Toward a Simplified Fluid-Sensitive MRI Protocol in Small Joints of the Hand in Early Arthritis Patients: Reliability between mDixon and Regular FSE Fat Saturation MRI Sequences

Background:MRI facilitates early recognition of rheumatoid arthritis (RA) by depicting inflammation. Contrast-enhanced T1-weighted and T2-weighted fat-suppressed sequences have been sensitive and thus recommended, but are hampered by invasiveness, costs and long scan time. Therefore we introduced a modified Dixon-sequence (mDixon) which is more patient-friendly, reduces cost, and scan times by 83%. However, it is not known if this mDixon-sequence is reliable in relation to regular MRI-sequences with and without contrast (T1- and T2-weighted, respectively).Objectives:We determined the reliability between regular MRI-sequences with and without contrast (T1- and T2-weighted, respectively) and mDixon-MRI in early arthritis patients.Methods:29 early arthritis patients underwent regular fat-suppressed-MRI (T1- and T2-weighted) and mDixon-sequences, of metacarpophalangeal-2-5 and wrist-joints. Two readers scored erosions, osteitis, synovitis and tenosynovitis. Intraclass correlation coefficients (ICCs) between readers, and comparing the two sequences, were studied. Spearman correlations were determined.Results:Performance between the two readers with the regular-MRI sequences, was good to excellent (ICCs all ≥0.88). The between reader ICC was also good to excellent for the mDixon-MRI (ICCs all ≥0.76). Next, ICCs between the two sequences was investigated to determine the reliability of mDixon. ICCs were good to excellent for total RAMRIS score 0.87 (95%CI 0.74-0.94), for erosions 0.88 (95%CI 0.69-0.95), and total inflammation score 0.84 (95%CI 0.69-0.82). The individual MRI-inflammation scores, had ICCs for osteitis 0.97 (95%CI 0.93-0.98), for tenosynovitis 0.78 (95%CI 0.58-0.89), and for synovitis 0.57 (95%CI 0.26-0.77). In addition, scores were highly correlated for total RAMRIS, erosions, and total MRI-inflammation score (ρ=0.82, ρ=0.81, ρ=0.80, respectively).Conclusion:Regular-MRI sequences and mDixon-MRI perform equally well, this suggests that mDixon-sequence is reliable to detect joint inflammation. Thus, this is the first step towards an simplified and abridged MRI-protocol in small hand-joints in early arthritis patients. The ultimate goal will be implementation of this mDixon-MRI sequence. Validation in larger studies is warranted.Disclosure of Interests:None declared

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Neuroimaging signs of brain lesions in patients with gene-associated microangiopathy (CADASIL)

Medical Visualization ◽

10.24835/1607-0763-2018-3-17-25 ◽

2018 ◽

pp. 17-25

Author(s):

N. S. Kurochkina ◽

A. A. Moroz ◽

R. N. Konovalov ◽

N. Yu. Abramycheva ◽

М. V. Krotenkova ◽

...

Keyword(s):

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Brain Lesions ◽

Perivascular Spaces ◽

Vascular Changes ◽

Conventional Mri ◽

External Capsule ◽

Mri Protocol ◽

Mri Sequences ◽

Echo Planar

Purpose. To evaluate specific changes in MRI of the human brain, associated with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).Materials and methods. We enrolled 24 patients with genetically confirmed CADASIL (19–81 y.o.). The following MRI sequences were performed for every subject: T1 MPR, T2, T2-FLAIR, DTI and SWI. Brain tissue lesions were assessed using STandards for ReportIng Vascular changes on nEuroimaging (STRIVE).Results. In the CADASIL group the following changes were observed (in % of patients): recent small subcortical infarcts – none; lacunes – 54%; white matter hyperintensities (WMH) by Fazekas 1 – 12%, Fazekas 2 – 17%, Fazekas 3 – 71% (sites of predilection: anterior temporal lobe and external capsule); cerebral microbleeds – 42%; enlarged perivascular spaces – 88%; brain atrophy – 27%.Conclusion. Neuroimaging signs of brain lesions are common for all types of cerebral small vessel disease, including CADASIL. However, there are some features in patients with CADASIL. The detection of petechial intraparenchymal hemorrhages is a diagnostically and prognostically useful marker, so it is very important to use gradient echo planar T2* or SWI sequence in the conventional MRI protocol.

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The role of 3D volumetric MR sequences in diagnosing intraventricular neurocysticercosis: preliminar results

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000100015 ◽

2011 ◽

Vol 69 (1) ◽

pp. 74-78 ◽

Cited By ~ 25

Author(s):

