Magnetic resonance imaging in osteoarthritis: which method best reflects synovial membrane inflammation?

Abstract

Objectives: : To study synovial membrane (SM) inflammation near the patella with different magnetic resonance imaging (MRI) approaches performed using a T1-injected sequence in knee osteoarthritis (OA), and to compare MRI results with macroscopic, microscopic and clinical findings.Methods: Fifteen patients fulfilling American College of Rheumatology (ACR) criteria for knee OA and requiring joint lavage completed a functional index (Lequesne's functional index) and a pain visual analog scale (VAS). SM inflammation near the patella was assessed on axial fat saturation post-injected T1 MRI images using three different methods: (1) semi-quantitative score ¼ MRI synovitis score; (2) synovial membrane volume (SMV) analysis; (3) SMV with low (SMVL) (<0.3%/s À1 ), intermediate (SMVI) (0.3%/s À1 to 1%/s À1 ) and high (SMVH) (!1%/s À1 ) speed of enhancement. Chondral lesions and SM inflammation were macroscopically graded and SM biopsies performed for microscopic scoring.Results: All MRI approaches exhibited excellent intra-and inter-observer reproducibility. MRI synovitis score correlated well with macroscopic (r ¼ 0.61, P ¼ 0.003) and total microscopic scores (r ¼ 0.55, P ¼ 0.03). Correlations between SMV and macroscopic (r ¼ 0.60, P ¼ 0.02) and microscopic congestion (r ¼ 0.63, P ¼ 0.01) were good. SMVH was correlated only with microscopic congestion (r ¼ 0.79, P ¼ 0.01). Low SMV was associated with neither macroscopic nor microscopic scores. However, it did correlate well with pain-VAS score (r ¼ 0.61, P ¼ 0.03) and moderately with a functional index (r ¼ 0.46, P ¼ 0.10). Conclusion:The three MRI approaches used here provided highly reproducible information on SM inflammation near the patella in knee OA. Compared to SMV, MRI synovitis score seems sufficient to assess synovial inflammation but high SMV is an appropriate indicator of vascular congestion, and low SMV reflects pain in knee OA.

Serum and synovial fluid C-reactive protein level variations in dogs with degenerative joint disease and their relationships with physiological parameters

“…In the present study we assessed the patients DJD grade by evaluating digital x-rays images of the affected stifle, using DJD Brunnberg classification. However, other image complementary means such as magnetic resonance imaging (MRI) and ultrasound (US) can also be used to detect DJD changes with greater sensitivity, such as, effusions, popliteal cysts, and synovial thickening (Fernandez-Madrid et al 1994;Hill et al 2001;Loeuille et al 2005;Conaghan et al 2006;Hill et al 2007;Kumm et al 2009;Loeuille et al 2009;Baker et al 2010). By rating the DJD according to its radiological characteristics, it was possible to note that higher grades of DJD (III and IV) presented higher SCRP and SFCRP means than the lower grades of DJD (I and II); nevertheless, statistically significant differences were registered only for SCRP.…”

Relation of synovitis to knee pain using contrast-enhanced MRIs

“…Only a handful of studies have examined the relation of synovitis and pain in knees and, until now, all have used non-contrast-enhanced images, making it difficult to obtain an accurate estimate of the extent of synovitis present, particularly if there is joint effusion 2–4. In recent work by Loeuille et al , synovial membrane inflammation assessed by contrast-enhanced (CE) MRI correlated well with synovial membrane inflammation confirmed by biopsy while synovitis on non-CE MRI did not 5. We are unaware of any study that has evaluated the relationship of knee pain with synovitis assessed using CE scans.…”

Inhibition of Cytokine Expression and Prostaglandin E2 Production in Monocyte/Macrophage-Like Cells by Avocado/Soybean Unsaponifiables and Chondroitin Sulfate

“…Imaging studies have detected signs of synovitis in osteoarthritic joints showing no clinical signs of inflammation (Smith et al, 2001;Loeuille et al, 2005;Loeuille et al, 2009). Immunohistochemical inspection of synovial tissue biopsies from osteoarthritic joints revealed increased mononuclear cell infiltration where the intensity of inflammation was greatest during the early phase of the disease (Benito et al, 2005).…”