1
|
Kalisvaart GM, Van Den Berghe T, Grootjans W, Lejoly M, Huysse WCJ, Bovée JVMG, Creytens D, Gelderblom H, Speetjens FM, Lapeire L, van de Sande MAJ, Sys G, de Geus-Oei LF, Verstraete KL, Bloem JL. Evaluation of response to neoadjuvant chemotherapy in osteosarcoma using dynamic contrast-enhanced MRI: development and external validation of a model. Skeletal Radiol 2024; 53:319-328. [PMID: 37464020 PMCID: PMC10730632 DOI: 10.1007/s00256-023-04402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To identify which dynamic contrast-enhanced (DCE-)MRI features best predict histological response to neoadjuvant chemotherapy in patients with an osteosarcoma. METHODS Patients with osteosarcoma who underwent DCE-MRI before and after neoadjuvant chemotherapy prior to resection were retrospectively included at two different centers. Data from the center with the larger cohort (training cohort) was used to identify which method for region-of-interest selection (whole slab or focal area method) and which change in DCE-MRI features (time to enhancement, wash-in rate, maximum relative enhancement and area under the curve) gave the most accurate prediction of histological response. Models were created using logistic regression and cross-validated. The most accurate model was then externally validated using data from the other center (test cohort). RESULTS Fifty-five (27 poor response) and 30 (19 poor response) patients were included in training and test cohorts, respectively. Intraclass correlation coefficient of relative DCE-MRI features ranged 0.81-0.97 with the whole slab and 0.57-0.85 with the focal area segmentation method. Poor histological response was best predicted with the whole slab segmentation method using a single feature threshold, relative wash-in rate <2.3. Mean accuracy was 0.85 (95%CI: 0.75-0.95), and area under the receiver operating characteristic curve (AUC-index) was 0.93 (95%CI: 0.86-1.00). In external validation, accuracy and AUC-index were 0.80 and 0.80. CONCLUSION In this study, a relative wash-in rate of <2.3 determined with the whole slab segmentation method predicted histological response to neoadjuvant chemotherapy in osteosarcoma. Consistent performance was observed in an external test cohort.
Collapse
Affiliation(s)
- Gijsbert M Kalisvaart
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| | - Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Willem Grootjans
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Maryse Lejoly
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Wouter C J Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Frank M Speetjens
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Michiel A J van de Sande
- Department of Orthopedics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Gwen Sys
- Department of Orthopedics, Ghent University Hospital, Ghent, Belgium
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Koenraad L Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Johan L Bloem
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| |
Collapse
|
2
|
Noebauer-Huhmann IM, Grieser T, Panotopoulos J, Dieckmann K, Lalam RK, Bloem JL, Weber MA. Presurgical Perspective and Posttreatment Evaluation of Soft Tissue Tumors of the Ankle and Foot in Adults. Semin Musculoskelet Radiol 2022; 26:730-743. [PMID: 36791741 DOI: 10.1055/s-0042-1760218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This article discusses soft tissue tumors of the ankle and foot region in adults, including tumors of the joints, and also briefly addresses tumor-simulating lesions. We offer general recommendations and describe specific aspects of common entities in that region, such as typical imaging appearance, therapeutic strategies, and posttherapeutic considerations. Focal masses and diffuse swelling are common in the foot and ankle region; most of them are non-neoplastic. Some of the tumors, such as plantar fibromatosis, tenosynovial giant cell tumor, synovial chondromatosis, or schwannoma, have a very typical appearance on magnetic resonance imaging. Sarcomas are rare among true soft tissue tumors; however, they can be small and well demarcated, may grow slowly, and are often misinterpreted as benign. This is especially true for synovial sarcoma, one of the most common sarcomas in this region. Densely packed tissues in the foot and ankle may hamper determining the tissue of origin. Adherence to diagnostic guidelines and cooperation with tumor centers is crucial including for posttherapeutic surveillance. We also describe typical posttherapeutic changes and complications after surgery, radiation therapy, and chemotherapy, as well as parameters for the detection and exclusion of recurrence of soft tissue tumors of the ankle and foot.
