Combined High-Resolution Single Photon Emission Computed Tomography and Magnetic Resonance Imaging for Therapy Monitoring in Rheumatoid Arthritis

Philipp Sewerin¹, Christian Buchbender², Katalin Mattes-György³, Falk Miese², Hans-Jörg Wittsack², Christof Specker⁴, Gerald Antoch², Matthias Schneider⁵, Axel Scherer² and Ben Ostendorf¹, ¹Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany, ²Diagnostic and Interventional Radiology, Heinrich-Heine-University, Düsseldorf, Germany, ³Nuclear Medicine, Heinrich-Heine-University, Düsseldorf, Germany, ⁴Department of rheumatology and clinical immunology, Hospital Essen Sued, Essem, Germany, ⁵Endocrinology, Diabetology and Rheumatology, Heinrich-Heine-University, Duesseldorf, Germany

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: joint destruction, Magnetic resonance imaging (MRI), positron emission tomography (PET) and rheumatoid arthritis (RA)

Session Information

Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging, Computed Tomography and X-ray

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To evaluate whether combined multi-pinhole single photon emission computed tomography (MPH-SPECT) with technetium-99m-labelled disphosphonates (Tc99m-DPD) and magnetic resonance imaging (MRI) detect changes in inflammation in early rheumatoid arthritis (ERA) patients under methotrexat (MTX) therapy and to investigate the relation between Tc99m-DPD uptake and the development of erosion.

Methods:

MPH-SPECT and MRI of metacarpophalangeal joints (MCP) have been prospectively performed in 10 consecutive ERA patients (8 female, 2 male; 49 ± 13 years [mean ± SD]), range: 24 – 68) prior to and 6 months after initiation of MTX. The Tc99m-DPD uptake was measured using a region of analysis. The course of synovitis, bone marrow edema (BME) and erosions were scored according to the Rheumatoid Arthritis MRI Score (RAMRIS) criteria.

Results:

The frequency of increased Tc99m-DPD uptake, synovitis and BME decreased under MTX therapy; but the number of bone erosions increased. Joints with progressive and newly developed erosions on follow-up had a higher baseline Tc99m-DPD uptake (2.64 ±1.23 vs. 1.43 ±0.91) (p< 0.001). Joints with persistent synovitis did not show higher Tc99m-DPD uptake values (1.56 ±1.27 vs. 1.47 ± 0.75) (p= 0.74). There was no correlation between persistence of synovitis and the development of erosions (Fc= 0.3, p= 0.12).

Conclusion:

Persistence of synovitis seems to be independent from Tc99m-DPD uptake and the development of erosions, while early increased bone metabolism is found in MCP joints which show erosive progression under MTX therapy. Hybrid MPH-SPECT and MRI might thus provide valuable additional information for individual risk-stratified therapeutic decisions.

Disclosure:

P. Sewerin,
None;

C. Buchbender,
None;

K. Mattes-György,
None;

F. Miese,
None;

H. J. Wittsack,
None;

C. Specker,
None;

G. Antoch,
None;

M. Schneider,
None;

A. Scherer,
None;

B. Ostendorf,
None.

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