Dynamic contrast-enhanced magnetic resonance imaging of the wrist in children with juvenile idiopathic arthritis

Abstract

BackgroundDynamic contrast-enhanced MRI provides information on the heterogeneity of the synovium, the primary target of disease in children with juvenile idiopathic arthritis (JIA).ObjectiveTo evaluate the feasibility of dynamic contrast-enhanced MRI in the wrist of children with JIA using conventional descriptive measures and time-intensity-curve shape analysis. To explore the association between enhancement characteristics and clinical disease status.Materials and methodsThirty-two children with JIA and wrist involvement underwent dynamic contrast-enhanced MRI with movement-registration and were classified using validated criteria as clinically active (n = 27) or inactive (n = 5). Outcome measures included descriptive parameters and the classification into time-intensity-curve shapes, which represent the patterns of signal intensity change over time. Differences in dynamic contrast-enhanced MRI outcome measures between clinically active and clinically inactive disease were analyzed and correlation with the Juvenile Arthritis Disease Activity Score was determined.ResultsComprehensive evaluation of disease status was technically feasible and the quality of the dynamic dataset was improved by movement registration. The conventional descriptive measure maximum enhancement differed significantly between clinically active and inactive disease (P = 0.019), whereas time-intensity-curve shape analysis showed no differences. Juvenile Arthritis Disease Activity Score correlated moderately with enhancing volume (P = 0.484).ConclusionDynamic contrast-enhanced MRI is a promising biomarker for evaluating disease status in children with JIA and wrist involvement. Conventional descriptive dynamic contrast-enhanced MRI measures are better associated with clinically active disease than time-intensity-curve shape analysis.Electronic supplementary materialThe online version of this article (doi:10.1007/s00247-016-3736-2) contains supplementary material, which is available to authorized users.

Imaging update in inflammatory arthritis

“…9 In children with JIA, DCE-MRI was found to be a valuable tool for detecting synovitis, including in the temporomandibular joint. 34,35 Diffusion Weighted Imaging (DWI) has been successfully applied in inflammatory rheumatic diseases. 36 It has been shown that apparent diffusion coefficient (ADC) discriminates between active and inactive JIA, and identifies patients with AS, nonradiographic AS, and lower back pain not due to AS at baseline.…”

Novel Imaging Techniques in Rheumatic Diseases

“…DCE-MRI proved to be a feasible technique in children with active arthritis in wrists, hips and knee joints. 8,[26][27][28] In JIA, DCE-MRI showed to be able to differentiate children with active and inactive JIA by the differences in the relative number of TIC shapes (TIC shape type 4, ►Fig. 1) as well as with descriptive parameters of maximum enhancement, maximal initial slope and the initial area under the curve.…”

“…1) as well as with descriptive parameters of maximum enhancement, maximal initial slope and the initial area under the curve. 8,28 Workie et al, showed that DCE-MRI was sensitive to change since a decrease in pharmacokinetic parameter values corresponded with reduction of disease activity. 27 Regarding the construct validity of DCE-MRI in JIA, DCE parameters correlated in JIA patients moderately to substantially with conventional Juvenile Arthritis MRI Scores (JAMRIS) of disease activity in children with knee involvement.…”

Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation

“…Finally, DCE-MRI has been proposed as a potential biomarker in children with juvenile idiopathic arthritis and wrist involvement demonstrating an association between clinical active disease and derived-parameters such as maximum relative enhancement[ 56 ].…”