Synovitis assessed on static and dynamic contrast-enhanced magnetic resonance imaging and its association with pain in knee osteoarthritis: A cross-sectional study

Riis, R.; Gudbergsen, Henrik; Henriksen, Marius; Ballegaard, Christine; Bandak, Elisabeth; Röttger, Diana; Bliddal, Henning; Hansen, Bjarke Brandt; Hangaard, Stine; Boesen, Mikael

doi:10.1016/j.ejrad.2016.03.017

Cited by 46 publications

(45 citation statements)

References 28 publications

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“…This indicates that other knee joint changes are of importance. Consistent with this, other factors have been reported to be associated with OA symptoms [5, 23]. …”

Section: Discussionsupporting

confidence: 82%

“…1), was drawn in the medial femoral condyle and tibial plateau, respectively, to obtain quantitative data. Time intensity curves (TICs) expressing the enhancement pattern of each voxel were classified as one of four color-coded models for gadolinium uptake: (i) no enhancement; (ii) persistent enhancement; (iii) plateau (baseline → uptake → plateau); (iv) wash-out (baseline → uptake {→ plateau}→ wash-out) [23]. The volume of voxels with the pattern of ‘plateau’ and ‘wash-out’ enhancement were pooled to a value N voxel and used as a measure of the volume of inflammation [22, 23].…”

Section: Methodsmentioning

confidence: 99%

“…Time intensity curves (TICs) expressing the enhancement pattern of each voxel were classified as one of four color-coded models for gadolinium uptake: (i) no enhancement; (ii) persistent enhancement; (iii) plateau (baseline → uptake → plateau); (iv) wash-out (baseline → uptake {→ plateau}→ wash-out) [23]. The volume of voxels with the pattern of ‘plateau’ and ‘wash-out’ enhancement were pooled to a value N voxel and used as a measure of the volume of inflammation [22, 23]. The initial rate of enhancement (IRE) and maximal enhancement (ME) in the segmented area were also recorded to obtain the heuristic DCE variables IRExN voxel and MExN voxel [23].…”

Section: Methodsmentioning

confidence: 99%

“…The volume of voxels with the pattern of ‘plateau’ and ‘wash-out’ enhancement were pooled to a value N voxel and used as a measure of the volume of inflammation [22, 23]. The initial rate of enhancement (IRE) and maximal enhancement (ME) in the segmented area were also recorded to obtain the heuristic DCE variables IRExN voxel and MExN voxel [23]. Due to the applied method, no reference value was needed for calculating TICs.

Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The volumetric proportion of detectable enhancement in knee OA using T1 CE FS has been reported to constitute 62% of the BML volume using proton density (PD) weighted FS sequences [11]. Comparison with DCE-MRI of BMLs has to our knowledge not been performed, although knee OA has been investigated with regard to synovial changes using DCE-MRI [21–23]. The diagnostic value of T1 CE FS and DCE-MRI compared to a STIR sequence only needs to be investigated in relation to BMLs.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI: a comparison of fluid sensitive and contrast enhanced sequences

Nielsen

Egund

Jørgensen

et al. 2016

BMC Musculoskelet Disord

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BackgroundBone marrow lesions (BMLs) in knee osteoarthritis (OA) can be assessed using fluid sensitive and contrast enhanced sequences. The association between BMLs and symptoms has been investigated in several studies but only using fluid sensitive sequences. Our aims were to assess BMLs by contrast enhanced MRI sequences in comparison with a fluid sensitive STIR sequence using two different segmentation methods and to analyze the association between the MR findings and disability and pain.MethodsTwenty-two patients (mean age 61 years, range 41–79 years) with medial femoro-tibial knee OA obtained MRI and filled out a WOMAC questionnaire at baseline and follow-up (median interval of 334 days). STIR, dynamic contrast enhanced-MRI (DCE-MRI) and fat saturated T1 post-contrast (T1 CE FS) MRI sequences were obtained. All STIR and T1 CE FS sequences were assessed independently by two readers for STIR-BMLs and contrast enhancing areas of BMLs (CEA-BMLs) using manual segmentation and computer assisted segmentation, and the measurements were compared. DCE-MRIs were assessed for the relative distribution of voxels with an inflammatory enhancement pattern, Nvoxel, in the bone marrow. All findings were compared to WOMAC scores, including pain and overall symptoms, and changes from baseline to follow-up were analyzed.ResultsThe average volume of CEA-BML was smaller than the STIR-BML volume by manual segmentation. The opposite was found for computer assisted segmentation where the average CEA-BML volume was larger than the STIR-BML volume. The contradictory finding by computer assisted segmentation was partly caused by a number of outliers with an apparent generally increased signal intensity in the anterior parts of the femoral condyle and tibial plateau causing an overestimation of the CEA-BML volume.Both CEA-BML, STIR-BML and Nvoxel were significantly correlated with symptoms and to a similar degree. A significant reduction in total WOMAC score was seen at follow-up, but no significant changes were observed for either CEA-BML, STIR-BML or Nvoxel.ConclusionsNeither the degree nor the volume of contrast enhancement in BMLs seems to add any clinical information compared to BMLs visualized by fluid sensitive sequences. Manual segmentation may be needed to obtain valid CEA-BML measurements.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1336-9) contains supplementary material, which is available to authorized users.

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“…This indicates that other knee joint changes are of importance. Consistent with this, other factors have been reported to be associated with OA symptoms [5, 23]. …”

Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Fig.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI: a comparison of fluid sensitive and contrast enhanced sequences

Nielsen

Egund

Jørgensen

et al. 2016

BMC Musculoskelet Disord

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Serum Urate Levels Predict Joint Space Narrowing in Non‐Gout Patients With Medial Knee Osteoarthritis

Krasnokutsky

Oshinsky

Attur

et al. 2017

Arthritis & Rheumatology

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Objective OA pathogenesis includes both mechanical and inflammatory features. Studies have implicated synovial fluid urate (UA) as a potential OA biomarker, possibly reflecting chondrocyte damage. Whether serum urate (sUA) levels reflect/contribute to OA is unknown. We investigated whether sUA predicts OA progression in a non-gout knee OA population. Methods Eighty-eight subjects with medial knee OA (BMI <33) but without gout were included. Baseline sUA was measured in previously banked serum. At 0 and 24 months, subjects underwent standardized weight-bearing fixed-flexion posteroanterior knee radiographs to determine joint space width (JSW) and Kellgren-Lawrence (KL) grades. Joint space narrowing (JSN) was determined as JSW change from 0 to 24 months. Twenty-seven subjects underwent baseline contrast-enhanced 3T knee MRI for synovial volume (SV) assessment. Results sUA correlated with JSN in both univariate (r=0.40, p≤0.01) and multivariate analyses (r=0.28, p=0.01). There was a significant difference in mean JSN after dichotomizing at sUA of 6.8 mg/dL, the solubility point for serum urate, even after adjustment (JSN of 0.90 mm for sUA≥6.8; JSN of 0.31 mm for sUA<6.8, p<0.01). Baseline sUA distinguished progressors (JSN>0.2mm) and fast progressors (JSN>0.5mm) from nonprogressors (JSN≤0.0mm) in multivariate analyses (area under the receiver operating characteristic curve 0.63, p=0.03; AUC 0.62, p=0.05, respectively). sUA correlated with SV (r=0.44, p<0.01), a possible marker of JSN, though this correlation did not persist after controlling for age, gender and BMI (r=0.13, p=0.56). Conclusions In non-gout patients with knee OA, sUA predicted future JSN and may serve as a biomarker for OA progression.

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Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

Sujlana

Skrok

Fayad

2017

Magnetic Resonance Imaging

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Synovitis assessed on static and dynamic contrast-enhanced magnetic resonance imaging and its association with pain in knee osteoarthritis: A cross-sectional study

Cited by 46 publications

References 28 publications

Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI: a comparison of fluid sensitive and contrast enhanced sequences

Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI: a comparison of fluid sensitive and contrast enhanced sequences

Serum Urate Levels Predict Joint Space Narrowing in Non‐Gout Patients With Medial Knee Osteoarthritis

Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

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