Rationale and Objectives
To investigate the diagnostic value of high-resolution dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for assessment of synovitis in erosive osteoarthritis (EOA) of the hand and compare the results with those acquired in its potential mimic, the psoriatic arthritis (PsA).
Materials and Methods
Twenty-six patients (17 PsA, 9 EOA) were examined at 3 T. The time course of synovial contrast uptake was measured by ROI analysis using a three-dimensional encoded spoiled gradient-echo sequence. Characteristic parameters of synovial uptake curves (time to peak [TTP], peak value, mean transit time [MTT], area under the curve [AUC], and maximum upslope) of PsA and EOA patients were compared using gamma variate analysis and calculation of the late relative enhancement 15 minutes after contrast administration.
Results
Enhancement curves of PsA and EOA patients paralleled each other at comparable levels in the early phase after contrast injection without statistical difference in the following calculated characteristic curve parameters: TTP, peak value, MTT, AUC, and maximum upslope. However, significant difference was found in the late relative enhancement 15 minutes after contrast injection ( P = .0275) with higher values in EOA patients.
Conclusion
DCE-MRI provides assessment of synovitis in both patients with EOA and PsA. Interestingly, synovial enhancement characteristics were comparable for the most part in these two disorders. However, late enhancement might help in differentiation which is essential for guiding therapy.
Erosive osteoarthritis (EOA) of the hand is an inflammatory form of osteoarthritis (OA) that affects predominantly postmenopausal middle-aged women and is considered a more severe form of OA with pathologic features suggestive of inflammatory synovial changes . EOA shares features typical of OA as well as inflammatory arthritis. Joint involvement may or may not be symmetric with the distal and proximal interphalangeal (PIP) joints as preferred target sites. Symptoms can wax and wane as well as inflammatory signs can be involved in different joints at different times . Early in the disease, patients present with a nonspecific synovial inflammatory arthropathy with abrupt onset of pain, tenderness, swelling, and redness of the affected joints. In the course of the disease, patients can considerably suffer from acute episodes of intense inflammation with residual deformity and impairment of function .
Psoriatic arthritis (PsA) is a synovial inflammatory arthropathy that is defined as the occurrence of seronegative arthritis and psoriasis . PsA encompasses a variety of clinical entities including a distal interphalangeal (DIP) joint polyarthritis (row type), dactylitis (ray type), enthesitis, arthritis mutilans, rheumatoid arthritis-like symmetric polyarthritis, monoarthritis, or asymmetric oligoarthritis . The peripheral joint involvement in PsA is mostly asymmetrical and oligoarticular, but can also mimic rheumatoid arthritis with eventually destructive involvement of multiple small hand joints. DIP joint disease is very typical of PsA and can range from mild changes to an aggressive and destructive arthropathy . PsA can involve tendons, ligaments, fascia, bone, and bone marrow . However, collateral ligaments and tendons are a common target at clinical presentation in both PsA and EOA , so that it may be difficult to differentiate between the two groups based on morphologic imaging features alone.
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Materials and methods
Patient Population
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Table 1
Patients’ Characteristics and Enhancement Values
Psoriatic Arthritis (PsA) Erosive Osteoarthritis (EOA)P Value PsA vs. EOA Number of patients 17 9 Male/female 8/9 5/4 Mean age (y) 48 ± 7 (37–61) 59 ± 5 (51–66) Disease duration (y) 7.2 ± 7.5 (0.2–22.0) 1.8 ± 1.7 (0.3–4.5) Patients with MCP joint prevalence 8 3 Patients with PIP, DIP joint prevalence 9 6 Time to peak (min) 3.3 ± 0.7 (1.9–4.8) 3.3 ± 0.7 (2.1–4.1) 0.96 Mean transit time (min) 9.5 ± 2.8 (4.8–13.1) 8.6 ± 2.5 (4.9–12.3) 0.46 Peak value (a.u.) 382 ± 145 (197–772) 385 ± 100 (253–550) 0.95 Area under the curve 4544 ± 1528 (2671–8371) 4398 ± 1992 (2695–8345) 0.85 Maximum upslope 15,959 ± 35,249 (335–132,941) 17,949 ± 40,808 (299–118,475) 0.91 RE 15min in % 269 ± 55 (191–404) 362 ± 97 (249–526) 0.0275 ∗
a.u., absolute units; DIP, distal interphalangeal joint; MCP, metacarpophalangeal joint; PIP, proximal interphalangeal joint; RE 15min, relative enhancement at 15 minutes after intravenous contrast administration.
Values are given in mean ± standard deviation (range).
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MRI Examination Protocol
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Image Analysis
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Statistical Analysis
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Results
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Discussion
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