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Abstract Number: 1617

Whole-Body Magnetic Resonance Imaging of Disease Manifestations in Axial and Peripheral Joints and Entheses in Rheumatoid Arthritis Patients

Mette Bjørndal Axelsen1, Anne Duer2, Iris Eshed3, Jakob M. Møller4, Susanne Juhl Pedersen1 and Mikkel Østergaard5, 1Depart of Rheumatology RM, Glostrup Hospital, Copenhagen, Denmark, 2Department of Radiology, Copenhagen University Hospital at Hvidovre, Hvidovre, Denmark, 3Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel, 4Department of Radiology, Copenhagen University Hospital in Herlev, Copenhagen, Denmark, 5Copenhagen University Hospital Glostrup, Copenhagen, Denmark

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: magnetic resonance imaging (MRI) and rheumatoid arthritis (RA)

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Session Information

Title: Imaging of Rheumatic Diseases II: Magnetic Resonance Imaging

Session Type: Abstract Submissions (ACR)

Background/Purpose: To investigate the ability of whole-body magnetic resonance imaging (WBMRI) to visualize synovitis, bone marrow edema and erosions in patients with rheumatoid arthritis (RA) and to examine the agreement between findings from WBMRI and clinical examination.

Methods:

3 Tesla WBMR images were acquired in a head-to-toe scan using an integrated quadrature body coil and 6 imaging stations in 20 patients with RA (14/6 women/men, aged median 54 [range 21–76] years, disease duration 6 [1–20] years) and at least 1 swollen or tender joint. Imaging time was 1 hour 25 min. STIR and pre- and post contrast T1-weighted images were evaluated for the presence/absence of disease manifestations in 76 joints, 30 entheses and in the spine by one experienced reader (IE). Each location was assessed as not imaged, imaged but not readable or readable. Clinical tender and swollen joint counts of 66 joints were performed. 

Results:

Signs of disease activity were more frequently found by MRI evaluation than by clinical evaluation, table 1.

Table 1. Proportions of joints with signs of synovitis, bone marrow edema, erosions and readable images, and clinical signs of joint involvement.

 

Whole-body MRI Evaluation

Clinical Evaluation

 

Synovitis

Bone marrow edema

Erosions

Tender joints

Swollen joints

Joints evaluated

% with synovitis*

% Readable

% BME*

% Readable

% with erosions*

% Readable

%

(N=18)

%

(N=18)

Sternoclavicular

0

60

0

50

0

67.5

11

0

Acromioclavicular

50

85

35

85

0

87.5

ND

ND

Shoulder

61

90

33

90

10

97.5

33

6

Elbow

23

32.5

8

30

0

40

17

8

Wrist

67

82.5

45

82.5

19

80

36

19

1 CMC

92

60

65

50

16

92.5

19

0

1-5 MCP

28 (27–39)

84 (75-90)

12 (7–27)

79.5 (70-85)

3 (0–16)

 

89.5 (82.5-95)

25 (17–33)

25 (6–33)

1-5 PIP hands

15 (3–25)

77 (63–83)

7 (4–13)

71 (58–78)

3 (3–6)

83 (75-87.5)

31 (19–39)

11 (0–17)

2-5 DIP hands

0

63 (58–70)

0

56 (50–63)

0

72 (70–82.5)

13 (8–17)

0 (0–3)

 

Hip

25

100

10

100

0

100

17

NA

Knee

32

95

26

95

8

95

52

3

Ankles

50

100

7.5

100

5

100

52

22

TMT

62.5

100

37.5

100

10

100

ND

ND

MTP

35 (31–49)

95 (93–98)

31 (13–47)

92 (90–98)

18 (8–31)

99 (98–100)

36 (22–44)

11 (0–14)

PIP feet

10 (0–15)

79 (65–85)

9 (0–20)

60 (50–75)

0

94 (93–95)

2 (0–6) [0]

0 (0)

DIP feet

0 (0–3)

78 (68–78)

0

48 (48)

0

93 (93–95)

ND

ND

*Numbers given as % of the total number of readable joints, median (range). CMC: carpometacarpal joints; MCP: metacarpophalangeal joints; PIP: proximal interphalangeal joints; DIP: distal interphalangeal joints; TMT: tarsometatarsal joints; NA: not applicable;ND: not done

Synovitis was most frequent in 1stcarpometacarpal joints (CMC), wrist, the tarsometatarsal (TMT) and shoulder joints (92%, 67%, 63% and 61%, respectively). BME was most frequently present in CMC, wrist, shoulder and  the acromio-clavicular joints (65%, 45%, 33% and 35%, respectively). Erosions were seen primarily in the wrist, MTP, CMC, shoulder and TMT joints (19%, 18%, 16%, 10% and 10%, respectively).

In the spine abnormal findings were less frequent. BME was seen in all cervical disco-vertebral units (DVUs) (7% of evaluated cervical DVUs), and in a few DVUs in the thoracic-lumbar spine (3% of evaluated thoracic- and lumbar DVUs). Fat infiltrations were found in the cervical and lumbar (but not thoracic) spine (3% of evaluated cervical and lumbar DVUs), and erosions were only seen in a single patient in the lumbar spine.

The most frequently involved entheses were those at greater trochanter, calcaneus, greater tuberosity of the humerus, medial condyle of the femur, and upper patella (60%, 26%, 26%, 16% and 13%, respectively, readability 75–100%). The entheses at costo-sternal joints 1 and 7, elbow, lower patella and tubers of the tibia were only readable in 40%, 10%, 25-35%, 5% and 0% of cases, respectively).

MRI findings (synovitis and BME) and clinical findings (tenderness and swelling) were not correlated, neither on the patient level (counts of involved joints) nor consistently on the level of individual joints.

Conclusion: Inflammation (synovitis and BME) in peripheral and axial joints and entheses could be identified by WBMRI, and was more frequent than detected clinically. 3T WB-MRI is a promising tool for evaluation of disease manifestations in RA patients. Optimization of positioning of the feet and hands and acquisition of images is needed.


Disclosure:

M. B. Axelsen,

Abbott Laboratories,

2;

A. Duer,
None;

I. Eshed,
None;

J. M. Møller,
None;

S. Juhl Pedersen,
None;

M. Østergaard,

Abbott Immunology Pharmaceuticals,

5,

Abbott Immunology Pharmaceuticals,

5,

Abbott Immunology Pharmaceuticals,

8,

Centocor, Inc.,

5,

Merck Pharmaceuticals,

5,

Merck Pharmaceuticals,

8,

Mundipharma,

8,

Novo ,

8,

Pfizer Inc,

5,

Pfizer Inc,

8,

Roche Pharmaceuticals,

5,

UCB,

5,

UCB,

8.

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