title: Contrast-enhanced dynamic and static MRI correlates with quantitative 99Tcm-labelled nanocolloid scintigraphy. Study of early rheumatoid arthritis patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate the roles of contrast-enhanced dynamic and static magnetic resonance imaging (MRI) and quantitative 99Tcm-labelled nanocolloid (NC) scintigraphy in detecting wrist joint inflammation in early rheumatoid arthritis (RA) patients.
  
  
  METHODS
  Twenty-eight early RA patients (median symptom duration 5 months, range 1-12 months) underwent MRI, NC scintigraphy, laboratory and clinical examinations. Static wrist MRI scans were retrospectively scored for synovitis, bone oedema and erosions by two independent readers using the recently published rheumatoid arthritis MRI scoring system (RAMRIS). Twenty NC scans were analysed quantitatively by measuring maximum 99Tcm-NC uptake in three small areas of each wrist. From the same locations on the wrists, dynamic MRI gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) enhancement rates (E-rate) were measured. The average 99Tcm-NC uptake of the whole wrist region was also measured and average E-rates were calculated. Correlations between MRI and NC scintigraphy measurements were calculated. Correlations between imaging methods of the wrist and the global measures of inflammation (laboratory and clinical examinations) were also assessed.
  
  
  RESULTS
  Strong correlations emerged between maximal 99Tcm-NC uptake and MRI E-rates, reflecting similar performance of the methods in detecting local synovial inflammation. 99Tcm-NC uptake and MRI E-rate correlated with semiquantitative scoring of synovitis and bone oedema from static MRI scans. The erythrocyte sedimentation rate (ESR) correlated with MRI scores, E-rate and 99Tcm-NC uptake. No correlation between the clinical parameters and the imaging methods was detected. Inter-observer reliability for scoring synovial hypertrophy, bone oedema and bone erosions from static MR images were high (single-measure fixed-effects intra-class correlations 0.87, 0.93 and 0.91 respectively). Intra-observer reliability for E-rate and 99Tcm-NC measurements of 10 randomly picked scans was found to be high, with an intra-class correlation of 0.92; 95% confidence interval (CI) 0.84-0.96 and 0.99; 95% CI 0.98-1.00, respectively.
  
  
  CONCLUSIONS
  Objective information about wrist joint inflammation can be obtained with contrast-enhanced dynamic MRI and quantitative 99Tcm-labelled NC scintigraphy. MRI also allows visualization and semiquantitative scoring of bone oedema and erosions of the wrist. Dynamic MRI and NC scintigraphy are safe and easy to perform, and they can be used in a long-term follow-up of rheumatoid patients.
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, FIN-90029, BOX 50, Finland. kari.palosaari@oulu.fi
authors.forename: K
authors.initials: K
authors.lastname: Palosaari
authors.forename: J
authors.initials: J
authors.lastname: Vuotila
authors.forename: R
authors.initials: R
authors.lastname: Takalo
authors.forename: A
authors.initials: A
authors.lastname: Jartti
authors.forename: R
authors.initials: R
authors.lastname: Niemelä
authors.forename: M
authors.initials: M
authors.lastname: Haapea
authors.forename: I
authors.initials: I
authors.lastname: Soini
authors.forename: O
authors.initials: O
authors.lastname: Tervonen
authors.forename: M
authors.initials: M
authors.lastname: Hakala
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013668:Technetium Tc 99m Aggregated Albumin; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D003287:Contrast Media; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid