Skip to main content

Advertisement

SpringerLink
Log in

Quantitative MR characterization of disease activity in the knee in children with juvenile idiopathic arthritis: a longitudinal pilot study

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

The development of a quantifiable and noninvasive method of monitoring disease activity and response to therapy is vital for arthritis management.

Objective

The purpose of this study was to investigate the utility of quantitative dynamic contrast-enhanced MRI (DCE-MRI) based on pharmacokinetic (PK) modeling to evaluate disease activity in the knee and correlate the results with the clinical assessment in children with juvenile idiopathic arthritis (JIA).

Materials and methods

A group of 17 children with JIA underwent longitudinal clinical and laboratory assessment and DCE-MRI of the knee at enrollment, 3 months, and 12 months. A PK model was employed using MRI signal enhancement data to give three parameters, Ktrans ′ (min−1), kep (min−1), and Vp ′ and to calculate synovial volume.

Results

The PK parameters, synovial volumes, and clinical and laboratory assessments in most children were significantly decreased (P < 0.05) at 12 months when compared to the enrollment values. There was excellent correlation between the PK and synovial volume and the clinical and laboratory assessments. Differences in MR and clinical parameter values in individual subjects illustrate persistent synovitis when in clinical remission.

Conclusion

A decrease in PK parameter values obtained from DCE-MRI in children with JIA likely reflects diminution of disease activity. This technique may be used as an objective follow-up measure of therapeutic efficacy in patients with JIA. MR imaging can detect persistent synovitis in patients considered to be in clinical remission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Brewer EJ Jr, Bass J, Baum J et al (1977) Current proposed revision of JRA criteria. JRA Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Section of The Arthritis Foundation. Arthritis Rheum 20:195–199

    PubMed  Google Scholar 

  2. Firestein GS (1999) Starving the synovium: angiogenesis and inflammation in rheumatoid arthritis. J Clin Invest 103:3–4

    Article  PubMed  CAS  Google Scholar 

  3. Cimmino MA, Innocenti S, Livrone F et al (2003) Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease. Arthritis Rheum 48:1207–1213

    Article  PubMed  Google Scholar 

  4. van Rossum MA, Zwinderman AH, Boers M et al (2003) Radiologic features in juvenile idiopathic arthritis: a first step in the development of a standardized assessment method. Arthritis Rheum 48:507–515

    Article  PubMed  Google Scholar 

  5. Wallace CA, Levinson JE (1991) Juvenile rheumatoid arthritis: outcome and treatment for the 1990s. Rheum Dis Clin North Am 17:891–905

    PubMed  CAS  Google Scholar 

  6. Ostergaard M, Hansen M, Stoltenberg M et al (1999) Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 42:918–929

    Article  PubMed  CAS  Google Scholar 

  7. Gaffney K, Cookson J, Blades S et al (1998) Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging. Ann Rheum Dis 57:152–157

    Article  PubMed  CAS  Google Scholar 

  8. Forslind K, Larsson EM, Johansson A et al (1997) Detection of joint pathology by magnetic resonance imaging in patients with early rheumatoid arthritis. Br J Rheumatol 36:683–688

    Article  PubMed  CAS  Google Scholar 

  9. Reiser MF, Bongartz GP, Erlemann R et al (1989) Gadolinium-DTPA in rheumatoid arthritis and related diseases: first results with dynamic magnetic resonance imaging. Skeletal Radiol 18:591–597

    Article  PubMed  CAS  Google Scholar 

  10. Ostergaard M, Gideon P, Henriksen O et al (1994) Synovial volume – a marker of disease severity in rheumatoid arthritis? Quantification by MRI. Scand J Rheumatol 23:197–202

    PubMed  CAS  Google Scholar 

  11. Gaffney K, Cookson J, Blake D et al (1995) Quantification of rheumatoid synovitis by magnetic resonance imaging. Arthritis Rheum 38:1610–1617

    Article  PubMed  CAS  Google Scholar 

  12. Ostergaard M, Stoltenberg M, Lovgreen-Nielsen P et al (1998) Quantification of synovitis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 16:743–754

    Article  PubMed  CAS  Google Scholar 

  13. Reece RJ, Kraan MC, Radjenovic A et al (2002) Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging. Arthritis Rheum 46:366–372

