Towards a simplified fluid-sensitive MRI protocol in small joints of the hand in early arthritis patients: reliability between modified Dixon and regular Gadolinium enhanced TSE fat saturated MRI-sequences

Abstract

Objective MRI of small joints plays an important role in the early detection and early treatment of rheumatoid arthritis. Despite its sensitivity to demonstrate inflammation, clinical use is hampered by accessibility, long scan time, intravenous contrast, and consequent high costs. To improve the feasibility of MRI implementation in clinical practice, we introduce a modified Dixon sequence, which does not require contrast and reduces total acquisition time to 6 min. Because the reliability in relation to conventional MRI sequences is unknown, we determined this. Methods In 29 consecutive early arthritis patients, coronal and axial T2-weighted modified Dixon acquisitions on 3.0 T MRI scanner were acquired from metacarpophalangeal 2-5 to the wrist, followed by the standard contrast-enhanced protocol on 1.5 T extremity MRI. Two readers scored osteitis, synovitis and tenosynovitis (summed as total MRI-inflammation), and erosions (all summed as total Rheumatoid Arthritis MRI Score (RAMRIS)). Intraclass correlation coefficients (ICCs) between readers, and comparing the two sequences, were studied. Spearman correlations were determined. Results Performance between readers was good/excellent. Comparing modified Dixon and conventional sequences revealed good/excellent reliability: ICC for total MRI-inflammation score was 0.84 (95% CI:0.70-0.92), for erosions 0.90 (95% CI:0.79-0.96), and for the total RAMRIS score 0.88 (95% CI:0.77-0.94). The scores of total MRI-inflammation, total erosions, and total RAMRIS were highly correlated (ρ = 0.80, ρ = 0.81, ρ = 0.82, respectively). ConclusionThe modified Dixon protocol is reliable compared to the conventional MRI protocol, suggesting it is accurate to detect MRI inflammation. The good correlation may be the first step towards a patient-friendly, short and affordable MRI protocol, which can facilitate the implementation of MRI for early detection of inflammation in rheumatology practice.

The Natural Sequence in Which Subclinical Inflamed Joint Tissues Subside or Progress to Rheumatoid Arthritis: A Study of Serial MRIs in the TREAT EARLIER Trial

“…Such a study is impossible with the current Rheumatoid Arthritis Magnetic Resonance Imaging Scoring protocol because of the high costs related to the long scan times and because contrast agent administration is required to depict synovitis and tenosynovitis and high frequent administration of intravenous contrast agent may increase the risk of gadolinium depositions (18). Advanced MRI protocols however require less scanning time (<10 minutes) and do not need intravenous contrast administration (19). These advances may allow for frequently repeated MRIs in the near future and make it possible to discern more specifically in which joint tissue inflammation starts during the development of RA.…”

“…A further understanding of the trajectories and temporal orders may propose an emerging opportunity to advance prognostication toward staging, as used, for example, for different types of malignancies or chronic kidney disease. The development of a staging system in CSA, using the earlier mentioned MRI techniques that allow serial MRIs at shorter intervals, is a subject for further research (19). Once a staging system for the trajectory from CSA to RA is developed, possible future treatment of arthralgia patients might be different for various substages, with an aim of inducing recovery toward a better stage.…”

High-resolution ultrasound and MRI in the evaluation of the forefoot and midfoot

“…To reduce costs and optimize image resolution, only the most symptomatic joint area, rather than MRI of both wrists, hands, ankles, and feet, is undertaken (35) . MRI of early RA is facilitated by using a short, modified Dixon protocol instead of gadolinium-enhanced T1W FS MRI-sequences (36) .…”

Advances in the application of manganese dioxide and its composites for theranostics

“…17 Molecular imaging is a valuable method in disease diagnosis to assess metabolic changes and detect disease progression. With rapid advancements in nanotechnology, MITs including photoacoustic imaging (PA), 18 fluorescence (FL) imaging, 19 single-photon emission computed tomography, 20 optical microscopy, 21 positron emission computed tomography 22 and magnetic resonance imaging (MRI), 23 have attracted significant attention based on nanometer-scale contrast agents. Among them, MRI contrast agents can provide anatomical structures and pathology with a high spatial resolution, [24][25][26] these agents are used in the fields of inflammation detection, 27 fibrosis diagnosis, 28 thromboembolic disease imaging 29 and cancer therapy.…”