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Abstract Number: 128

Quantitative Assessment of Synovitis in Patients with Rheumatoid Arthritis Using Fluorescence Optical Imaging

Valentin S. Schäfer1, Wolfgang Hartung2, Patrick Hoffstetter3, Jörn Berger4, Martina Müller5, Martin Fleck2 and Boris P. Ehrenstein2, 1Rheumatology & Clinical Immunology, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany, 2Rheumatology & Clinical Immunology, Asklepios Clinic Bad Abbach, Bad Abbach, Germany, 3Radiology, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany, 4mivenion GmbH, Berlin, Germany, 5Clinic for Internal Medicine I, University Clinic Regensburg, Regensburg

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Activity score, imaging techniques, rheumatoid arthritis (RA) and synovitis

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Session Information

Title: Imaging of Rheumatic Diseases: Ultrasound, Nuclear Medicine and Fluorescence Imaging

Session Type: Abstract Submissions (ACR)

Background/Purpose: To prospectively evaluate quantitative assessment of indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) for differentiation of synovitic from non-synovitic joints in patients suffering from rheumatoid arthritis (RA). 

Methods: FOI of the hands was performed in patients with active RA as recommended by the manufacturer (Xiralite system, Mivenion GmbH, Berlin, Germany; ICG bolus of 0.1 mg/kg/ body weight, sequence of 360 images, one image per second, stratified fluorescence readout (FLRO) of 3 phases (I: 1 – 120 s; II: 121 – 240 s; III: 241 to 360 s)). To dissect the effect of the overall perfusion of the hand from the perfusion due to active synovitis, a fluorescence ratio (FLRA) was calculated for each individual joint dividing the readout of the joint by the readout of the eponychium of the index finger. For comparison, absence or presence of synovitis in 5 joints of the clinical predominant hand (carpal joint, metacarpophalangeal and proximal interphalangeal joints of digits II & III) were analyzed using grayscale (GSUS) and power Doppler (PDUS) ultrasonography, or magnetic resonance imaging (MRI). The mean FLRO and FLRA were compared between joints with absent vs. present synovitis determined by GSUS, PDUS and MRI using student’s t-test.

Results: Ninety joints of 18 patients (8 female (44%), mean (± SD) age 63±10 years) with RA were included. The quantitative analysis for individual joints yielded values for the FLRO ranging from 4.4 to 49.0 x 103, and the FLRA ranging from 0.37 to 2.27. A comparison of mean (±SD) of FLRO and FLRA is depicted in table 1. Overall, the analyses based on the FLRA revealed a higher discrimination than the analyses related to the FLRO. The most significant differences were observed for mean values of phases II & III. A sensitivity of 26/39 (67%) and a specificity of 31/40 (77%) were calculated for the FLRA of phase III using a cut-off value of more than 1.2 to detect MRI-diagnosed synovitis with FOI.

Conclusion: ICG enhanced FOI has a potential for visualizing synovitis in subjects with RA. For adequate FOI interpretation, phases II & III appear to be most relevant. Utilizing the presented quantitative approach, significant differences of the mean FLRO and particularly of the FLRA could be demonstrated comparing synovitic to non-synovitic joints in patients with active RA. However, a definitive cut-off value for either analytic method could not be established.

Table 1. Mean fluorescence readout and fluorescence ratios for joints with vs. without evidence of synovitis determined by established imaging techniques. Fluorescence readout results are displayed for better readability divided by 103, FOI= fluorescence optical imaging, GSUS=grey scale ultrasonography, PDUS=power Doppler ultrasonography, MRI=magnetic resonance imaging;  §11 joints could not be evaluated with MRI; ns comparison was not significant (p≥.05) with student’s t-test.

 

 

phase I
1 – 120 s

 

phase II
121 – 240 s

 

phase III
241 – 360 s

 

 

 

 

 

 

 

 

 

Synovitis

n

mean ± SD

p

mean ± SD

 p

mean ± SD

 p

 

 

 

 

 

 

 

 

 

 

FOI readout

 

FOI readout

 

FOI readout

 

 

 

 

 

 

 

 

 

GSUS yes

39

21.0 ± 11.4

ns

23.5 ± 10.4

<.01

15.8 ± 7.9

<.01

GSUS no

51

17.7 ± 7.5

 

16.6 ± 6.8

 

10.5 ± 4.8

 

 

 

 

 

 

 

 

 

PDUS yes

23

24.1 ± 12.3

<.05

23.8 ± 9.3

<.05

15.0 ± 5.9

ns

PDUS no

67

17.5 ± 7.7

 

18.2 ± 8.7

 

12.0 ± 7.0

 

 

 

 

 

 

 

 

 

MRI yes

39§

20.9 ± 10.1

ns

22.3 ± 9.5

<.05

14.8 ± 7.3

<.05

MRI no

40§

17.8 ± 9.6

 

17.2 ± 9.2

 

10.9 ± 6.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOI ratio

 

FOI ratio

 

FOI ratio

 

 

 

 

 

 

 

 

 

GSUS yes

39

1.06 ± 0.47

ns

1.33 ± 0.48

<.05

1.37 ± 0.48

<.01

GSUS no

51

0.91 ± 0.32

 

1.10 ± 0.26

 

1.12 ± 0.26

 

 

 

 

 

 

 

 

 

PDUS yes

23

1.22 ± 0.46

<.01

1.52 ± 0.52

<.01

1.53 ± 0.53

<.01

PDUS no

67

0.89 ± 0.33

 

1.09 ± 0.26

 

1.12 ± 0.26

 

 

 

 

 

 

 

 

 

MRI yes

39§

1.11 ± 0.46

<.01

1.38 ± 0.47

<.001

1.41 ± 0.46

<.001

MRI no

40§

0.86 ± 0.33

 

1.06 ± 0.26

 

1.08 ± 0.26

 


Disclosure:

V. S. Schäfer,
None;

W. Hartung,

Abbott Immunology Pharmaceuticals,

5,

Pfizer Inc,

5;

P. Hoffstetter,
None;

J. Berger,

mivenion GmbH,

3,

Physikalisch-Technische Bundesanstalt, Braunschweig,

9;

M. Müller,
None;

M. Fleck,

Abbott Immunology Pharmaceuticals,

5,

Roche Pharmaceuticals,

5,

Pfizer Inc,

5;

B. P. Ehrenstein,

Abbott Immunology Pharmaceuticals,

5,

Pfizer Inc,

5,

Roche Pharmaceuticals,

5.

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