Dynamic contrast-enhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis
Dynamic contrast-enhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis
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DOI：
10.1093/rheumatology/kep343
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发表时间：
2010-01-01
期刊：
影响因子：
5.5
通讯作者：
Martini, Alberto
中科院分区：
文献类型：
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作者：
Malattia, Clara;Damasio, Maria B.;Martini, Alberto
目标。目的探讨动态增强磁共振成像(DCE-MRI)评价幼年特发性关节炎(JIA)疾病活动性的能力和可靠性。对21例临床受累较重的腕关节或髋关节进行了DCE-MRI检查，并进行了标准的临床评估和生化分析。根据感兴趣区的增强曲线计算最大滑膜强化水平(ME)、最大强化速率(MV)和早期强化速率(REE)来评价滑膜炎症。分析动态参数与疾病活动性临床指标、静态MRI滑膜炎评分的相关性。在腕关节炎患者中，REE与腕关节肿胀评分(r(S)=0.72)、血沉(r(S)=0.69)、疼痛评分(r(S)=0.6 3)、童年生活质量(r(S)=0.6 0)呈正相关。在髋关节炎患者中，ME与髋关节活动受限相关(0.69卢比)。腕部关节炎患者的静态MRI滑膜增强评分与MV(r=0.63)相关，髋关节炎患者的静态MRI滑膜炎症评分与ME(r=0.68)相关。ME、MV和REE的类内相关系数(ICC)分别为0.98、0.97和0.84，具有较好的符合性。DCE-MRI是评估JIA疾病活动性的一种很有前途的方法，特别是在腕关节炎患者中。据我们所知，这项研究首次证明了DCE-MRI在JIA中的可行性、可靠性和结构效度。考虑到它在治疗决策和临床试验中的进一步应用，这些结果应该在大规模的纵向研究中得到证实。
Objective. To determine the capability and reliability of dynamic contrast-enhanced MRI (DCE-MRI) in the assessment of disease activity in juvenile idiopathic arthritis (JIA).Methods. DCE-MRI of the clinically more affected wrist or hip joints was undertaken in 21 patients, coupled with standard clinical assessment and biochemical analysis. Synovial inflammation was assessed by computing the maximum level of synovial enhancement (ME), the maximum rate of enhancement (MV) and the rate of early enhancement (REE) from the enhancement curves generated from region of interest independently delineated by two readers in the area of the ME. Correlations between dynamic parameters and clinical measures of disease activity, and static MRI synovitis score were investigated.Results. In patients with wrist arthritis, REE correlated with the wrist swelling score (r(s) = 0.72), ESR (r(s) = 0.69), pain assessment scale (r(s) = 0.63) and childhood HAQ (r(s) = 0.60). In patients with hip arthritis, ME correlated with the hip limitation of motion (rs 0.69). Static MRI synovitis score based on post-gadolinium enhancement correlated with MV (rs 0.63) in patients with wrist arthritis and with ME (r = 0.68) in those with hip arthritis. The inter-reader agreement assessed by intra-class correlation coefficient (ICC) for ME, MV and REE (ICC = 0.98, 0.97 and 0.84, respectively) was excellent.Conclusions. DCE-MRI represents a promising method for the assessment of disease activity in JIA, especially in patients with wrist arthritis. As far as we know, this study is the first to demonstrate the feasibility, reliability and construct validity of DCE-MRI in JIA. These results should be confirmed in large-scale longitudinal studies in view of its further application in therapeutic decision making and in clinical trials.