Quantitative and semiquantitative imaging techniques in detecting joint inflammation in patients with rheumatoid arthritis : phase-shift water-fat MRI method for fat suppression at 0.23 T, contrast-enhanced dynamic and static MRI, and quantitative 99mTc-nanocolloid scintigraphy
1University of Oulu, Faculty of Medicine, Institute of Diagnostics, Department of Diagnostic Radiology
2University of Oulu, Faculty of Medicine, Institute of Clinical Medicine, Department of Internal Medicine
3Rheumatism Foundation Hospital
4University of Tampere, Department of Musculoskeletal Medicine and Rehabilitation, Medical School
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|Academic Dissertation to be presented, with the assent of the Faculty of Medicine of the University of Oulu, for public defence in Auditorium 7 of Oulu University Hospital, on September 26th, 2008, at 12 noon
Docent Kimmo Mattila
Professor Timo Möttönen
The purpose of this study was to evaluate the value of 0.23T low-field magnetic resonance imaging (MRI) and nanocolloid (NC) scintigraphy in assessing joint pathology associated with rheumatoid arthritis (RA).
Fat suppression methods combined with contrast media enhancement aid in distinguishing enhancing inflamed tissue from the surrounding fat, especially in the imaging of arthritic joints. The feasibility and image quality of a phase-shift water-fat MRI method for fat suppression at low-field 0.23T open configuration MR scanner was evaluated. The technique was combined with contrast-enhanced imaging to assess the conspicuity of synovial hypertrophy in the joints of 30 RA patients. Improved conspicuity and delineation of synovitis was detected with this method. However, because of a great amount of manual post processing, future development is needed to make this method more feasible.
Contrast-enhanced MRI and NC scintigraphy may provide objective and quantitative information about the inflammatory activity in arthritic joints. The value of quantitative and semiquantitative measures of inflammation derived from NC scintigraphy and low-field MRI of the wrist joint of 28 early RA patients was evaluated. Furthermore, it was investigated whether these parameters have predictive value of further erosive development during two years of follow-up.
Strong correlations were detected between the NC scintigraphy and MRI measures, and these parameters were associated with laboratory markers of inflammation. During the two-year follow-up, the initial MRI and NC scintigraphy measures were closely related with the progression of wrist joint erosions.
Small erosive-like bone defects can occasionally be found in wrist MRI of patients without clinically overt arthritis. The prevalence of these lesions was studied in bilateral wrist MRI examinations of 31 healthy persons. Small lesions resembling erosions were detected in 14 out of 31 subjects. Altogether 24 of the 930 wrist bones evaluated showed such lesions (3%). Thus small changes resembling erosions can be found in the wrist MRI of healthy subjects; the significance of these findings must always be interpreted with reference to the clinical picture.
In conclusion, early RA patients with high local inflammatory activity, as detected by NC scintigraphy and MRI are at risk of developing further bone damage. Furthermore, in the follow-up of early RA patients, if clinically sustained response is not achieved, these methods help to identify patients who need more intensive drug treatment.
Acta Universitatis Ouluensis. D, Medica
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