Near-infrared Fluorescence Optical Imaging in Early Rheumatoid Arthritis: A Comparison to Magnetic Resonance Imaging and Ultrasonography.
OBJECTIVE
Near-infrared fluorescence optical imaging (FOI) is a novel imaging technology in the detection and evaluation of different arthritides. FOI was validated in comparison to magnetic resonance imaging (MRI), greyscale ultrasonography (GSUS), and power Doppler ultrasonography (PDUS) in patients with early rheumatoid arthritis (RA).


METHODS
Hands of 31 patients with early RA were examined by FOI, MRI, and US. In each modality, synovitis of the wrist, metacarpophalangeal joints (MCP) 2-5, and proximal interphalangeal joints (PIP) 2-5 were scored on a 4-point scale (0-3). Sensitivity and specificity of FOI were analyzed in comparison to MRI and US as reference methods, differentiating between 3 phases of FOI enhancement (P1-3). Intraclass correlation coefficients (ICC) were calculated to evaluate the agreement of FOI with MRI and US.


RESULTS
A total of 279 joints (31 wrists, 124 MCP and 124 PIP joints) were evaluated. With MRI as the reference method, overall sensitivity/specificity of FOI was 0.81/0.00, 0.49/0.84, and 0.86/0.38 for wrist, MCP, and PIP joints, respectively. Under application of PDUS as reference, sensitivity was even higher, while specificity turned out to be low, except for MCP joints (0.88/0.15, 0.81/0.76, and 1.00/0.27, respectively). P2 appears to be the most sensitive FOI phase, while P1 showed the highest specificity. The best agreement of FOI was shown for PDUS, especially with regard to MCP and PIP joints (ICC of 0.57 and 0.53, respectively), while correlation with MRI was slightly lower.


CONCLUSIONS
FOI remains an interesting diagnostic tool for patients with early RA, although this study revealed limitations concerning the detection of synovitis. Further research is needed to evaluate its full diagnostic potential in rheumatic diseases.
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Michaela
M
Krohn
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Sarah
S
Ohrndorf
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Stephanie G
SG
Werner
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Bernd
B
Schicke
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Gerd-Rüdiger
GR
Burmester
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Bernd
B
Hamm
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
Marina
M
Backhaus
From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital. kghermann@gmail.com.
Kay-Geert A
KG
Hermann
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005453:Fluorescence; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology
FLUORESCENCE OPTICAL IMAGING; MAGNETIC RESONANCE IMAGING; RHEUMATOID ARTHRITIS; SENSITIVITY; SPECIFICITY; ULTRASONOGRAPHY