Collapse
Affiliation(s)
- Iris-Melanie Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, United Kingdom
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| |
Collapse
|
3
|
Rodríguez Ruiz A, van Hoolwerff M, Sprangers S, Suchiman E, Schoenmaker T, Dibbets-Schneider P, Bloem JL, Nelissen RGHH, Freund C, Mummery C, Everts V, de Vries TJ, Ramos YFM, Meulenbelt I. Mutation in the CCAL1 locus accounts for bidirectional process of human subchondral bone turnover and cartilage mineralization. Rheumatology (Oxford) 2022; 62:360-372. [PMID: 35412619 PMCID: PMC9788812 DOI: 10.1093/rheumatology/keac232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To study the mechanism by which the readthrough mutation in TNFRSF11B, encoding osteoprotegerin (OPG) with additional 19 amino acids at its C-terminus (OPG-XL), causes the characteristic bidirectional phenotype of subchondral bone turnover accompanied by cartilage mineralization in chondrocalcinosis patients. METHODS OPG-XL was studied by human induced pluripotent stem cells expressing OPG-XL and two isogenic CRISPR/Cas9-corrected controls in cartilage and bone organoids. Osteoclastogenesis was studied with monocytes from OPG-XL carriers and matched healthy controls followed by gene expression characterization. Dual energy X-ray absorptiometry scans and MRI analyses were used to characterize the phenotype of carriers and non-carriers of the mutation. RESULTS Human OPG-XL carriers relative to sex- and age-matched controls showed, after an initial delay, large active osteoclasts with high number of nuclei. By employing hiPSCs expressing OPG-XL and isogenic CRISPR/Cas9-corrected controls to established cartilage and bone organoids, we demonstrated that expression of OPG-XL resulted in excessive fibrosis in cartilage and high mineralization in bone accompanied by marked downregulation of MGP, encoding matrix Gla protein, and upregulation of DIO2, encoding type 2 deiodinase, gene expression, respectively. CONCLUSIONS The readthrough mutation at CCAL1 locus in TNFRSF11B identifies an unknown role for OPG-XL in subchondral bone turnover and cartilage mineralization in humans via DIO2 and MGP functions. Previously, OPG-XL was shown to affect binding between RANKL and heparan sulphate (HS) resulting in loss of immobilized OPG-XL. Therefore, effects may be triggered by deficiency in the immobilization of OPG-XL Since the characteristic bidirectional pathophysiology of articular cartilage calcification accompanied by low subchondral bone mineralization is also a hallmark of OA pathophysiology, our results are likely extrapolated to common arthropathies.
Collapse
Affiliation(s)
| | | | | | - Eka Suchiman
- Department of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden
| | - Ton Schoenmaker
- Department of Oral Cell Biology,Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit , Amsterdam
| | | | | | - Rob G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Teun J de Vries
- Department of Oral Cell Biology,Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit , Amsterdam
| | - Yolande F M Ramos
- Correspondence to: Department of Molecular Epidemiology, Leiden University Medical Center, LUMC Postzone S-05-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail:
| | | |
Collapse
|
4
|
Gitto S, Cuocolo R, van Langevelde K, van de Sande MAJ, Parafioriti A, Luzzati A, Imbriaco M, Sconfienza LM, Bloem JL. MRI radiomics-based machine learning classification of atypical cartilaginous tumour and grade II chondrosarcoma of long bones. EBioMedicine 2022; 75:103757. [PMID: 34933178 PMCID: PMC8688587 DOI: 10.1016/j.ebiom.2021.103757] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background Atypical cartilaginous tumour (ACT) and grade II chondrosarcoma (CS2) of long bones are respectively managed with watchful waiting or curettage and wide resection. Preoperatively, imaging diagnosis can be challenging due to interobserver variability and biopsy suffers from sample errors. The aim of this study is to determine diagnostic performance of MRI radiomics-based machine learning in differentiating ACT from