Using magnetic resonance angiography to measure abnormal synovial blood vessels in early inflammatory arthritis: a new imaging biomarker?
OBJECTIVE
To ascertain whether magnetic resonance angiography (MRA) can reliably detect synovial neovascularization in subjects with early inflammatory arthritis.


METHODS
Subjects with 6 weeks to 6 months of clinical evidence of inflammatory hand arthritis had a radiograph, power Doppler ultrasound (PDU) scan, magnetic resonance imaging (MRI), and contrast enhanced MRA performed on the more symptomatic hand. Ultrasound examination of the wrist and 2nd-5th metacarpophalangeal (MCP) joints was scored for erosions, synovial thickening, and synovial blood flow. MRI were assessed using the OMERACT Rheumatoid Arthritis MRI Score (RAMRIS). MRA was used to assess the number of abnormal vessels in the 2nd-5th MCP and in the wrist.


RESULTS
Of 30 subjects, 66.7% showed abnormal vasculature on MRA in the MCP and/or wrist; mean number of abnormal vessels was 5.24 (range 0-22). Number of abnormal vessels on MRA was strongly correlated with degree of blood flow seen in the corresponding area on PDU (r = 0.79, p <or= 0.0001). The number of abnormal vessels was highly correlated with MRI MCP synovitis scores (r = 0.69, p <or= 0.0001), MRI wrist synovitis scores (r = 0.73, p <or= 0.0001), and ultrasound synovitis scores (r = 0.68, p <or= 0.0001).


CONCLUSIONS
In this cross-sectional pilot study, MRA identified abnormal vessels in patients with early inflammatory arthritis. This is the first report of MRA visualizing abnormal vessels in this patient population. If the degree of neovascularization in early inflammatory arthritis predicts disease course, MRA evidence of abnormal vessels could be a new imaging biomarker.
Vasanth
Lisa C
LC
Division of Rheumatology and Division of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. vasanthl@hss.edu
Foo
Li Foong
LF
Potter
Hollis G
HG
Adler
Ronald S
RS
Finzel
Kathleen C
KC
Pavlov
Helene
H
Mandl
Lisa A
LA
D000328:Adult; D001168:Arthritis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015415:Biomarkers; D001783:Blood Flow Velocity; D001808:Blood Vessels / Q000473:pathology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000473:pathology; D010865:Pilot Projects; D011379:Prognosis; D011859:Radiography; D011795:Surveys and Questionnaires; D013583:Synovial Membrane / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D013585:Synovitis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology
D015415:Biomarkers