To Contrast or Not to Contrast? On the Role of Contrast Enhancement in Hand MRI Studies of Patients with Rheumatoid Arthritis

Frenken, Miriam; Rübsam, G.; Mewes, Alexander; Radke, Karl Ludger; Li, Lien; Wilms, Lena Marie; Nebelung, Sven; Abrar, D; Sewerin, Philipp

doi:10.3390/diagnostics12020465

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…Pilot studies have evaluated gadolinium free STIR and 3D gradient echo sequences and termed this version RAMRIS Sine-Gadolinium-For-Experts (RAMRIS-SAFE) [37]. High correlations between the full RAMRIS and RAMRIS-SAFE synovitis subscores was observed, which might be explained by the higher field strength of 3Tesla used in this study, but the correlation for tenosynovitis was only modest [38]. This is a promising direction requiring larger studies comparing MRI sequences with and without gadolinium.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 96%

Advances in Imaging for Clinical Trials in Rheumatic Diseases

Maksymowych

2023

Proc Shevchenko Sci Soc Med Sci

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The successful execution of clinical trials for novel anti-rheumatic compounds is increasingly approaching the limits of what can be achieved using radiographic outcomes for the assessment of disease modification. Moreover, there is a growing need for more objective tools to assess joint inflammation, especially for disorders such as axial spondyloarthritis where spinal symptoms are often non-specific and physical findings may be minimal until later stages of disease. The use of MRI to evaluate inflammation in the synovium and bone marrow as well as erosions in peripheral joints of patients with RA and PsA represents a major new advance that should now be routinely implemented in clinical trials of RA. MRI-based scoring systems have been well validated and demonstrate that, for RA, MRI changes after therapeutic intervention may be observed in a month and precede findings on radiography that only become evident after a year. The assessment of disease activity on MRI of the sacroiliac joints and spine using a standardized and well-validated method, such as the SPARCC instruments, is indispensable to the evaluation of efficacy for new agents aimed at the treatment of spondyloarthritis. Further advances include the use of whole-body MRI evaluation to assess inflammation in both the axial and peripheral skeleton as well as sequences that dispense with the requirement for the use of contrast agents, such as gadolinium, and data processing techniques that permit full automation and absolute quantification. This review will discuss how imaging is transforming clinical trials in rheumatic diseases.

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Section: Magnetic Resonance Imagingmentioning

confidence: 96%

Advances in Imaging for Clinical Trials in Rheumatic Diseases

Maksymowych

2023

Proc Shevchenko Sci Soc Med Sci

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“…The objective of this study was to evaluate a gadolinium-free MRI protocol of the hand assessing synovium and osteitis as primary inflammatory disease outcomes, utilizing the previously published RAMRIS-Sine-Gadolinium-For-Experts (RAMRIS-SAFE) using T1-weighted images and the STIR sequence to evaluate changes in synovial thickening as a surrogate for synovitis post-gadolinium. 12 The primary aim was to evaluate speed of response using this gadolinium-free protocol and validate the results by comparing them with hand function as a measure of early improvement.…”

Section: Introduction and Backg Roundmentioning

confidence: 99%

“…The objective of this study was to evaluate a gadolinium‐free MRI protocol of the hand assessing synovium and osteitis as primary inflammatory disease outcomes, utilizing the previously published RAMRIS‐Sine‐Gadolinium‐For‐Experts (RAMRIS‐SAFE) using T1‐weighted images and the STIR sequence to evaluate changes in synovial thickening as a surrogate for synovitis post‐gadolinium 12 …”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging RAMRIS‐SAFE score—A low‐risk effective measure of rapid response to therapy in rheumatoid arthritis clinical trials

