Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging

Gaffney, Karl; Cookson, John; Blades, S.; Coumbe, A.; Blake, David R.

doi:10.1136/ard.57.3.152

Cited by 119 publications

(77 citation statements)

References 43 publications

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“…The second method is based on the experimental observation that the rate of synovial enhancement following Gd-DPTA injection is proportional to the degree of synovial inflammation (4,11,12,25). The "E-ratio," defined as the rate of increased synovial enhancement after Gd-DPTA injection divided by the baseline SI of the synovium, was first proposed as a measure of synovitis by Tamai et al (11).…”

Section: Discussionmentioning

confidence: 99%

“…This investigation showed that the E-ratio correlated with histologic signs of inflammation. Gaffney et al (12) later revised this analysis, proposing that the initial rate of synovial enhancement was a more absolute measure of synovitis than the steady-state E-ratio. The methods employed in this investigation parallel the technique developed by Gaffney et al (12).…”

Section: Discussionmentioning

confidence: 99%

“…The technique of dynamic gadolinium-enhanced MRI (DEMRI) provides a quantitative assessment of inflammation based on analysis of changes in the signal intensity (SI) resulting from Gd-DTPA enhancement that are proportional to the Gd-DTPA concentration (7)(8)(9)(10). DEMRI, combined with computer-assisted quantitative analysis, provides a measure of blood perfusion, capillary permeability, and extracellular volume, all of which reflect the inflammatory process of synovitis (11,12). The implementation of active treatment strategies for patients newly diagnosed as having RA may delay the progression of radiographically evident bone damage.…”

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confidence: 99%

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Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

Reece¹,

Kraan²,

Radjenovic³

et al. 2002

Arthritis & Rheumatism

103

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Objective. Ethical constraints on the conduct of placebo-controlled trials evaluating new therapies for serious chronic diseases, such as rheumatoid arthritis (RA), indicate the need for discerning methods to assess treatment effect in active-controlled clinical trials. Dynamic gadolinium-enhanced magnetic resonance imaging (DEMRI) is a sensitive technique for the detection of synovial inflammation in RA. Therefore, this investigation was undertaken to evaluate DEMRI as an efficacy assessment tool for differentiating treatment effect in a randomized, active-controlled trial comparing leflunomide and methotrexate.Methods. Patients with active RA (n ‫؍‬ 39) were randomized in a 2-center, prospective, double-blind clinical trial to receive either leflunomide (n ‫؍‬ 18) or methotrexate (n ‫؍‬ 21) therapy for 4 months. DEMRI scans were obtained at baseline and at 4 months, and the initial rate of enhancement (IRE) and the maximal signal intensity (SI) enhancement (ME) were calculated from the SI curves. Clinical improvement was assessed by conventional outcome measures.Results. Thirty-four patients (17 treated with leflunomide and 17 with methotrexate) had usable baseline and end point DEMRI scans. Leflunomide treatment was associated with a significantly greater improvement in IRE compared with methotrexate treatment (P < 0.05). Average values of ME indicated reduction of inflammation with both leflunomide and methotrexate. The improvement in clinical signs and symptoms, as measured by traditional assessments, was comparable for both active treatments.Conclusion. Results of this study validate the sensitivity of DEMRI in detecting inflammatory changes in active RA in response to treatment. Improvement in synovial inflammation as measured by IRE was significantly better with leflunomide than with methotrexate over 4 months of therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

Reece¹,

Kraan²,

Radjenovic³

et al. 2002

Arthritis & Rheumatism

103

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“…Another limitation of the study to be considered is the underlying assumption that bursal inflammation correlates with MRI enhancement. Although the link between MRI enhancement and histological markers of inflammation has been demonstrated in the knee in rheumatoid arthritis, this has not been proven for subacromial bursitis [23], and dynamic contrast-enhanced MRI may be a better measurement of inflammatory activity [34][35][36][37].…”

Section: Mri Of the Subacromial Bursa In Rotator Cuff Tearsmentioning

confidence: 99%

Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears

Hodgson

O’Connor²,

Hensor³

et al. 2012

The British Journal of Radiology

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Objective: Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient's pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/ subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder. Methods: The shoulders of 255 patients were screened with ultrasound. 33 fullthickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain. Results: There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age. Conclusion: Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair. Advances in knowledge: Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear.

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“…Technical protocol has been standardized and should include T1W images to assess tissue structure, T2 or STIR images to detect bone edema and gadolinium-enhanced fat-suppressed T1 images to show tissue inflammation (6,9,10).…”

Section: Introductionmentioning

confidence: 99%

Contrast Enhanced Magnetic Resonance Imaging in Sacroiliitis

et al. 2016

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Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging

Cited by 119 publications

References 43 publications

Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears

Contrast Enhanced Magnetic Resonance Imaging in Sacroiliitis

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