title: MR and CEUS monitoring of patients with severe rheumatoid arthritis treated with biological agents: a preliminary study.
abstract: OBJECTIVE
  This study was done to propose a study protocol for patients with rheumatoid arthritis (RA) treated with biological agents, by evaluating the contribution of contrast-enhanced magnetic resonance (CE-MR) imaging, a software programme that calculates the volume of synovitis on CE-MR images, and contrast-enhanced ultrasound (CEUS).
  
  
  METHODS
  Sixteen patients with RA receiving treatment with biologics were analysed. The patients underwent clinical examination, CE-MR imaging and CEUS on the same day. Images were postprocessed with the software and evaluated independently by three physicians in terms of RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score), SAMIS (Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score) and CEUS grade. The techniques were correlated statistically.
  
  
  RESULTS
  The RAMRIS and SAMIS scores were found to correlate statistically. CE-MR imaging correlated with the clinical data (p < 0.05), whereas CEUS did not. The data provided by the software did not correlate statistically with the other techniques. The most painful joint was consistently found to be the joint with most synovitis.
  
  
  CONCLUSIONS
  CE-MR imaging may be used prior to treatment and for long-term follow-up. CEUS might be useful in the short-term follow-up, as it seems to provide an indication of the presence or absence of disease, though not of its severity. The software is a very useful tool that can supplement, but not replace, the other techniques.
authors.affiliation: Section of Radiology, Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stramare
authors.forename: Alessandro
authors.initials: A
authors.lastname: Coran
authors.forename: Alex
authors.initials: A
authors.lastname: Faccinetto
authors.forename: Giulia
authors.initials: G
authors.lastname: Costantini
authors.forename: Livio
authors.initials: L
authors.lastname: Bernardi
authors.forename: Costantino
authors.initials: C
authors.lastname: Botsios
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.forename: Enrico
authors.initials: E
authors.lastname: Grisan
authors.forename: Valeria
authors.initials: V
authors.lastname: Beltrame
authors.forename: Bernd
authors.initials: B
authors.lastname: Raffeiner
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D001685:Biological Factors / Q000627:therapeutic use*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010743:Phospholipids; D012984:Software; D013459:Sulfur Hexafluoride; D011795:Surveys and Questionnaires; D013585:Synovitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D014463:Ultrasonography
chemical_list: D001685:Biological Factors; D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D002097:C-Reactive Protein; D013459:Sulfur Hexafluoride