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a Department
of Rheumatology, Bristol Royal Infirmary, Bristol , b Department of Medical Physics
and Bioengineering, Bristol General Hospital, Bristol , c Vascular, Inflammatory and
Musculo-Skeletal Research Department, Zeneca Pharmaceuticals, Cheshire
, d Department of Radiodiagnosis, Bristol Royal
Infirmary, Bristol
Correspondence to: Dr P Creamer, Division of Rheumatology, University of Maryland, Rm 8-34 MSTF, 10 South Pine St, Baltimore MD 21201, USA.
Accepted for publication 18 March 1997
OBJECTIVES
To investigate the potential of
quantitative magnetic resonance imaging (MRI) to differentiate between
therapeutically induced changes in inflammation and synovial
proliferation in rheumatoid arthritis (RA) of the knee.
METHODSMRI of the knee was performed on
patients with RA before and one week after injection with
corticosteroid (triamcinolone acetonide, TA group, n=9) and before,
four, and 12 weeks after injection with yttrium-90 plus TA (TA+Y group,
n=7). MRI scans were analysed by subjective visual grading by a trained
observer and by computer aided quantitation for three features:
synovial fluid volume, synovial pannus volume, and synovial enhancement
after intravenous contrast agent.
RESULTSAll TA subjects improved clinically at
one week but the effects of TA+Y were more variable. TA significantly
reduced synovial enhancement and effusion volume, whereas TA+Y at 12 weeks tended to increase synovial enhancement and decrease pannus
volume. Quantitative MRI values agreed well with subjective assessment
of scans. Comparison of calculated change on MRI scan before and
immediately after aspiration with actual volume aspirated showed high
correlation (r=0.96).
CONCLUSIONSQuantitative MRI correlates with
subjective visual assessment and, at least for synovial fluid, is
accurate. MRI can differentiate actions of two therapeutic modalities
on various pathological processes and is sensitive enough to detect
change after one week. With the additional advantage of lack of
observer bias, it will probably become a useful tool in the development
and assessment of existing and novel treatments.
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