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Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness.

Materials and Methods

Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed.

Results

At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses.

Conclusion

Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment.

Key Points

Eliminating gadolinium contrast administration results in low specificity for synovitis

For tenosynovitis, sensitivity is low without gadolinium contrast administration

Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis

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References

  1. Krabben A, Stomp W, Huizinga TWJ et al (2013) Concordance between inflammation at physical examination and on MRI in patients with early arthritis. Ann Rheum Dis. doi:10.1136/annrheumdis-2013-204005

    Google Scholar 

  2. Østergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386

    PubMed  Google Scholar 

  3. Eshed I, Feist E, Althoff CE et al (2009) Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology (Oxford) 48:887–891

    Article  Google Scholar 

  4. Haavardsholm EA, Østergaard M, Ejbjerg BJ et al (2007) Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study. Ann Rheum Dis 66:1216–1220

    Article  PubMed Central  PubMed  Google Scholar 

  5. De Rooy DPC, van der Linden MPM, Knevel R et al (2011) Predicting arthritis outcomes–what can be learned from the Leiden Early Arthritis Clinic? Rheumatology (Oxford) 50:93–100

    Article  Google Scholar 

  6. Stomp W, Krabben A, van der Heijde D et al (2014) Are rheumatoid arthritis patients discernible from other early arthritis patients using 1.5 T extremity magnetic resonance imaging? A large cross-sectional study. J Rheumatol 41:1630–1637. doi:10.3899/jrheum.131169

  7. Stomp W, Krabben A, van der Heijde D et al (2014) Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema? Eur Radiol 24:2614–2622. doi:10.1007/s00330-014-3272-0

  8. Tamai M, Kawakami A, Uetani M et al (2012) Magnetic resonance imaging (MRI) detection of synovitis and bone lesions of the wrists and finger joints in early-stage rheumatoid arthritis: comparison of the accuracy of plain MRI-based findings and gadolinium-diethylenetriamine pentaacetic acid-enhanced MRI-based findings. Mod Rheumatol 22:654–658

    Article  PubMed  Google Scholar 

  9. Ostergaard M, Conaghan PG, O’Connor P et al (2009) Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection – Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol 36:1806–1810

    Article  PubMed  Google Scholar 

  10. Tehranzadeh J, Ashikyan O, Anavim A, Tramma S (2006) Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skelet Radiol 35:814–822

    Article  Google Scholar 

  11. Thomsen HS, Morcos SK, Almén T et al (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23:307–318

    Article  PubMed  Google Scholar 

  12. Hemke R, Kuijpers TW, van den Berg JM et al (2013) The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis. Eur Radiol 23:1998–2004. doi:10.1007/s00330-013-2770-9

  13. Loeuille D, Sauliere N, Champigneulle J et al (2011) Comparing non-enhanced and enhanced sequences in the assessment of effusion and synovitis in knee OA: associations with clinical, macroscopic and microscopic features. Osteoarthr Cartil/OARS, Osteoarthr Res Soc. doi:10.1016/j.joca.2011.08.010

    Google Scholar 

  14. Li X, Liu X, Du X, Ye Z (2014) Diffusion-weighted MR imaging for assessing synovitis of wrist and hand in patients with rheumatoid arthritis: A feasibility study. Magn Reson Imaging 32:350–353. doi:10.1016/j.mri.2013.12.008

  15. Jeromel M, Jevtič V, Serša I et al (2012) Quantification of synovitis in the cranio-cervical region: dynamic contrast enhanced and diffusion weighted magnetic resonance imaging in early rheumatoid arthritis–a feasibility follow up study. Eur J Radiol 81:3412–3419

    Article  CAS  PubMed  Google Scholar 

  16. Boss A, Martirosian P, Fritz J et al (2009) Magnetic resonance spin-labeling perfusion imaging of synovitis in inflammatory arthritis at 3.0 T. MAGMA 22:175–180

    Article  PubMed  Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is Monique Reijnierse. Wouter Stomp has received speaker fees from GE Healthcare. Mikkel Østergaard has received consultancy/speaker fees and/or research support form Abbott/Abbvie, BMS, Boehringer-Ingelheim, Eli-Lilly, Centocor, GSK, Janssen, Merck, Mundipharma, Novo, Pfizer, Schering-Plough, Roche UCB, and Wyeth. This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl), and the Dutch Arthritis Foundation, project TRACER (grant 04I-202). The research has also been funded by The European Community Seventh Framework Program FP7 Health-F2-2008-223404 (Masterswitch) as well as by a European grant from the Innovative medicine Initiative: BTCURE. This work of A. van der Helm-van Mil is supported by a Vidi-grant of the Netherlands Organisation for Scientific Research. The work of A. Krabben is supported by a grant of the Dutch Arthritis Foundation. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects in this study. Patients are participating in the Leiden Early Arthritis clinic, and multiple articles have been published about this cohort with ongoing inclusion, including two other studies on MRI results (Krabben A, Stomp W, Huizinga TWJ, et al. (2013) Concordance between inflammation at physical examination and on MRI in patients with early arthritis. Ann Rheum Dis. doi: 10.1136/annrheumdis-2013-204005 and Stomp W, Krabben A, van der Heijde D, et al. (2014) Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema? Eur Radiol 24:2614–2622. doi: 10.1007/s00330-014-3272-0). Methodology: prospective cross sectional study performed at one institution.

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Stomp, W., Krabben, A., van der Heijde, D. et al. Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?. Eur Radiol 25, 1520–1527 (2015). https://doi.org/10.1007/s00330-014-3522-1

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  • DOI: https://doi.org/10.1007/s00330-014-3522-1

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