Quantifying Bone Marrow Edema in the Rheumatoid Cervical Spine Using Magnetic Resonance Imaging
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Objective. To determine the reliability and feasibility of a new magnetic resonance imaging (MRI) score to quantify bone marrow edema (BME), synovitis, and erosions in the cervical spine of patients with rheumatoid arthritis (RA); and to investigate the correlations among neck pain, clinical markers of RA disease activity, and MRI features of disease activity in the cervical spine. Methods. Thirty patients with RA (50% with neck pain) and a Disease Activity Score 28-joint count > 3.2 had an MRI scan of their cervical spine. STIR, VIBE, and T1-weighted postcontrast sequences were used to quantify BME. MRI scans were scored for total BME, synovitis, and erosions using a new scoring method developed by the authors and assessed for reliability and feasibility. Associations between neck pain and clinical markers of disease activity were investigated. Results. BME was present in 14/30 patients; 9/14 (64%) had atlantoaxial BME, 10/14 (71%) had subaxial BME, and 5/14 (36%) had both. Interobserver reliability for total cervical BME score was moderate [intraclass correlation coefficient (ICC) = 0.51]. ICC improved to 0.67 if only the vertebral bodies and dens were considered. There was no correlation between neck pain or clinical measures of RA disease activity and the presence of any MRI features including BME, synovitis, or erosions. Conclusion. Current RA disease activity scores do not identify activity in the cervical spine. An MRI score that quantifies BME, synovitis, and erosions in the cervical spine may provide useful information regarding inflammation and damage. This could alert clinicians to the presence of significant pathology and influence management.Keywords:
Neck pain
Objective. To determine the reliability and feasibility of a new magnetic resonance imaging (MRI) score to quantify bone marrow edema (BME), synovitis, and erosions in the cervical spine of patients with rheumatoid arthritis (RA); and to investigate the correlations among neck pain, clinical markers of RA disease activity, and MRI features of disease activity in the cervical spine. Methods. Thirty patients with RA (50% with neck pain) and a Disease Activity Score 28-joint count > 3.2 had an MRI scan of their cervical spine. STIR, VIBE, and T1-weighted postcontrast sequences were used to quantify BME. MRI scans were scored for total BME, synovitis, and erosions using a new scoring method developed by the authors and assessed for reliability and feasibility. Associations between neck pain and clinical markers of disease activity were investigated. Results. BME was present in 14/30 patients; 9/14 (64%) had atlantoaxial BME, 10/14 (71%) had subaxial BME, and 5/14 (36%) had both. Interobserver reliability for total cervical BME score was moderate [intraclass correlation coefficient (ICC) = 0.51]. ICC improved to 0.67 if only the vertebral bodies and dens were considered. There was no correlation between neck pain or clinical measures of RA disease activity and the presence of any MRI features including BME, synovitis, or erosions. Conclusion. Current RA disease activity scores do not identify activity in the cervical spine. An MRI score that quantifies BME, synovitis, and erosions in the cervical spine may provide useful information regarding inflammation and damage. This could alert clinicians to the presence of significant pathology and influence management.
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Poster: ECR 2011 / C-0452 / The role of very early diagnosis and treatment of RA in the reversibility of bone edema , synovitis and bone erosions evaluated by Magnetic Resonance Imaging of the dominant hand by: P. Kosta , P. V. VOULGARI, A. Zikou, A. drosos, M. Argyropoulou; Ioannina/GR
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The cervical spine is commonly destroyed in rheumatoid arthritis. Spinal fusion for deformity of the cervical spine was done in thirty-one patients. We analyzed these postoperative results and defined the operative indications for this disorder. The range of follow-up was three months to twenty years. There were twelve postoperative deaths but almost all of the remaining patients were satisfied with the operation, because they were pain-free.
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Magnetic resonance imaging (MRI) allows the direct visualization of many bone and soft tissue changes in rheumatoid arthritis. Synovitis volume, bone marrow oedema and bone erosions are suitable for serial measurement. The outcome measures in rheumatoid arthritis clinical trials (OMERACT) rheumatoid arthritis magnetic resonance imaging (RAMRIS) system is designed to allow straightforward, reproducible scoring of all these features. Alternatively, synovial volumes may be directly and quickly measured using semi-automated techniques. There is the potential for similar systems for measuring erosions. Dynamic contrast enhanced MRI depends on the rate of enhancement of the synovium after intravenous contrast agent. Measurements depend on the underlying physiology of the inflamed synovium, in particular the vascularity and capillary permeability which are expected to closely mirror inflammatory activity in the joint. Measurements from MRI have been shown to correlate with clinical, laboratory, imaging and histological measures of inflammation, predict erosive progression and respond rapidly to various types of treatment. They are, therefore, expected to be good measures of disease activity, progression and response to therapy.
