M Østergaard1, M Klarlund. 1. The Danish Research Centre of Magnetic Resonance and the Department of Rheumatology, Hvidovre Hospital, Denmark. mo@dadlnet.dk
Abstract
BACKGROUND: Volumes of inflamed synovial membrane determined by magnetic resonance imaging (MRI) are closely related to histopathological synovitis and may predict erosive progression in rheumatoid arthritis (RA). However, after IV injection, leakage of MRI contrast from the synovium gradually compromises the differentiation of synovium from joint fluid. OBJECTIVE: To determine the time period after IV MRI contrast (gadolinium-DTPA (Gd)) injection in which synovial membrane volume determination is reliable. METHODS: MRI of five RA knees with clinical synovitis was carried out, with axial, T(1) weighted, spin echo images before IV Gd injection and every 1.75 minutes for 60 minutes post-Gd. By a semiautomated "signal enhancement threshold" method, including voxels with >35% or >45% relative post-Gd enhancement, synovial membrane volumes were estimated at each time point. At 4.25 minutes post-Gd, volumes were also determined by a more accurate but time consuming "manual method". RESULTS: The initially observed synovium-effusion borderline remained clearly visible, and on the same location, within at least the initial 11 minutes post-Gd (that is, within the normal time frame of post-Gd imaging in RA) but started blurring and moving centripetally thereafter. Compared with volumes at all other time points, synovial membrane volumes at 0.75 and 2.50 minutes post-Gd were significantly lower (Wilcoxon-Pratt), suggesting that some synovial membrane areas had not yet exceeded the enhancement threshold. Thereafter, the measured volumes remained practically unchanged. CONCLUSION: This study suggests that MR image acquisition in arthritic knee joints should be performed within the initial approximately 10 minutes after gadolinium contrast injection to achieve the most accurate distinction between synovium and joint fluid but that small time variations are not of major importance to the measured synovial membrane volumes.
BACKGROUND: Volumes of inflamed synovial membrane determined by magnetic resonance imaging (MRI) are closely related to histopathological synovitis and may predict erosive progression in rheumatoid arthritis (RA). However, after IV injection, leakage of MRI contrast from the synovium gradually compromises the differentiation of synovium from joint fluid. OBJECTIVE: To determine the time period after IV MRI contrast (gadolinium-DTPA (Gd)) injection in which synovial membrane volume determination is reliable. METHODS: MRI of five RA knees with clinical synovitis was carried out, with axial, T(1) weighted, spin echo images before IV Gd injection and every 1.75 minutes for 60 minutes post-Gd. By a semiautomated "signal enhancement threshold" method, including voxels with >35% or >45% relative post-Gd enhancement, synovial membrane volumes were estimated at each time point. At 4.25 minutes post-Gd, volumes were also determined by a more accurate but time consuming "manual method". RESULTS: The initially observed synovium-effusion borderline remained clearly visible, and on the same location, within at least the initial 11 minutes post-Gd (that is, within the normal time frame of post-Gd imaging in RA) but started blurring and moving centripetally thereafter. Compared with volumes at all other time points, synovial membrane volumes at 0.75 and 2.50 minutes post-Gd were significantly lower (Wilcoxon-Pratt), suggesting that some synovial membrane areas had not yet exceeded the enhancement threshold. Thereafter, the measured volumes remained practically unchanged. CONCLUSION: This study suggests that MR image acquisition in arthritic knee joints should be performed within the initial approximately 10 minutes after gadolinium contrast injection to achieve the most accurate distinction between synovium and joint fluid but that small time variations are not of major importance to the measured synovial membrane volumes.
Authors: M Ostergaard; B Ejbjerg; M Stoltenberg; P Gideon; B Volck; K Skov; C H Jensen; I Lorenzen Journal: Ann Rheum Dis Date: 2001-03 Impact factor: 19.103
Authors: Ali Guermazi; Frank W Roemer; Daichi Hayashi; Michel D Crema; Jingbo Niu; Yuqing Zhang; Monica D Marra; Avinash Katur; John A Lynch; George Y El-Khoury; Kristin Baker; Laura B Hughes; Michael C Nevitt; David T Felson Journal: Ann Rheum Dis Date: 2010-12-27 Impact factor: 19.103
Authors: Frank W Roemer; David T Felson; Tianzhong Yang; Jingbo Niu; Michel D Crema; Martin Englund; Michael C Nevitt; Yuqing Zhang; John A Lynch; George Y El Khoury; James Torner; Cora E Lewis; Ali Guermazi Journal: Semin Arthritis Rheum Date: 2012-12-25 Impact factor: 5.532
Authors: Jasper F M M Rieter; Laura Tanturri de Horatio; Charlotte M Nusman; Lil-Sofie Ording Müller; Robert Hemke; Derk F M Avenarius; Marion A J van Rossum; Clara Malattia; Mario Maas; Karen Rosendahl Journal: Pediatr Radiol Date: 2016-07-12
Authors: Karen Lambot; Peter Boavida; Maria Beatrice Damasio; Laura Tanturri de Horatio; Marie Desgranges; Clara Malattia; Domenico Barbuti; Claudia Bracaglia; Lil-Sofie Ording Müller; Caroline Elie; Brigitte Bader-Meunier; Pierre Quartier; Karen Rosendahl; Francis Brunelle Journal: Pediatr Radiol Date: 2013-02-05
Authors: Anouk M Barendregt; E Charlotte van Gulik; Paul F C Groot; Koert M Dolman; J Merlijn van den Berg; Amara Nassar-Sheikh Rashid; Dieneke Schonenberg-Meinema; Cristina Lavini; Karen Rosendahl; Robert Hemke; Taco W Kuijpers; Mario Maas; Charlotte M Nusman Journal: Pediatr Radiol Date: 2019-02-01
Authors: Ali Guermazi; Daichi Hayashi; Frank W Roemer; Yanyan Zhu; Jingbo Niu; Michel D Crema; M Kassim Javaid; Monica D Marra; John A Lynch; George Y El-Khoury; Yuqing Zhang; Michael C Nevitt; David T Felson Journal: J Rheumatol Date: 2014-01-15 Impact factor: 4.666