Fabian Hilbert1, Annette Holl-Wieden2, Alexander Sauer1, Herbert Köstler1, Henning Neubauer3,4. 1. Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany. 2. Department of Paediatrics, University Hospital Wuerzburg, Wuerzburg, Germany. 3. Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany. inu75@web.de. 4. Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. inu75@web.de.
Abstract
BACKGROUND: MRI of synovitis relies on use of a gadolinium-based contrast agent. Diffusion-weighted MRI (DWI) visualises thickened synovium but is of limited use in the presence of joint effusion. OBJECTIVE: To investigate the feasibility and diagnostic accuracy of diffusion-weighted MRI with intravoxel incoherent motion (IVIM) for diagnosing synovitis in the knee joint of children with juvenile idiopathic arthritis. MATERIALS AND METHODS: Twelve consecutive children with confirmed or suspected juvenile idiopathic arthritis (10 girls, median age 11 years) underwent MRI with contrast-enhanced T1-weighted imaging and DWI at 1.5 T. Read-out segmented multi-shot DWI was acquired at b values of 0 s/mm2, 200 s/mm2, 400 s/mm2 and 800 s/mm2. We calculated the IVIM parameters perfusion fraction (f) and tissue diffusion coefficient (D). Diffusion-weighted images at b=800 s/mm2, f parameter maps and post-contrast T1-weighted images were retrospectively assessed by two independent readers for synovitis using the Juvenile Arthritis MRI Scoring system. RESULTS: Seven (58%) children showed synovial hypertrophy on contrast-enhanced imaging. Diagnostic ratings for synovitis on DWI and on f maps were fully consistent with contrast-enhanced imaging, the diagnostic reference. Two children had equivocal low-confidence assessments on DWI. Median f was 6.7±2.0% for synovitis, 2.1±1.2% for effusion, 5.0±1.0% for muscle and 10.6±5.7% for popliteal lymph nodes. Diagnostic confidence was higher based on f maps in three (25%) children and lower in one child (8%), as compared to DWI. CONCLUSION: DWI with IVIM reliably visualises synovitis of the knee joint. Perfusion fraction maps differentiate thickened synovium from joint effusion and hence increase diagnostic confidence.
BACKGROUND: MRI of synovitis relies on use of a gadolinium-based contrast agent. Diffusion-weighted MRI (DWI) visualises thickened synovium but is of limited use in the presence of joint effusion. OBJECTIVE: To investigate the feasibility and diagnostic accuracy of diffusion-weighted MRI with intravoxel incoherent motion (IVIM) for diagnosing synovitis in the knee joint of children with juvenile idiopathic arthritis. MATERIALS AND METHODS: Twelve consecutive children with confirmed or suspected juvenile idiopathic arthritis (10 girls, median age 11 years) underwent MRI with contrast-enhanced T1-weighted imaging and DWI at 1.5 T. Read-out segmented multi-shot DWI was acquired at b values of 0 s/mm2, 200 s/mm2, 400 s/mm2 and 800 s/mm2. We calculated the IVIM parameters perfusion fraction (f) and tissue diffusion coefficient (D). Diffusion-weighted images at b=800 s/mm2, f parameter maps and post-contrast T1-weighted images were retrospectively assessed by two independent readers for synovitis using the Juvenile Arthritis MRI Scoring system. RESULTS: Seven (58%) children showed synovial hypertrophy on contrast-enhanced imaging. Diagnostic ratings for synovitis on DWI and on f maps were fully consistent with contrast-enhanced imaging, the diagnostic reference. Two children had equivocal low-confidence assessments on DWI. Median f was 6.7±2.0% for synovitis, 2.1±1.2% for effusion, 5.0±1.0% for muscle and 10.6±5.7% for popliteal lymph nodes. Diagnostic confidence was higher based on f maps in three (25%) children and lower in one child (8%), as compared to DWI. CONCLUSION: DWI with IVIM reliably visualises synovitis of the knee joint. Perfusion fraction maps differentiate thickened synovium from joint effusion and hence increase diagnostic confidence.
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Authors: Robert Hemke; Nele Herregods; Jacob L Jaremko; Gunnar Åström; Derk Avenarius; Fabio Becce; Dennis K Bielecki; Mikael Boesen; Danoob Dalili; Chiara Giraudo; Kay-Geert Hermann; Paul Humphries; Amanda Isaac; Anne Grethe Jurik; Andrea S Klauser; Ola Kvist; Frederiek Laloo; Mario Maas; Adam Mester; Edwin Oei; Amaka C Offiah; Patrick Omoumi; Olympia Papakonstantinou; Athena Plagou; Susan Shelmerdine; Paolo Simoni; Iwona Sudoł-Szopińska; Laura Tanturri de Horatio; James Teh; Lennart Jans; Karen Rosendahl Journal: Eur Radiol Date: 2020-05-12 Impact factor: 5.315