CS2 of long bones. Methods One-hundred-fifty-eight patients with surgically treated and histology-proven cartilaginous bone tumours were retrospectively included at two tertiary bone tumour centres. The training cohort consisted of 93 MRI scans from centre 1 (n=74 ACT; n=19 CS2). The external test cohort consisted of 65 MRI scans from centre 2 (n=45 ACT; n=20 CS2). Bidimensional segmentation was performed on T1-weighted MRI. Radiomic features were extracted. After dimensionality reduction and class balancing in centre 1, a machine-learning classifier (Extra Trees Classifier) was tuned on the training cohort using 10-fold cross-validation and tested on the external test cohort. In centre 2, its performance was compared with an experienced musculoskeletal oncology radiologist using McNemar's test. Findings After tuning on the training cohort (AUC=0.88), the machine-learning classifier had 92% accuracy (60/65, AUC=0.94) in identifying the lesions in the external test cohort. Its accuracies in correctly classifying ACT and CS2 were 98% (44/45) and 80% (16/20), respectively. The radiologist had 98% accuracy (64/65) with no difference compared to the classifier (p=0.134). Interpretation Machine learning showed high accuracy in classifying ACT and CS2 of long bones based on MRI radiomic features. Funding ESSR Young Researchers Grant.
Collapse
Affiliation(s)
- Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Radiology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Renato Cuocolo
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy; Laboratory of Augmented Reality for Health Monitoring (ARHeMLab), Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, Università degli Studi di Napoli "Federico II", Naples, Italy
| | | | | | | | | | - Massimo Imbriaco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Johan L Bloem
- Radiology Department, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
5
|
Kalisvaart GM, Grootjans W, Bovée JVMG, Gelderblom H, van der Hage JA, van de Sande MAJ, van Velden FHP, Bloem JL, de Geus-Oei LF. Prognostic Value of Quantitative [18F]FDG-PET Features in Patients with Metastases from Soft Tissue Sarcoma. Diagnostics (Basel) 2021; 11:diagnostics11122271. [PMID: 34943508 PMCID: PMC8700088 DOI: 10.3390/diagnostics11122271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Prognostic biomarkers are pivotal for adequate treatment decision making. The objective of this study was to determine the added prognostic value of quantitative [18F]FDG-PET features in patients with metastases from soft tissue sarcoma (STS). Methods: Patients with metastases from STS, detected by (re)staging [18F]FDG-PET/CT at Leiden University Medical Centre, were retrospectively included. Clinical and histopathological patient characteristics and [18F]FDG-PET features (SUVmax, SUVpeak, SUVmean, total lesion glycolysis, and metabolic tumor volume) were analyzed as prognostic factors for overall survival using a Cox proportional hazards model and Kaplan–Meier methods. Results: A total of 31 patients were included. SUVmax and SUVpeak were significantly predictive for overall survival (OS) in a univariate analysis (p = 0.004 and p = 0.006, respectively). Hazard ratios (HRs) were 1.16 per unit increase for SUVmax and 1.20 per unit for SUVpeak. SUVmax and SUVpeak remained significant predictors for overall survival after correction for the two strongest predictive clinical characteristics (number of lesions and performance status) in a multivariate analysis (p = 0.02 for both). Median SUVmax and SUVpeak were 5.7 and 4.9 g/mL, respectively. The estimated mean overall survival in patients with SUVmax > 5.7 g/mL was 14 months; otherwise, it was 39 months (p < 0.001). For patients with SUVpeak > 4.9 g/mL, the estimated mean overall survival was 18 months; otherwise, it was 33 months (p = 0.04). Conclusions: In this study, SUVmax and SUVpeak were independent prognostic factors for overall survival in patients with metastases from STS. These results warrant further investigation of metabolic imaging with [18F]FDG-PET/CT in patients with metastatic STS.