    Article  PubMed  CAS  Google Scholar 

  14. Larsson HB, Stubgaard M, Frederiksen JL et al (1990) Quantitation of blood-brain barrier defect by magnetic resonance imaging and gadolinium-DTPA in patients with multiple sclerosis and brain tumors. Magn Reson Med 16:117–131

    Article  PubMed  CAS  Google Scholar 

  15. Zhu XP, Li KL, Kamaly-Asl ID et al (2000) Quantification of endothelial permeability, leakage space, and blood volume in brain tumors using combined T1 and T2* contrast-enhanced dynamic MR imaging. J Magn Reson Imaging 11:575–585

    Article  PubMed  CAS  Google Scholar 

  16. Roberts HC, Roberts TP, Bollen AW et al (2001) Correlation of microvascular permeability derived from dynamic contrast-enhanced MR imaging with histologic grade and tumor labeling index: a study in human brain tumors. Acad Radiol 8:384–391

    Article  PubMed  CAS  Google Scholar 

  17. Tofts PS, Berkowitz B, Schnall MD (1995) Quantitative analysis of dynamic Gd-DTPA enhancement in breast tumors using a permeability model. Magn Reson Med 33:564–568

    Article  PubMed  CAS  Google Scholar 

  18. Daldrup HE, Shames DM, Husseini W et al (1998) Quantification of the extraction fraction for gadopentetate across breast cancer capillaries. Magn Reson Med 40:537–543

    Article  PubMed  CAS  Google Scholar 

  19. Port RE, Knopp MV, Hoffmann U et al (1999) Multicompartment analysis of gadolinium chelate kinetics: blood-tissue exchange in mammary tumors as monitored by dynamic MR imaging. J Magn Reson Imaging 10:233–241

    Article  PubMed  CAS  Google Scholar 

  20. Brix G, Henze M, Knopp MV et al (2001) Comparison of pharmacokinetic MRI and [18F] fluorodeoxyglucose PET in the diagnosis of breast cancer: initial experience. Eur Radiol 11:2058–2070

    Article  PubMed  CAS  Google Scholar 

  21. Larsson HB, Fritz-Hansen T, Rostrup E et al (1996) Myocardial perfusion modeling using MRI. Magn Reson Med 35:716–726

    Article  PubMed  CAS  Google Scholar 

  22. Fritz-Hansen T, Rostrup E, Sondergaard L et al (1998) Capillary transfer constant of Gd-DTPA in the myocardium at rest and during vasodilation assessed by MRI. Magn Reson Med 40:922–929

    Article  PubMed  CAS  Google Scholar 

  23. Workie D, Dardzinski B, Graham T et al (2004) Quantification of dynamic contrast-enhanced MR imaging of the knee in children with juvenile rheumatoid arthritis based on pharmacokinetic modeling. Magn Reson Imaging 22:1201–1210

    Article  PubMed  Google Scholar 

  24. Workie D, Dardzinski B, Laor T et al (2004) Quantification of DCE-MRI of knees of children with JRA: using an arterial input function extracted from popliteal artery enhancement. Proceedings of the 12th International Society for Magnetic Resonance in Medicine (ISMRM). 15–21 May 2004, Kyoto, Japan

  25. Workie DW, Dardzinski BJ (2005) Quantifying dynamic contrast-enhanced MRI of the knee in children with juvenile rheumatoid arthritis using an arterial input function (AIF) extracted from popliteal artery enhancement, and the effect of the choice of the AIF on the kinetic parameters. Magn Reson Med 54:560–568

    Article  PubMed  Google Scholar 

  26. Petty RE, Southwood TR, Manners P et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  27. Brewer EJ Jr, Giannini EH (1982) Standard methodology for Segment I, II, and III Pediatric Rheumatology Collaborative Study Group studies. I. Design. J Rheumatol 9:109–113

    PubMed  Google Scholar 

  28. Singh G, Athreya BH, Fries JF et al (1994) Measurement of health status in children with juvenile rheumatoid arthritis. Arthritis Rheum 37:1761–1769

