title: Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology.
abstract: BACKGROUND
  Indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) is an established technology for imaging of inflammation in animal models. In experimental models of arthritis, FOI findings corresponded to histologically proven synovitis. This is the first comparative study of FOI with other imaging modalities in humans with arthritis.
  
  
  METHODS
  252 FOI examinations (Xiralite system, mivenion GmbH, Berlin, Germany; ICG bolus of 0.1 mg/kg/body weight, sequence of 360 images, one image per second) were compared with clinical examination (CE), ultrasonography (US) and MRI of patients with arthritis of the hands.
  
  
  RESULTS
  In an FOI sequence, three phases could be distinguished (P1-P3). With MRI as reference, FOI had a sensitivity of 76% and a specificity of 54%, while the specificity of phase 1 was 94%. FOI had agreement rates up to 88% versus CE, 64% versus greyscale US, 88% versus power Doppler US and 83% versus MRI, depending on the compared phase and parameter. FOI showed a higher rate of positive results compared to CE, US and MRI. In individual patients, FOI correlated significantly (p<0.05) with disease activity (Disease Activity Score 28, r=0.41), US (r=0.40) and RAMRIS (Rheumatoid Arthritis MRI Score) (r=0.56). FOI was normal in 97.8% of joints of controls.
  
  
  CONCLUSIONS
  ICG-enhanced FOI is a new technology offering sensitive imaging detection of inflammatory changes in subjects with arthritis. FOI was more sensitive than CE and had good agreement with CE, US in power Doppler mode and MRI, while showing more positive results than these. An adequate interpretation of an FOI sequence requires a separate evaluation of all phases. For the detection of synovitis and tenosynovitis, FOI appears to be as informative as 1.5 T MRI and US.
authors.affiliation: Rheumatology, Immunology, Osteology Center, Duesseldorf, Germany.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Werner
authors.forename: Hans-Eckhard
authors.initials: HE
authors.lastname: Langer
authors.forename: Sarah
authors.initials: S
authors.lastname: Ohrndorf
authors.forename: Malte
authors.initials: M
authors.lastname: Bahner
authors.forename: Peter
authors.initials: P
authors.lastname: Schott
authors.forename: Carsten
authors.initials: C
authors.lastname: Schwenke
authors.forename: Michael
authors.initials: M
authors.lastname: Schirner
authors.forename: Hans
authors.initials: H
authors.lastname: Bastian
authors.forename: Gudrun
authors.initials: G
authors.lastname: Lind-Albrecht
authors.forename: Bernward
authors.initials: B
authors.lastname: Kurtz
authors.forename: Gerd R
authors.initials: GR
authors.lastname: Burmester
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000000981:diagnostic imaging; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D004396:Coloring Agents; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005453:Fluorescence; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007208:Indocyanine Green; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013585:Synovitis / Q000175:diagnosis / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green