Collapse
Affiliation(s)
- Gijsbert M. Kalisvaart
- Department of Radiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands; (W.G.); (F.H.P.v.V.); (J.L.B.); (L.-F.d.G.-O.)
- Correspondence:
| | - Willem Grootjans
- Department of Radiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands; (W.G.); (F.H.P.v.V.); (J.L.B.); (L.-F.d.G.-O.)
| | - Judith V. M. G. Bovée
- Department of Pathology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | - Jos A. van der Hage
- Department of Surgical Oncology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | | | - Floris H. P. van Velden
- Department of Radiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands; (W.G.); (F.H.P.v.V.); (J.L.B.); (L.-F.d.G.-O.)
| | - Johan L. Bloem
- Department of Radiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands; (W.G.); (F.H.P.v.V.); (J.L.B.); (L.-F.d.G.-O.)
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands; (W.G.); (F.H.P.v.V.); (J.L.B.); (L.-F.d.G.-O.)
- Biomedical Photonic Imaging Group, University of Twente, 7522 NB Enschede, The Netherlands
| |
Collapse
|
6
|
Krijbolder DI, Verstappen M, Wouters F, Lard LR, de Buck P, Veris-van Dieren JJ, Bloem JL, Reijnierse M, van der Helm-van Mil A. Comparison between 1.5T and 3.0T MRI: both field strengths sensitively detect subclinical inflammation of hand and forefoot in patients with arthralgia. Scand J Rheumatol 2021; 51:284-290. [PMID: 34263716 DOI: 10.1080/03009742.2021.1935313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Magnetic resonance imaging (MRI) of small joints sensitively detects inflammation. This inflammation, and tenosynovitis in particular, has been shown to predict rheumatoid arthritis (RA) development in arthralgia patients. These data have predominantly been acquired on 1.0-1.5 T MRI. However, 3.0 T is now commonly used in practice. Evidence on the comparability of these field strengths is scarce and has never included subtle inflammation in arthralgia patients or tenosynovitis. Therefore, we assessed the comparability of 1.5 T and 3.0 T in detecting subclinical inflammation in arthralgia patients.Method: A total of 2968 locations (joints, bones, tendon sheaths) in the hands and forefeet of 28 patients with small-joint arthralgia, at risk for RA, were imaged on both 1.5 and 3.0 T MRI. Two blinded readers independently scored erosions, osteitis, synovitis, and tenosynovitis, in line with the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS). Features were summed into inflammation (osteitis, synovitis, tenosynovitis) and RAMRIS (inflammation and erosions). Agreement was assessed with intraclass correlation coefficients (ICCs) for continuous scores and after dichotomization into presence or absence of inflammation, on patient and location levels.Results: Interreader ICCs were excellent (> 0.90). Comparing 1.5 and 3.0 T revealed an ICC of 0.90 for inflammation and RAMRIS. ICCs for individual inflammation features were: tenosynovitis 0.87 (95% confidence interval 0.74-0.94), synovitis 0.65 (0.24-0.84), and osteitis 0.96 (0.91-0.98). Agreement was 83% for inflammation and 89% for RAMRIS. Analyses on the location level showed similar results.Conclusion: Agreement on subclinical inflammation between 1.5 T and 3.0 T was excellent. Although synovitis scores were slightly different, synovitis often occurs simultaneously with other inflammatory signs, suggesting that scientific results on the predictive value of MRI-detected inflammation for RA, obtained on 1.5 T MRI, can be generalized to 3.0 T MRI.
