Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection - Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS?

Mikkel Østergaard, Philip G. Conaghan, Philip O'Connor, Marcin Szkudlarek, Mette Klarlund, Paul Emery, Charles Peterfy, Harry Genant, Fiona M. McQueen, Paul Bird, Marissa Lassere, Bo Ejbjerg

    Publikation: Bidrag til tidsskriftArtikelForskningpeer review

    Abstrakt

    Objective. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) provides highly sensitive assessment of inflammatory and destructive changes in rheumatoid arthritis (RA) joints, but intravenous (IV) Gd injection prolongs examination time and increases cost, invasiveness, and patient discomfort. We explored to what extent RA joint pathologies in wrists and metacarpophalangeal (MCP) joints can be reliably assessed by unenhancedMRI images compared with Gd-enhancedMRI as the reference method. Methods. MRI data sets from 2 RAsubstudies were scored according to preliminary OMERACT RA MRI scoring system (RAMRIS): Substudy A included 1.0 T/1.5 T MR images from 40 RA patients, which were scored twice by 2 experienced readers. Substudy B included 0.2 T dedicated extremity MRI (E-MRI) images from 55 patients, scored twice by one experienced reader. The first reading included only unenhanced images, whereas complete image sets were available for the second reading. Results. Gd contrast injection appeared unimportant toMRI scores of bone erosions and bone edema in RA wrist and MCP joints. However, when post-Gd MRI was considered the standard reference, MRI without Gd provided only moderate to high agreement concerning assessment of synovitis, and omitting the post-Gd acquisitions increased the interreader variation on synovitis scores. Low-field (0.2 T) E-MRI in these exercises provided a lower sensitivity of unenhanced imaging for synovitis than MRI using higher-field strengths. Conclusion. Omitting IV contrast injection did not change scores of bone erosions and bone edema, but decreased the reliability of synovitis scores. However, this disadvantage may for some purposes be outweighed by the possibility to assess more joints and/or greater feasibility. The Journal of Rheumatology

    OriginalsprogEngelsk
    Sider (fra-til)1806-1810
    Antal sider5
    TidsskriftJournal of Rheumatology
    Vol/bind36
    Udgave nummer8
    DOI
    StatusUdgivet - 1 aug. 2009

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