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Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis

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Abstract

Objective

Dynamic contrast-enhanced MRI of patients with rheumatoid arthritis has shown a decrease in the early enhancement rate (EER) of synovitis after treatment. The purpose of this work was to investigate the underlying changes.

Methods

3D dynamic contrast-enhanced images were acquired from 13 patients before and 1–2 weeks after anti-TNFα treatment. The EER of the inflamed synovium was measured. The T1 relaxation time of the synovitis was calculated from images at different flip angles. The time course of the arrival of gadolinium at the radial artery was determined. The gadolinium enhancement of the inflamed synovium was modeled to calculate the fractional plasma volume (vp), the fractional extravascular, extracellular fluid volume (ve), and the volume transfer constant (Ktrans). Pre- and post-treatment values were compared and the dependence of the EER on each parameter was assessed.

Results

There was a decrease in the EER measured over 26 s after treatment (29%, p = 0.002). Reductions in T1 (12%, p = 0.001), Ktrans (31%, p = 0.002), and vp (43%, p = 0.01) contributed to this; however, the EER was relatively insensitive to changes in ve.

Conclusions

The decrease in EER after anti-TNFα treatment is largely caused by reductions in the volume transfer constant Ktrans, the fractional plasma volume vp, and the T1 relaxation time. Only the contributions from Ktrans and vp directly reflect synovial vascularity.

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Acknowledgements

The authors acknowledge Dr Marta Garcia-Finana and Mrs Susanna Dodd for professional statistical guidance, and the Royal College of Radiologists, UK, for a Research Fellowship.

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Authors and Affiliations

  1. MARIARC, University of Liverpool, Pembroke Place, Liverpool, L69 3GE, UK

    Richard J. Hodgson

  2. Clinical Rheumatology, School of Clinical Sciences, University of Aintree, Liverpool, UK

    Theresa Barnes & Robert Moots

  3. Whiston Hospital, Merseyside, UK

    Sylvia Connolly

  4. University Hospital Aintree, Liverpool, UK

    Brian Eyes

  5. Royal Liverpool Hospital, Liverpool, UK

    Robert S. D. Campbell

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  1. Richard J. Hodgson
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  2. Theresa Barnes
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  3. Sylvia Connolly
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  4. Brian Eyes
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  5. Robert S. D. Campbell
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Correspondence to Richard J. Hodgson.

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Hodgson, R.J., Barnes, T., Connolly, S. et al. Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis. Skeletal Radiol 37, 201–207 (2008). https://doi.org/10.1007/s00256-007-0408-1

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  • DOI: https://doi.org/10.1007/s00256-007-0408-1

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