Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Construct Validity and Responsiveness of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Early Rheumatoid Arthritis A Comparison with Conventional Magnetic Resonance Imaging and Clinical Measures of Disease Activity.

Axelsen1,  Mette Bjørndal, Ejbjerg2,  Bo J., Hetland1,  Merete L., Horslev-Petersen3,  Kim, Boesen4,  Mikael, Kubassova5,  Olga, Lauridsen1,  Ulrik B.

Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
Copenhagen University Hospital at Slagelse, Slagelse, Denmark
University of Southern Denmark, Graasten, Denmark
The Parker Institute, Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark
Image Analysis Ltd., Leeds, United Kingdom
ZiteLab ApS, Copenhagen, Denmark

Background/Purpose:

The aim of the study was to assess the responsiveness and construct validity of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters during aggressive treatment of early rheumatoid arthritis (RA), by comparison with conventional MRI and clinical measures of disease activity.

Methods:

DCE-MRI and conventional contrast-enhanced MRI of the non-dominant hand (wrist and 2.-5. metacarpophalangeal joints (MCP)) and clinical assessment were performed at months 0, 6 and 12 in 14 patients with early RA treated with disease modifying antirheumatic drugs (DMARDs) (methotrexate +/- cyclosporine) and intra-articular glucocorticoid in an investigator initiated clinical trial [1]. Conventional MRI was evaluated using the Rheumatoid Arthritis MRI score (RAMRIS). DCE-MRI (one coronal slice) was analysed using a computer-aided approach by which the temporal contrast uptake is characterized by parameters such as the Initial Rate of Enhancement (IRE), Maximal Enhancement (ME) and number of enhancing voxels (Nvoxel) [2]. The analysis was performed for 2 manually outlined Regions of Interest (ROIs) covering the wrist and 2.–5. MCP, respectively, and for the sum of wrist and MCP ROIs, ('Wrist+MCP').

Results:

All DCE-MRI parameters in the 'Wrist+MCP' declined significantly from month 0 to 12 (see table for separate wrist and MCP values and SRMs). The SRMs for RAMRIS synovitis was -0.67 to -1.05 from month 0–6 and 0–12. DAS28, and tender and swollen joint counts declined similarly (SRMs -0.51 to -1.11). Correlations with RAMRIS synovitis were high for ME (rho 0.56–0.87, p<0.04), Nvoxel (rho 0.76–0.80, p<=0.002) and IRExNvoxel (rho 0.73–0.81, p<=0.003), and low–moderate for IRE (0.09–0.56, p <=0.04–0.76).