    Article  PubMed  CAS  Google Scholar 

  29. Giannini EH, Ruperto N, Ravelli A et al (1997) Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum 40:1202–1209

    PubMed  CAS  Google Scholar 

  30. Ruperto N, Ravelli A, Murray KJ et al (2003) Preliminary core sets of measures for disease activity and damage assessment in juvenile systemic lupus erythematosus and juvenile dermatomyositis. Rheumatology (Oxford) 42:1452–1459

    Article  Google Scholar 

  31. Dardzinski BJ, Schmithorst VJ, Grahm TB (2002) Dynamic contrast enhancement patterns in the knee of children with JRA. Proceedings of the 10th ISMRM Annual Meeting. Honolulu, Hawaii

  32. Dardzinski BJ, Schmithorst VJ, Mosher TJ (1999) Entropy mapping of articular cartilage. Proceedings of the 7th ISMRM Annual Meeting. Philadelphia, PA

  33. Everitt BS, Landau S, Leese M (2001) Cluster analysis, 4th edn. Arnold, London

    Google Scholar 

  34. Hartigan JA (1975) Clustering algorithms. Wiley, New York

    Google Scholar 

  35. Gylys-Morin VM, Graham TB, Blebea JS et al (2001) Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 220:696–706

    Article  PubMed  CAS  Google Scholar 

  36. Weinmann HJ, Brasch RC, Press WR et al (1984) Characteristics of gadolinium-DTPA complex: a potential NMR contrast agent. AJR 142:619–624

    PubMed  CAS  Google Scholar 

  37. Simkin PA (1979) Synovial permeability in rheumatoid arthritis. Arthritis Rheum 22:689–696

    Article  PubMed  CAS  Google Scholar 

  38. Levick JR (1981) Permeability of rheumatoid and normal human synovium to specific plasma proteins. Arthritis Rheum 24:1550–1560

    Article  PubMed  CAS  Google Scholar 

  39. Ostergaard M, Ejbjerg B (2004) Magnetic resonance imaging of the synovium in rheumatoid arthritis. Semin Musculoskelet Radiol 8:287–299

    Article  PubMed  Google Scholar 

  40. Nistala K, Babar J, Johnson K et al (2006) Clinical assessment and core outcome variables are poor predictors of hip arthritis diagnosed by MRI in juvenile idiopathic arthritis. Rheumatology (Oxford) DOI 10.1093/rheumatology/kel401

  41. Brown AK, Quinn MA, Karim Z et al (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54:3761–3773

    Article  PubMed  CAS  Google Scholar 

  42. Molenaar ET, Voskuyl AE, Dinant HJ et al (2004) Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. Arthritis Rheum 50:36–42

    Article  PubMed  Google Scholar 

  43. Graham B, Detsky AS (2001) The application of decision analysis to the surgical treatment of early osteoarthritis of the wrist. J Bone Joint Surg Br 83:650–654

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

B.J. Dardzinski, T. Laor, and T.B. Graham acknowledge funding from the Arthritis Foundation, a Cincinnati Children’s Hospital Trustees grant, and NIH grants P30 AR47363-01 and P60 AR47784-01.

Author information

Authors and Affiliations

  1. Department of Physics, University of Cincinnati, Cincinnati, OH, USA

    Dagnachew W. Workie

  2. Imaging Research Center, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Dagnachew W. Workie, Akila Rajagopal, Kendall J. O’Brien, Wendy A. Bommer & Bernard J. Dardzinski

  3. Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    T. Brent Graham

  4. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Tal Laor, Judy M. Racadio & Bernard J. Dardzinski

  5. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Tal Laor, Judy M. Racadio & Bernard J. Dardzinski

  6. Division of Epidemiology and Biostatistics, University of Cincinnati, Cincinnati, OH, USA

    Norah J. Shire

  7. Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA

    Norah J. Shire

Authors
  1. Dagnachew W. Workie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Brent Graham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tal Laor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akila Rajagopal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kendall J. O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wendy A. Bommer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Judy M. Racadio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Norah J. Shire
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bernard J. Dardzinski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernard J. Dardzinski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Workie, D.W., Graham, T.B., Laor, T. et al. Quantitative MR characterization of disease activity in the knee in children with juvenile idiopathic arthritis: a longitudinal pilot study. Pediatr Radiol 37, 535–543 (2007). https://doi.org/10.1007/s00247-007-0449-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-007-0449-6

Keywords

Search

Navigation