Francisco Edward Frota Mont'Alverne Filho ◽

Luís dos Ramos Machado ◽

Leandro Tavares Lucato ◽

Claudia Costa Leite

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Fast Imaging ◽

Cystic Lesions ◽

Resonance Imaging ◽

Mri Protocol ◽

Mri Sequences ◽

Mr Sequences

OBJECTIVE: The purpose of this paper was to investigate the role of two three-dimensional magnetic resonance (MRI) sequences: enhanced spoiled gradient recalled echo (SPGR), and fast imaging employing steady-state acquisition (FIESTA) in the evaluation of intraventricular neurocysticercosis cysts and scolices. METHOD: Seven neurocysticercosis patients suspected of presenting intraventricular lesions were evaluated by magnetic resonance imaging using enhanced SPGR, and FIESTA. RESULTS: Enhanced SPGR detected eight cystic lesions, with scolices in four. Contrast enhancement was observed in three cysts. FIESTA also detected eight cystic lesions with the presence of scolices in seven of those cystic lesions. Four patients presented parenchymal involvement, while the remaining three presented the racemose form. CONCLUSION: FIESTA and SPGR are sequences that can detect intraventricular cysts of neurocysticercosis, and FIESTA also is good for the detection of the scolex. Considering this information we suggest that FIESTA and SPGR should be included in the MRI protocol for the investigation of intraventricular neurocysticercosis.

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THU0533 A SINGLE MRI DIXON SEQUENCE TO ASSESS DISEASE ACTIVITY AND CARTILAGE IN EARLY RHEUMATOID HANDS: ONE SEQUENCE TO ASSESS THEM ALL?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1685 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 506.1-506

Author(s):

T. Kirchgesner ◽

M. Stoenoiu ◽

N. Michoux ◽

P. Durez ◽

B. Vande Berg

Keyword(s):

Disease Activity ◽

Cartilage Thickness ◽

Observer Agreement ◽

Dixon Method ◽

Contrast Enhanced ◽

Core Set ◽

Phase Images ◽

Mri Protocol ◽

Mri Sequences ◽

And Cartilage

Background:OMERACT recommends three “core set” MRI sequences with an optional cartilage-dedicated sequence to perform Rheumatoid Arthritis (RA) MRI scoring (RAMRIS) (1). Dixon method allows the production of four different images from a single MRI sequence.Objectives:To test a short MRI protocol based on a single Dixon sequence to assess disease activity and cartilage in hands of patients with early RA.Methods:Twenty-four patients (16 women, mean age 45.7 years old) with early DMARD-naive RA meeting the ACR/EULAR 2010 criteria were prospectively included. Both hands of each patient were imaged with MRI including contrast-enhanced T1-weighted Dixon and OMERACT “core set” MRI sequences and with conventional radiography.Two musculoskeletal radiologists (R1 and R2) separately assessed disease activity according to RAMRIS scoring system based on the Dixon images (contrast-enhanced T1-weighted Dixon water-only images to score synovitis, tenosynovitis and osteitis and contrast-enhanced T1-weighted Dixon fat-only images to score erosions) and the three OMERACT “core set” MRI sequences (contrast-enhanced fat-saturated T1-weighted images to score synovitis and tenosynovitis, fat-saturated T2-weighted images to score osteitis and T1-weighted images without contrast-material injection to score erosions).One radiologist (R1) separately measured the thickness of the cartilage in the joints corresponding to those assessed by the Sharp/van der Heijde modified scoring method on contrast-enhanced T1-weighted Dixon out-of-phase images and radiographs (2).RAMRIS scoring and measurement of the cartilage thickness were repeated by R1 to assess intra-observer agreement. Statistical analysis was based on intra-class correlation coefficients (ICC) with 95% confidence interval to assess inter-technique, intra-observer and inter-observer agreement. The strength of agreement was interpreted as follows: ≤0, poor; 0.01-0.20, slight; 0.21-0.40, fair; 0.41-0.60, moderate; 0.61-0.80, substantial and ≥0.81, excellent.Results:Agreement between total RAMRIS scores obtained with the Dixon water- and fat-only images and total RAMRIS scores obtained with the OMERACT sequences was excellent for R1 (0.94; 0.86-0.97) and R2 (0.91; 0.81-0.96). Intra-observer agreement was excellent with Dixon images (0.97; 0.92-0.98) and OMERACT sequences (0.96; 0.90-0.98). Inter-observer agreement was excellent with Dixon images (0.92; 0.82-0.96) and OMERACT sequences (0.93; 0.85-0.97).Agreement between the measures of cartilage thickness on the Dixon out-of-phase images and the measures of cartilage thickness on radiographs was substantial (0.71; 0.66-0.75). Intra-observer agreement was excellent with Dixon out-of-phase images (0.94; 0.93-0.95) and radiographs (0.93; 0.92-0.94).Conclusion:An MRI protocol based on a single contrast-enhanced T1-weighted Dixon sequence allows reproducible RAMRIS scoring and measurement of the cartilage thickness. Further studies should be performed to evaluate the value of a short MRI protocol based on the Dixon method to monitor disease activity including cartilage loss in treated RA patients.References:[1]Ostergaard M, Peterfy CG, Bird P, Gandjbakhch F, Glinatsi D, Eshed I, et al. The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: Updated Recommendations by the OMERACT MRI in Arthritis Working Group. J Rheumatol. 2017;44(11):1706-12.[2]van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 1999;26(3):743-5.Disclosure of Interests:Thomas Kirchgesner: None declared, Maria Stoenoiu: None declared, Nicolas Michoux: None declared, Patrick Durez Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Pfizer, Sanofi, Bruno Vande Berg: None declared

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