, and 241 to 360 seconds) [8,19]. To allow for quantitative assessment, five joints (wrist, MCP II and III, and PIP II and III) of each patient were analyzed using circular regions of interest (ROI), with the size of each ROI defined according to the anatomical size of the corresponding joint (a diameter of 22 pixel for wrists, 12 pixel for MCP- and 10 pixel for PIP-joints; see Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…The major drawback of FOI is the limited tissue penetration of light; however, as inflammatory arthopathies typically affect the small joints of the hands and feet, this is not necessarily a significant limitation for this imaging method [19]. Under various experimental conditions, FOI proved to correspond to synovitis [17,18,20-24].…”

Section: Introductionmentioning

confidence: 99%

“…In a clinical study by Werner et al [8] FOI had, taking MRI as a reference, a sensitivity of 76% and a specificity of 54%. Recently, another study by Meier et al [19] reported that FOI had a sensitivity of 39.6% and a specificity of 85.2%, compared with MRI demonstrating conflicting results regarding the reliability of this new method. In 2011 Dziekan et al [28] proposed a quantitative analysis of FOI using normalized variances of fluorescence time correlation functions.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative assessment of synovitis in patients with rheumatoid arthritis using fluorescence optical imaging

et al. 2013

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IntroductionTo prospectively evaluate quantitative assessment of fluorescence optical imaging (FOI) for differentiation of synovitic from non-synovitic joints in patients suffering from rheumatoid arthritis (RA).MethodsFOI of the hands was performed in patients with active RA, and a stratified quantitative fluorescence readout (FLRO) of 3 phases (1-120 s; 121-240 s; 241-360 s) was generated for 5 individual joints of the clinical predominant hand (carpal joint, metacarpophalangeal and proximal interphalangeal joints of digits II & III). To dissect the effect of the overall perfusion of the hand from the perfusion due to synovitis, a fluorescence ratio (FLRA) was additionally calculated, dividing each FLRO by the readout of the eponychium of digit II. The mean FLRO and FLRA were compared between joints with absent vs. present synovitis determined by clinical examination, grayscale, color Doppler ultrasonography, or magnetic resonance imaging (MRI).ResultsThe analysis for 90 individual joints from 18 patients yielded FLRO ranging from 4.4 to 49.0 × 103, and FLRAs ranging from 0.37 to 2.27. Overall, the analyses based on the FLRA revealed a higher discrimination than the analyses related to the FLRO, demonstrating most significant differences in phases 2 and 3. A sensitivity of 26/39 (67%) and a specificity of 31/40 (77%) were calculated for FLRA of phase 3 using a cut-off value of more than 1.2 to detect MRI-confirmed synovitis with FOI.ConclusionsFOI has a potential for visualizing synovitis in subjects with RA. For adequate FOI interpretation, quantitative analysis should be based on the novel FLRA calculated for phases 2 and 3.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative assessment of synovitis in patients with rheumatoid arthritis using fluorescence optical imaging

et al. 2013

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“…Since hypoxia affects both tissue blood content and oxygenation [22,24], near-infrared optical methods-diffuse optical spectroscopy (DOS) and tomography (DOT), and photoacoustic tomography (PAT)-that are sensitive to these physiological parameters are being developed to supplement/replace clinical assessment and radiology for RA monitoring [25][26][27][28][29][30][31][32][33][34]. These emerging techniques, DOS in particular, have the potential to overcome most of the limitations of current RA monitoring methods since they are safe, relatively inexpensive, and have the potential to quickly and objectively assess RA inflammation at the individual joint level [34,35].…”

Section: Introductionmentioning

confidence: 99%

Joint blood flow is more sensitive to inflammatory arthritis than oxyhemoglobin, deoxyhemoglobin, and oxygen saturation

Rajaram

Ioussoufovitch

Morrison

et al. 2016

Biomed. Opt. Express

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Joint hypoxia plays a central role in the progression and perpetuation of rheumatoid arthritis (RA). Thus, optical techniques that can measure surrogate markers of hypoxia such as blood flow, oxyhemoglobin, deoxyhemoglobin, and oxygen saturation are being developed to monitor RA. The purpose of the current study was to compare the sensitivity of these physiological parameters to arthritis. Experiments were conducted in a rabbit model of RA and the results revealed that joint blood flow was the most sensitive to arthritis and could detect a statistically significant difference (p<0.05, power = 0.8) between inflamed and healthy joints with a sample size of only four subjects. Considering that this a quantitative technique, the high sensitivity to arthritis suggests that joint perfusion has the potential to become a potent tool for monitoring disease progression and treatment response in RA.

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Indocyanine Green–Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging

Werner

Länger

Schøtt

et al. 2013

Arthritis & Rheumatism

102

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Objective. Indocyanine green-enhanced fluorescence optical imaging (FOI) is a novel diagnostic tool for the assessment of inflammation in arthritis. We undertook this study to compare FOI with magnetic resonance imaging (MRI) in 32 patients with early and very early untreated arthritis (mean disease duration 7.1 months).Methods. FOI images were acquired with the commercially available Xiralite system. Image interpretation was done for an early phase (phase 1), an intermediate phase (phase 2), and a late phase (phase 3), and for an electronically generated composite image. The results were compared with those of clinical examination (960 joints) and contrast (gadolinium)-enhanced 1.5T MRI (382 joints) of the clinically more affected hand. Additionally, we evaluated FOI in a control group of 46 subjects without any signs of inflammatory joint disease (1,380 joints).Results. With MRI as the reference method, the sensitivity of FOI was 86% and the specificity was 63%, while the composite image, phase 1, and phase 3 reached high specificities (87%, 90%, and 88%, respectively). The results differed considerably between the composite image and the phases. FOI did not detect inflammation in 11 joint regions that showed palmar tenosynovitis on MRI. Intrareader and interreader agreements were moderate to substantial ( ‫؍‬ 0.55-0.73). In the control group, FOI showed positive findings in 5% of normal joints in phase 2.Conclusion. Further multicenter studies will address the question of whether FOI allows sensitive and reliable detection of inflammatory changes in early arthritis, as suggested by our initial findings. If this is confirmed, FOI has the potential to be a sensitive and valuable tool for monitoring disease activity on site in clinical settings and for serving as an outcome parameter in clinical trials.

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Detection of synovitis in the hands of patients with rheumatologic disorders: Diagnostic performance of optical imaging in comparison with magnetic resonance imaging

Abstract: The evaluated ICG-enhanced optical imaging system showed limitations for the detection of inflamed joints of the hand in comparison with MRI.

Cited by 42 publications

References 69 publications

Quantitative assessment of synovitis in patients with rheumatoid arthritis using fluorescence optical imaging

Quantitative assessment of synovitis in patients with rheumatoid arthritis using fluorescence optical imaging

Joint blood flow is more sensitive to inflammatory arthritis than oxyhemoglobin, deoxyhemoglobin, and oxygen saturation

Indocyanine Green–Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging

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