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To evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in detecting erosions, bone edema, and synovitis in the metacarpophalangeal and wrist joints for rheumatoid arthritis (RA).MRI scans of bilateral hands and wrists of 40 healthy subjects and 40 RA patients were performed using 0.2 T extremity-MRI and read blindly using a modified RA MRI (RAMRIS) system (no contrast injection, imaging in 1 plane only). To determine interreader reliability, images of 10 randomly selected subjects were read independently by a musculoskeletal radiologist.A total of 3360 bones were evaluated. Patients with RA had significantly more erosions as well as higher scores for bone edema and synovitis than healthy subjects. Age had a significant effect on the number of erosions in both groups. However, when disease duration was factored in, age became insignificant in RA patients. Erosion number correlated with positive rheumatoid factor and higher C-reactive protein values. The intraclass correlation coefficient between the 2 readers was 0.76 for individual joints and 0.88 for total scores. When having a single erosion was used as a positive test for RA, the sensitivity of this test was 90%, but the specificity was only 35%. Presence of bone edema provided 65% sensitivity and 82.5% specificity. Eliminating the lunate from scoring for bone edema increased the specificity to 87.5% while decreasing the sensitivity to 62.5%.While MRI is a highly sensitive tool for identifying and tracking the progression of erosions, erosions detected by MRI with measures commonly used in a rheumatologist's office (no contrast, imaging in 1 plane) provide low specificity for RA. Bone marrow edema is the most specific MRI lesion for RA in this setting.
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Background
The Rheumatoid Arthritis Magnetic Resonance Imaging Score(RAMRIS) is validated for magnetic resonance imaging (MRI) of the hand. Its' reliability when applied to metatarsophalangeal(MTP-1-5)-joints is unknown.Objectives
To assess the interreader- and intrareader-reliability of status scores and the interreader-reliability of change scores applied to the MTP-joints for the following MRI-outcomes: bone marrow edema, synovitis, tenosynovitis and erosions.Methods
Patients underwent 1.5T MRI of MTP(1-5)-joints. Two readers scored bone marrow edema(BME), synovitis, tenosynovitis and erosions. Interreader reliability was assessed of 441 consecutive early arthritis patients at baseline, the first 215 by two readers, the remaining 226 by two different readers. Additionally, baseline MRIs of 82 consecutive patients with arthralgia were scored by two readers, a random set of 40 patients by seven additional readers (nine readers in total). Intrareader reliability was determined on a random set of 15 early arthritis patients, scored twice by two readers. For change-scores, 30 early arthritis patients with baseline and 1-year follow-up MRI were scored by two readers. Intraclass correlation coefficients(ICCs), Bland-Altman(BA)-plots and smallest detectable change(SDC) were determined.Results
Interreader mean scores and ICCs in early arthritis are presented in Table 1; ICCs were good to excellent (0.85-0.92) In arthralgia-patients mean scores were lower, ICCs were comparable (Table 1). Intrareader ICCs for MRI-features were good to excellent (0.84-0.98), but for erosions moderate for reader 1 (0.71 and excellent for reader 2 (0.92). Mean change scores and ICCs are presented in Table 2; ICCs were generally excellent (≥0.90), but moderate for erosions (0.77). SDCs were ≤1.0. BA-plots for status and change scores showed no systematic bias.Conclusion
Status and change MRI-scores of BME, synovitis, tenosynovitis and erosions of MTP-joints can be assessed reliably by the RAMRIS. This is encouraging for the use of MRI of the MTP-joints in trials in early phases of RA.Disclosure of Interests
Yousra Dakkak: None declared, Xanthe Matthijssen: None declared, Désirée van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Union Chimique Belge, Monique Reijnierse Grant/research support from: Funding from the Dutch Arthritis Foundation. The funding source had no role in the design and conduct of the study., Annette van der Helm - van Mil Grant/research support from: The research leading to these results has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (Starting grant, agreement No 714312) and from the Dutch Arthritis Foundation. The funding source had no role in the design and conduct of the study.Tenosynovitis
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