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European Radiology
Published in: European Radiology 11/2017

Open Access 01-11-2017 | Musculoskeletal

Diffusion-weighted imaging for assessment of synovial inflammation in juvenile idiopathic arthritis: a promising imaging biomarker as an alternative to gadolinium-based contrast agents

Authors: Anouk M. Barendregt, E. Charlotte van Gulik, Cristina Lavini, Charlotte M. Nusman, J. Merlijn van den Berg, Dieneke Schonenberg-Meinema, Koert M. Dolman, Taco W. Kuijpers, Robert Hemke, Mario Maas

Published in: European Radiology | Issue 11/2017

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Abstract

Objectives

To compare dynamic-contrast-enhanced MRI (DCE) and diffusion-weighted imaging (DWI) in quantifying synovial inflammation in juvenile idiopathic arthritis (JIA).

Methods

Regions of interest (ROI) were drawn in the synovium of JIA patients on T1 DCE and T2 DWI, followed by extraction of the maximum enhancement (ME), maximum initial slope (MIS), time to peak (TTP), % of different time intensity curve shapes (TIC) and apparent diffusion coefficient (ADC) of the ROIs. Mann-Whitney-U test was used for comparing parameters between MRI-active and -inactive patients (defined by the juvenile arthritis MRI scoring system). Spearman’s rank was used to analyse the correlation between DCE and DWI.

Results

Thirty-five JIA patients (18 MRI active and 17 MRI inactive) were included. Median age was 13.1 years and 71% were female. ME, MIS, TTP, % TIC 5 and ADC were significantly different in MRI-active versus MRI-inactive JIA with median ADC 1.49 × 10-3mm2/s in MRI-active and 1.25 × 10-3mm2/s in MRI-inactive JIA, p = 0.001, 95% confidence interval of difference in medians =0.11-0.53 × 10-3mm2/s. ADC correlated to ME, MIS and TIC 5 shapes (r = 0.62, r = 0.45, r = -0.51, respectively, all p < 0.05).

Conclusions

Similar to DCE parameters, DWI-derived ADC is significantly different in MRI-active JIA as compared to MRI-inactive JIA. The non-invasiveness of DWI combined with its possibility to detect synovial inflammation shows the potential of DWI.

Key Points

• MRI can quantify: dynamic contrast-enhanced and diffusion-weighted MRI can quantify synovitis
• Both DWI and DCE can differentiate active from inactive JIA
• The DWI-derived apparent diffusion coefficient (ADC) is higher in active JIA
• DWI is non-invasive and thus safer and more patient-friendly
• DWI is a potentially powerful and non-invasive imaging biomarker for JIA
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Metadata
Title
Diffusion-weighted imaging for assessment of synovial inflammation in juvenile idiopathic arthritis: a promising imaging biomarker as an alternative to gadolinium-based contrast agents
Authors
Anouk M. Barendregt
E. Charlotte van Gulik
Cristina Lavini
Charlotte M. Nusman
J. Merlijn van den Berg
Dieneke Schonenberg-Meinema
Koert M. Dolman
Taco W. Kuijpers
Robert Hemke
Mario Maas
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-4876-y

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