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Update on recent developments in imaging of inflammation in osteoarthritis: a narrative review

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Abstract

Synovitis is an important component of the osteoarthritis (OA) disease process, particularly regarding the “inflammatory phenotype” of OA. Imaging plays an important role in the assessment of synovitis in OA with MRI and ultrasound being the most deployed imaging modalities. Contrast-enhanced (CE) MRI, particularly dynamic CEMRI (DCEMRI) is the ideal method for synovitis assessment, but for several reasons CEMRI is not commonly performed for OA imaging in general. Effusion-synovitis and Hoffa-synovitis are commonly used as surrogate markers of synovitis on non-contrast-enhanced (NCE) MRI and have been used in many epidemiological observational studies of knee OA. Several semiquantitative MRI scoring systems are available for the evaluation of synovitis in knee OA. Synovitis can be a target tissue for disease-modifying OA drug (DMOAD) clinical trials. Both MRI and ultrasound may be used to determine the eligibility and assess the therapeutic efficacy of DMOAD approaches. Ultrasound is mostly used for evaluation of synovitis in hand OA, while MRI is typically used for larger joints, namely knees and hips. The role of other modalities such as CT (including dual-energy CT) and nuclear medicine imaging (such as positron-emission tomography (PET) and its hybrid imaging) is limited in the context of synovitis assessment in OA. Despite research efforts to develop NCEMRI-based synovitis evaluation methods, these typically underestimate the severity of synovitis compared to CEMRI, and thus more research is needed before we can rely only on NCEMRI.

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Authors and Affiliations

  1. Department of Radiology, Stony Brook University Renaissance School of Medicine, HSc Level 4, Room 120, Stony Brook, NY, 11794, USA

    Daichi Hayashi

  2. Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    Daichi Hayashi, Frank W. Roemer & Ali Guermazi

  3. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Daichi Hayashi

  4. Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany

    Frank W. Roemer

  5. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Mohamed Jarraya

  6. VA Boston Healthcare System, West Roxbury, Boston, MA, USA

    Ali Guermazi

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Correspondence to Daichi Hayashi.

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Conflict of interest

DH received publication royalties from Wolters Kluwer. FWR is a consultant to Calibr and Grünenthal. He is a shareholder to of Boston Imaging Core Lab., LLC. MJ has nothing to disclose. AG received consultancy fees from Pfizer, Novartis, MerckSerono, TissueGene, AstraZeneca, and Regeneron. He is a shareholder of Boston Imaging Core Lab., LLC.

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Key points

• Synovitis is an important component of the osteoarthritis (OA) disease process, particularly in the “inflammatory phenotype” of OA.

• Imaging plays an important role in the assessment of synovitis in OA.

• Contrast-enhanced MRI (CEMRI) and particularly dynamic CEMRI are the ideal methods for synovitis assessment in a research and clinical trial setting.

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Hayashi, D., Roemer, F.W., Jarraya, M. et al. Update on recent developments in imaging of inflammation in osteoarthritis: a narrative review. Skeletal Radiol 52, 2057–2067 (2023). https://doi.org/10.1007/s00256-022-04267-3

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