Table 1. Responsiveness of DCE-MRI, Conventional MRI and Clinical Parameters

 Baseline Median (range)6 months Median (range)12 months Median (range)Change 0–6 months Median (range)Change 0–12 months Median (range)SRM 0–6 monthsSRM 0–12 months
Dynamic Contrast-Enhanced Magnetic Resonance Imaging Parameters
Wrist+MCP IRE (%/s)1.79 (1.37 – 3.54)1.58 (0.91 – 2.68)1.55 (0.93 – 3.06)-0.22 (-2.12 – 1.00)*-0.42 (-2.22 – 1.38)*-0.49-0.53
Wrist+MCP ME1.53 (1.19 – 2.04)1.43 (1.15 – 1.80)1.32 (1.16 – 1.83)-0.21 (-0.53 – 0.28)-0.13 (-0.48 – 0.31)*-0.55-0.61
Wrist+MCP Nvoxel (voxels)1241 (267 – 7964)642 (12 – 2712)505 (16 – 2189)-665 (-6158 – 1867)-644 (-424 – 1344)**-0.49-0.65
Wrist+MCP IRExNvoxel (%voxels/s)2193 (365 – 23943)1168 (11 – 7281)741 (15 – 6699)-1192 (-21353 – 5859)-1337 (-21162 – 5277)**-0.43-0.53
Wrist IRE (%/s)1.88 (1.36 – 3.74)1.63 (0.91 – 2.98)1.55 (1.08 – 3.33)-0.28 (-2.33 – 1.31)-.54 (-2.42 – 1.66)*-0.49-0.54
Wrist ME1.58 (1.19 – 2.16)1.44 (1.14 – 1.92)1.33 (1.15 – 1.93)-0.16 (-0.64 – 0.37)-0.13 (-0.60 – 0–38)*-0.49-0.57
Wrist Nvoxel (voxels)759 (193 – 5473)552 (12 – 1732)356 (9 – 1547)-238 (-4687 – 958)260 (-773 – 4511)*-0.37-0.56
Wrist IRExNvoxel (%voxels/s)1394 (269 – 17951)936 (11 – 5161)522 (10 – 5151)-467 (-16756 – 3869)-679 (-16287 – 3858)*-0.36-0.46
MCP IRE (%/s)1.61 (1.21 – 2.66)1.51 (0.00 – 1.84)1.56 (0.50 – 1.95)-0.07 (-1.59 – 0.44)-0.05 (-1.3 – 0.28)-0.41-0.37
MCP ME1.48 (1.16 – 1.75)1.26 (0.00 – 1.60)1.25 (1.08 – 1.83)-0.12 (-1.27 – 0.29)-0.064 (-0.38 – 0.29)-0.54-0.38
MCP Nvoxel (voxels)389 (69 – 2491)131 (0.00 – 1020)90 (6 – 900)-278 (-1676 – 909)*-215 (-1913 – 571)*-0.61-0.70
MCP IRExNvoxel (%voxels/s)536 (96 – 5082)196 (0 – 1803)135 (4 – 1647)-484 (-3694 – 1675)*-342 (-3972 – 1123)*-0.58-0.65
Rheumatoid Arthritis Magnetic Resonance Imaging Scores (RAMRIS)
Wrist+MCP RAMRIS Synovitis13 (3 – 18)5.5 (3 – 19)5 (3 – 21)-4.5 (-14 – 1)*-3.5 (-15 – 4)*-1.05-0.89
Wrist RAMRIS synovitis7 (3 – 9)3 (3 – 6)4 (2 – 8)-3 (-6 – 2)**-2 (-6 – 2)**-1.04-1.02
MCPRAMRIS synovitis6 (1 – 9)3 (0 – 7)2 (0 – 6)-2 (-9 – 2)**-1.5 (-9 – 4)*-0.88-0.67
Clinical Parameters
DAS28(crp)3.99 (2.76 – 6.85)2.78 (1.66 – 3.46)2.23 (1.67 – 4.45)-0.63 (-3.68 – 1.83)*-0.78 (-4.54 – 1.81)**-0.52-0.53
Swollen Joint Count (28 joints)3 (1 – 14)0 (0 – 2)0 (0 – 1)-3.5 (-12 – 0)***-3.0 (-14 – 0)**-1.11-1.10
Tender Joint Count (28 joints)5 (0 – 19)0 (0 – 5)0 (0 – 8)-2 (-17 – 4)*-2.5 (-19 – 4)*-0.69-0.51
Wilcoxon Signed Rank test:p<=0.05:*,p<=0.01:**,p<=0.001:***
Correlations between parameters (Spearman's Correlation Coefficient, rho), changes over time (Wilcoxon Signed Rank test) and responsiveness (Standardized Response Mean (SRM)) were calculated.

Conclusion:

All DCE-MRI parameters declined significantly during treatment. With regard to responsiveness, DCE-MRI was comparable to DAS28 but inferior to RAMRIS synovitis. DCE-MRI demonstrated construct validity and moderate responsiveness.

References:

1Hetland, ML et al. Arthritis Rheum 2006;54:1401–1409

2Kubassova, O et al. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv 2007;10:261–269.

To cite this abstract, please use the following information:
Axelsen, Mette Bjørndal, Ejbjerg, Bo J., Hetland, Merete L., Horslev-Petersen, Kim, Boesen, Mikael, Kubassova, Olga, et al; Construct Validity and Responsiveness of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Early Rheumatoid Arthritis A Comparison with Conventional Magnetic Resonance Imaging and Clinical Measures of Disease Activity. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :946
DOI:

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