ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1857

High-resolution MRI Assessment of Flexor Tendon Pulleys in Psoriatic Arthritis for Disease Monitoring and Differentiation from Rheumatoid Arthritis Using a 16-channel Hand Coil

Philipp Sewerin1, Daniel Benjamin Abrar 2, Dennis McGonagle 3, Miriam Frenken 2, Karl Ludgar Ratke 4, Stefan Vordenbaeumen 5, Ralph Brinks 6, Matthias Schneider 7, Benedikt Ostendorf 5 and Christoph Schleich 2, 1Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf,, Duesseldorf, Germany, 2Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University, Duesseldorf, Germany, 3University of Leeds, Leeds, United Kingdom, 4Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Duesseldorf, Germany, 5Policlinic and Hiller Research Unit of Rheumatology, UKD, Heinrich Heine University, Duesseldorf, Germany, 6Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany, 7Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Heinrich-Heine-University Duesseldorf, Düsseldorf, Germany

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ,

Session Information

Date: Monday, November 11, 2019

Session Title: 4M111: Imaging of Rheumatic Diseases I (1854–1859)

Session Type: ACR Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), as well as for potential disease detection and monitoring.

Methods: A total of 17 patients with active PsA, 20 patients with active RA and 16 healthy controls (HC) were evaluated by high-resolution 3T MRI using a dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, the thickness of flexor tendon pulleys and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores: synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation and bone proliferation.

Results: Flexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm, p< 0.001) and HC (mean difference 0.2 mm, p< 0.001) and showed a higher degree of associated inflammatory changes (mean difference RA: 4.7, p=0.048; mean difference HC: 14.65, p< 0.001). Additionally, there was a strong correlation of pulley inflammation and total PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis and periarticular inflammation (digitus (D) 2: synovitis r=0.72, flexor tenosynovitis 0.7, overall PsAMRIS r=0.72; D3: flexor tenosynovitis r=0.91, periarticular inflammation 0.62, overall PsAMRIS r=0.81; D4: flexor tenosynovitis r=0.7, periarticular inflammation r=0.77; D5: synovitis r=0.83, flexor tenosynovitis 0.76, periarticular inflammation r=0.6, overall PsAMRIS r=0.8. p< 0.05).

Conclusion: The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection and monitoring in PsA, as well as for its distinction from RA and HC.

Transversal fat-saturated T1w images after iv contrast administration. A1 -A-C- and A2 -E-G- flexor tendon pulleys of D3 in PsA -A & E- and RA -B & F- patients and in HC -C & G-. A & E: 25 year old male with PsA. Flexor tendon pulleys at A1 and A2 level -white arrows- with increased contrast enhancement surrounding each pulley in its course and at ist attachment sites of the pulley -white arrowheads-. White asterisk indicates periarticular inflammation within the soft tissue. Black X marks intense flexor tenosynovitis. B & F: 29 year old female with RA. A1 and A2 Flexor tendon pulleys appear thinner -white arrows- than in A & E, with less contrast enhancement -white arrowheads-. There is also periarticular inflammation in the surrounding soft tissue -white asterisk-. C & G: 37 year old healthy male. Flexor tendon pulleys -white arrows- appear thinner than in PsA and RA. There is only minimal contrast enhancement surrounding each pulley -white arrowheads-. White asterisk indicates minimal periarticular inflammation.

Disclosure: P. Sewerin, AbbVie, 2, 5, 8, Biogen, 5, 8, BMS, 5, 8, Celgene, 2, 5, 8, Chugai, 2, 5, 8, Hexal, 5, 8, Janssen-Cilag, 2, 5, 8, Lilly, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 5, 8, Sanofi-Genzyme, 5, 8, Swedish Orphan Biovitrum, 5, 8, UCB, 2, 5, 8; D. Abrar, None; D. McGonagle, AbbVie, 9, Abbvie, 2, 8, BMS, 9, Celgene, 2, 8, 9, Janssen, 2, 8, Johnson & Johnson, 9, Lilly, 2, 8, MSD, 9, Novartis, 2, 8, 9, Pfizer, 2, 8, 9, UCB, 8, 9; M. Frenken, None; K. Ratke, None; S. Vordenbaeumen, None; R. Brinks, None; M. Schneider, None; B. Ostendorf, None; C. Schleich, None.

To cite this abstract in AMA style:

Sewerin P, Abrar D, McGonagle D, Frenken M, Ratke K, Vordenbaeumen S, Brinks R, Schneider M, Ostendorf B, Schleich C. High-resolution MRI Assessment of Flexor Tendon Pulleys in Psoriatic Arthritis for Disease Monitoring and Differentiation from Rheumatoid Arthritis Using a 16-channel Hand Coil [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/high-resolution-mri-assessment-of-flexor-tendon-pulleys-in-psoriatic-arthritis-for-disease-monitoring-and-differentiation-from-rheumatoid-arthritis-using-a-16-channel-hand-coil/. Accessed April 17, 2021.

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