title: Baseline MRA predicts the treatment response to vasodilator udenafil in patients with secondary Raynaud's phenomenon.
abstract: OBJECTIVE
  High-resolution MR angiography (HR-MRA) demonstrates blood flow in the digital arteries, which correlates with the severity of Raynaud's phenomenon (RP). This study investigates whether baseline HR-MRA of the hand can predict the treatment response to udenafil, a new PDE5-inhibitor, in patients with secondary RP.
  
  
  METHODS
  Baseline MRA and Doppler ultrasound were obtained in 12 patients with secondary RP. The patients were treated with udenafil 100 mg/day for 4 weeks and changes in blood flow were measured. Blood flow on MRA was scored on a 4-point scale: 0, no visible flow; 1, visible flow to the proximal phalanx; 2, to the middle phalanx; and 3, to the distal phalanx. Peak systolic velocity (PSV) was measured to determine blood flow. Paired t-test and ANOVA were used to determine the treatment response of the different MRA scores.
  
  
  RESULTS
  On baseline MRA, 53.3% of digital arteries had an MRA score of 0, 25.8% MRA score of 1, 9.2% MRA score of 2, and 11.6% MRA score of 3. Overall, 4-week udenafil treatment improved digital flow (p<0.05) in all MRA scores. Digital arteries with MRA score 2 showed the best response with improvement in PSV by 14.5 mm/sec (p<0.01), whereas improvement in arteries of MRA scores 1 and 3 were not better than an MRA score of 0 (all, p>0.05).
  
  
  CONCLUSIONS
  Digital arteries with moderate blood flow observed on MRA respond best to treatment with udenalfil. Therefore, baseline MRA may help predict treatment response in patients with secondary RP.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. jinkyunpark@gmail.com.
authors.forename: J K
authors.initials: JK
authors.lastname: Park
authors.forename: E-A
authors.initials: EA
authors.lastname: Park
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.forename: Y K
authors.initials: YK
authors.lastname: Kim
authors.forename: E Y
authors.initials: EY
authors.lastname: Lee
authors.forename: Y W
authors.initials: YW
authors.lastname: Song
authors.forename: E B
authors.initials: EB
authors.lastname: Lee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003240:Connective Tissue Diseases / Q000150:complications; D005260:Female; D005385:Fingers / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use*; D011928:Raynaud Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012039:Regional Blood Flow; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography; D000096926:Benzenesulfonamides
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; C419664:udenafil; D000096926:Benzenesulfonamides