Collapse
Affiliation(s)
- D I Krijbolder
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Verstappen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Wouters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - L R Lard
- Department of Rheumatology, LangeLand Hospital, Zoetermeer, The Netherlands
| | - Pdm de Buck
- Department of Rheumatology, Haaglanden Medical Center, The Hague, The Netherlands
| | - J J Veris-van Dieren
- Department of Rheumatology, Reumazorg Zuid West Nederland, Goes, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ahm van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Kalisvaart GM, Bloem JL, Bovée JVMG, van de Sande MAJ, Gelderblom H, van der Hage JA, Hartgrink HH, Krol ADG, de Geus-Oei LF, Grootjans W. Personalising sarcoma care using quantitative multimodality imaging for response assessment. Clin Radiol 2021; 76:313.e1-313.e13. [PMID: 33483087 DOI: 10.1016/j.crad.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/17/2020] [Indexed: 01/18/2023]
Abstract
Over the last decades, technological developments in the field of radiology have resulted in a widespread use of imaging for personalising medicine in oncology, including patients with a sarcoma. New scanner hardware, imaging protocols, image reconstruction algorithms, radiotracers, and contrast media, enabled the assessment of the physical and biological properties of tumours associated with response to treatment. In this context, medical imaging has the potential to select sarcoma patients who do not benefit from (neo-)adjuvant treatment and facilitate treatment adaptation. Due to the biological heterogeneity in sarcomas, the challenge at hand is to acquire a practicable set of imaging features for specific sarcoma subtypes, allowing response assessment. This review provides a comprehensive overview of available clinical data on imaging-based response monitoring in sarcoma patients and future research directions. Eventually, it is expected that imaging-based response monitoring will help to achieve successful modification of (neo)adjuvant treatments and improve clinical care for these patients.
Collapse
Affiliation(s)
- G M Kalisvaart
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - M A J van de Sande
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J A van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - A D G Krol
- Department of Radiation Oncology. Leiden University Medical Center, Leiden, the Netherlands
| | - L F de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
| | - W Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
8
|
Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Erratum: Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2021; 24:e1. [PMID: 33401313 DOI: 10.1055/s-0040-1722295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology,King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center,Leiden, The Netherlands
| |
Collapse
|
9
|
Bloem JL, Vriens D, Krol ADG, Özdemir M, Sande MAJVD, Gelderblom H, Bovee JVMG, Hage JAVD, Noebauer-Huhmann IM. Therapy-Related Imaging Findings in Patients with Sarcoma. Semin Musculoskelet Radiol 2020; 24:676-691. [PMID: 33307584 DOI: 10.1055/s-0040-1721097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Knowledge of imaging findings related to therapy administered to patients with sarcoma is pivotal in selecting appropriate care for these patients. Imaging studies are performed as surveillance in asymptomatic patients or because symptoms, including anxiety, develop. In addition to detection of recurrent disease and assessment of response to therapy, diagnosis of conditions related to therapy that may or may not need treatment has a marked positive impact on quality of life. The purpose of this review is to assist radiologists, nuclear physicians, and others clinicians involved in the diagnosis and treatment of these patients in recognizing imaging findings related to therapy and not to activity of the previously treated sarcoma. Imaging findings are time dependent and often specific in relation to therapy given.
Collapse
Affiliation(s)
- Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis Vriens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Augustinus D G Krol
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Murat Özdemir
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris M Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
10
|
Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2020; 24:627-644. [PMID: 33307581 DOI: 10.1055/s-0040-1721464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.
Collapse
Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
11
|
Abstract
The diagnosis of tumors and tumorlike lesions of bone is a routine part of both general and specialist radiologic practices. The spectrum of disorders ranges from the small incidental lesion to the potentially life-limiting malignancies whether primary or secondary. In this review, authored by experts from several European orthopaedic oncology centers, we present a collection of pieces of advice in the form of 10 commandments. Adherence in daily practice to this guidance should help minimize adverse patient experiences and outcomes.
