Quantitative MR characterization of disease activity in the knee in children with juvenile idiopathic arthritis: a longitudinal pilot study
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The development of a quantifiable and noninvasive method of monitoring disease activity and response to therapy is vital for arthritis management.
The purpose of this study was to investigate the utility of quantitative dynamic contrast-enhanced MRI (DCE-MRI) based on pharmacokinetic (PK) modeling to evaluate disease activity in the knee and correlate the results with the clinical assessment in children with juvenile idiopathic arthritis (JIA).
Materials and methods
A group of 17 children with JIA underwent longitudinal clinical and laboratory assessment and DCE-MRI of the knee at enrollment, 3 months, and 12 months. A PK model was employed using MRI signal enhancement data to give three parameters, Ktrans ′ (min−1), kep (min−1), and Vp ′ and to calculate synovial volume.
The PK parameters, synovial volumes, and clinical and laboratory assessments in most children were significantly decreased (P < 0.05) at 12 months when compared to the enrollment values. There was excellent correlation between the PK and synovial volume and the clinical and laboratory assessments. Differences in MR and clinical parameter values in individual subjects illustrate persistent synovitis when in clinical remission.
A decrease in PK parameter values obtained from DCE-MRI in children with JIA likely reflects diminution of disease activity. This technique may be used as an objective follow-up measure of therapeutic efficacy in patients with JIA. MR imaging can detect persistent synovitis in patients considered to be in clinical remission.
KeywordsJuvenile idiopathic arthritis Synovial volume Dynamic contrast-enhanced MRI (DCE-MRI) Pharmacokinetic modeling
B.J. Dardzinski, T. Laor, and T.B. Graham acknowledge funding from the Arthritis Foundation, a Cincinnati Children’s Hospital Trustees grant, and NIH grants P30 AR47363-01 and P60 AR47784-01.
- 6.Ostergaard M, Hansen M, Stoltenberg M et al (1999) Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 42:918–929PubMedCrossRefGoogle Scholar
- 12.Ostergaard M, Stoltenberg M, Lovgreen-Nielsen P et al (1998) Quantification of synovitis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 16:743–754PubMedCrossRefGoogle Scholar
- 24.Workie D, Dardzinski B, Laor T et al (2004) Quantification of DCE-MRI of knees of children with JRA: using an arterial input function extracted from popliteal artery enhancement. Proceedings of the 12th International Society for Magnetic Resonance in Medicine (ISMRM). 15–21 May 2004, Kyoto, JapanGoogle Scholar
- 25.Workie DW, Dardzinski BJ (2005) Quantifying dynamic contrast-enhanced MRI of the knee in children with juvenile rheumatoid arthritis using an arterial input function (AIF) extracted from popliteal artery enhancement, and the effect of the choice of the AIF on the kinetic parameters. Magn Reson Med 54:560–568PubMedCrossRefGoogle Scholar
- 31.Dardzinski BJ, Schmithorst VJ, Grahm TB (2002) Dynamic contrast enhancement patterns in the knee of children with JRA. Proceedings of the 10th ISMRM Annual Meeting. Honolulu, HawaiiGoogle Scholar
- 32.Dardzinski BJ, Schmithorst VJ, Mosher TJ (1999) Entropy mapping of articular cartilage. Proceedings of the 7th ISMRM Annual Meeting. Philadelphia, PAGoogle Scholar
- 33.Everitt BS, Landau S, Leese M (2001) Cluster analysis, 4th edn. Arnold, LondonGoogle Scholar
- 34.Hartigan JA (1975) Clustering algorithms. Wiley, New YorkGoogle Scholar
- 40.Nistala K, Babar J, Johnson K et al (2006) Clinical assessment and core outcome variables are poor predictors of hip arthritis diagnosed by MRI in juvenile idiopathic arthritis. Rheumatology (Oxford) DOI 10.1093/rheumatology/kel401
- 41.Brown AK, Quinn MA, Karim Z et al (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54:3761–3773PubMedCrossRefGoogle Scholar