Bird

Needham²,

Spiers³

et al. 2023

Int J of Rheum Dis

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AimTo assess the rapidity of magnetic resonance imaging (MRI) measured synovitis (as measured by synovial thickening using the RAMRIS‐SAFE score) and bone edema in active rheumatoid arthritis (RA) subjects treated with golimumab. Secondary aims: to correlate MRI measures with disabilities of the arm, shoulder, and hand (DASH), physician global (PhysG) and patient global (PatG) assessments.MethodsPatients with active RA and inadequate response to methotrexate were recruited. Active RA was defined as RA with a Disease Activity Score of 28 joints – C‐reactive protein ≥4.2 at screening AND active disease (synovitis and edema) of the chosen hand or wrist on MRI at screening, as determined by the central blinded MRI reader (PB). Outcomes measures were assessed at baseline, 2, 6, and 12 weeks. MRI results were interpreted by one experienced observer (PB), blinded to clinical measures. Pearson's correlation co‐efficient (SPSS) was used to express the relationship between DASH, PhysG, PatG and MRI measures.ResultsEighteen patients were included in the study. All subjects completed follow‐up visits and MRI assessment. Mean age was 60.6 years (range 22–72), and 10 were female, 8 male, and disease duration was mean 4.72 years (range 1–28); all patients were taking background methotrexate. The changes in MRI synovial volume were evident by visit 2. The strongest correlations with the DASH for MRI parameters were total synovial thickening (0.923) and edema (0.921).ConclusionGolimumab was associated with rapid improvement in clinical measures and patient‐reported outcome measures. Mean synovial thickening demonstrated early rapid improvement. MRI synovial thickening demonstrated a strong correlation with DASH, PatG and PhysG.

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A simplified fluid-sensitive MRI protocol for the hands to detect inflammation without contrast administration: a large study of symptom-free subjects from the general population as a reference for normality

Boeren,

Ton,

van Mulligen

et al. 2024

Skeletal Radiol

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Objective MRI of the hands is valuable for risk-stratification in patients with arthralgia at-risk for developing rheumatoid arthritis (RA). Contrast-enhanced MRI is considered standard for assessment of RA, but has practical disadvantages. It also shows inflammation-like features in the general population, especially at older age, which should be considered in image interpretation. The modified-Dixon (mDixon) technique is reliable compared to contrast-enhanced sequences. Moreover, this short protocol without contrast-enhancement is patient-friendly. Whether it also shows inflammation-like features in the general population is unknown. We studied this to support accurate use in the clinic. Methods Two hundred twenty symptom-free volunteers from different age-categories were recruited from the general population and underwent mDixon MRI of both hands. Two readers independently scored MRIs for synovitis, tenosynovitis, and bone marrow edema (BME) in the metacarpophalangeal-joints (MCP) and wrists according to the RAMRIS. Features were considered present if scored by both readers; frequencies > 5% were considered relevant in terms of specificity and determined per age-category (< 40/40- < 60/ ≥ 60-years). Results Higher age correlated with higher BME-scores (p-value < 0.005), but not with synovitis and tenosynovitis-scores. BME (grade 1) occurred in some bones in people aged ≥ 60, 14% had BME in the lunate, 7% in metacarpal-1, and 6% in the trapezium. Synovitis and tenosynovitis did not occur in > 5%, except for grade-1 synovitis in the right distal radio-ulnar-joint in people aged ≥ 60 (11%). Conclusion On mDixon MRI, inflammatory features in the hands of the general population are rare. This facilitates image interpretation. To prevent overinterpretation, only several locations should be considered when evaluating people aged ≥ 60-years.

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To Contrast or Not to Contrast? On the Role of Contrast Enhancement in Hand MRI Studies of Patients with Rheumatoid Arthritis

Cited by 6 publications

References 27 publications

Advances in Imaging for Clinical Trials in Rheumatic Diseases

Advances in Imaging for Clinical Trials in Rheumatic Diseases

Magnetic resonance imaging RAMRIS‐SAFE score—A low‐risk effective measure of rapid response to therapy in rheumatoid arthritis clinical trials

A simplified fluid-sensitive MRI protocol for the hands to detect inflammation without contrast administration: a large study of symptom-free subjects from the general population as a reference for normality

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