TY - JOUR
T1 - Aiming for a simpler early arthritis MRI protocol
T2 - can Gd contrast administration be eliminated?
AU - Stomp, Wouter
AU - Krabben, Annemarie
AU - van der Heijde, Désirée
AU - Huizinga, Tom W J
AU - Bloem, Johan L
AU - Østergaard, Mikkel
AU - van der Helm-van Mil, Annette H M
AU - Reijnierse, Monique
N1 - COPECARE
PY - 2015/5
Y1 - 2015/5
N2 - PURPOSE: To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness.MATERIALS AND METHODS: Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed.RESULTS: At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses.CONCLUSION: Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment.KEY POINTS: • Eliminating gadolinium contrast administration results in low specificity for synovitis • For tenosynovitis, sensitivity is low without gadolinium contrast administration • Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis.
AB - PURPOSE: To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness.MATERIALS AND METHODS: Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed.RESULTS: At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses.CONCLUSION: Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment.KEY POINTS: • Eliminating gadolinium contrast administration results in low specificity for synovitis • For tenosynovitis, sensitivity is low without gadolinium contrast administration • Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis.
KW - Arthritis
KW - Contrast Media
KW - Early Diagnosis
KW - Female
KW - Gadolinium
KW - Humans
KW - Image Enhancement
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Observer Variation
KW - Reproducibility of Results
KW - Sensitivity and Specificity
KW - Synovitis
KW - Tenosynovitis
KW - Wrist Joint
U2 - 10.1007/s00330-014-3522-1
DO - 10.1007/s00330-014-3522-1
M3 - Journal article
C2 - 25636414
SN - 0938-7994
VL - 25
SP - 1520
EP - 1527
JO - European Radiology
JF - European Radiology
IS - 5
ER -