title: Bone structure and perfusion quantification of bone marrow edema pattern in the wrist of patients with rheumatoid arthritis: a multimodality study.
abstract: OBJECTIVE
  To quantify bone structure and perfusion parameters in regions of bone marrow edema pattern (BMEP), non-edematous bone marrow (NBM), and pannus tissue areas in the wrists of patients with rheumatoid arthritis (RA) using 3-Tesla (3T) magnetic resonance imaging (MRI), and high resolution peripheral quantitative computed tomography (HR-pQCT).
  
  
  METHODS
  Sixteen subjects fulfilling American College of Rheumatology classification were imaged using a HR-pQCT system and a 3T MRI scanner with an 8-channel wrist coil. Coronal T2-weighted and dynamic contrast-enhanced (DCE-MRI) images were acquired. BMEP and pannus tissue areas were segmented semiautomatically in T2-weighted images. NBM areas were placed at a similar distance from the joint space as BMEP regions. MR and HR-pQCT images were registered, and bone variables were calculated within the BMEP and NBM regions. Perfusion parameters in BMEP, pannus tissue, and NBM regions were calculated based on the signal-time curve obtained from DCE-MRI.
  
  
  RESULTS
  Eighteen BMEP areas were segmented, 15 of them presented proximal to pannus-filled erosions. Significant increases in bone density and trabecular thickness and number were observed in all BMEP regions compared to NMB (p < 0.05). Significantly elevated perfusion measures were observed in both BMEP and pannus tissue regions compared to NBM (p < 0.05).
  
  
  CONCLUSIONS
  BMEP regions showed significantly increased bone density and structures as well as perfusion measures, suggesting bone remodeling and active inflammation. Combining MRI and HR-pQCT provides a powerful multimodality approach for understanding BMEP and erosions, and for potentially identifying novel imaging markers for disease progression in RA.
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Teruel
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Burghardt
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: Julien
authors.initials: J
authors.lastname: Rivoire
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: Waraporn
authors.initials: W
authors.lastname: Srikhum
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Noworolski
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Link
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
authors.forename: John B
authors.initials: JB
authors.lastname: Imboden
authors.affiliation: From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF. xiaojuan.li@ucsf.edu.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D015519:Bone Density; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology*; D004487:Edema / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D014057:Tomography, X-Ray Computed; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: BONE EROSIONS; BONE MARROW EDEMA; COMPUTED TOMOGRAPHY; MAGNETIC RESONANCE IMAGING; RHEUMATOID ARTHRITIS