Collapse
Affiliation(s)
- Mark Davies
- Department of Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Radhesh Lalam
- Department of Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Klaus Woertler
- Department of Imaging, Technische Universitat Munchen, Munich, Germany
| | - Johan L Bloem
- Department of Imaging, Leiden University Medical Center, Leiden, The Netherlands
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
12
|
Damman W, Liu R, Reijnierse M, Rosendaal FR, Bloem JL, Kloppenburg M. Effusion attenuates the effect of synovitis on radiographic progression in patients with hand osteoarthritis: a longitudinal magnetic resonance imaging study. Clin Rheumatol 2020; 40:315-319. [PMID: 32862337 PMCID: PMC7782402 DOI: 10.1007/s10067-020-05341-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/27/2020] [Accepted: 08/09/2020] [Indexed: 11/27/2022]
Abstract
An exploratory study to determine the role of effusion, i.e., fluid in the joint, in pain, and radiographic progression in patients with hand osteoarthritis. Distal and proximal interphalangeal joints (87 patients, 82% women, mean age 59 years) were assessed for pain. T2-weighted and Gd-chelate contrast-enhanced T1-weighted magnetic resonance images were scored for enhanced synovial thickening (EST, i.e., synovitis), effusion (EST and T2-high signal intensity [hsi]) and bone marrow lesions (BMLs). Effusion was defined as follows: (1) T2-hsi > 0 and EST = 0; or 2) T2-hsi = EST but in different joint locations. Baseline and 2-year follow-up radiographs were scored following Kellgren-Lawrence, increase ≥ 1 defined progression. Associations between the presence of effusion and pain and radiographic progression, taking into account EST and BML presence, were explored on the joint level. Effusion was present in 17% (120/691) of joints, with (63/120) and without (57/120) EST. Effusion on itself was not associated with pain or progression. The association with pain and progression, taking in account other known risk factors, was stronger in the absence of effusion (OR [95% CI] 1.7 [1.0–2.9] and 3.2 [1.7–5.8]) than in its presence (1.6 [0.8–3.0] and 1.3 [0.5–3.1]). Effusion can be assessed on MR images and seems not to be associated with pain or radiographic progression but attenuates the association between synovitis and progression.Key Points • Effusion is present apart from synovitis in interphalangeal joints in patients with hand OA. • Effusion in finger joints can be assessed as a separate feature on MR images. • Effusion seems to be of importance for its attenuating effect on the association between synovitis and radiographic progression. |
Collapse
Affiliation(s)
- W Damman
- Department of Rheumatology, Leiden University Medical Center, C1-R, PO Box 9600, 2300, RC, Leiden, The Netherlands.
| | - R Liu
- Department of Rheumatology, Leiden University Medical Center, C1-R, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - M Reijnierse
- Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - F R Rosendaal
- Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - J L Bloem
- Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, C1-R, PO Box 9600, 2300, RC, Leiden, The Netherlands
- Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| |
Collapse
|
13
|
Swart NM, van Oudenaarde K, Bierma-Zeinstra SMA, Bloem JL, Bindels PJE, Algra PR, Reijnierse M, Luijsterburg PAJ. Predicting no return to sports after three months in patients with traumatic knee complaints in general practice by combining patient characteristics, trauma characteristics and knee complaints. Eur J Gen Pract 2019; 25:205-213. [PMID: 31431084 PMCID: PMC6853237 DOI: 10.1080/13814788.2019.1646241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: It remains unclear to what extent patients with traumatic knee complaints aged 18–45 years seen in general practice experience difficulties with return to sports. Objectives: This study aims to determine the proportion of patients with a knee trauma that return to sports at six weeks and three months follow-up. Also examined were associations between no return to sports and baseline patient/trauma characteristics, knee complaints and MR (magnetic resonance) findings, as well as the additive value of MR findings. Methods: Included were patients with traumatic knee complaints participating in a randomized controlled trial assessing the cost-effectiveness of an MR scan in general practice. Patients were classified as ‘no return to sports’ or ‘return to sports’ (sports on pre-injury or adapted level). Potential baseline predictors for no return to sports were assessed using logistic regression analyses. The area under the curves (AUC) was compared. Results: At six weeks and three months follow-up, 147 (59%) and 175 (74%) patients, respectively, reported return to sports. Combining patient characteristics, trauma characteristics and knee complaints predicted no return to sports with an AUC of 0.86 (95%CI: 0.81–0.90) at six weeks and of 0.82 (95%CI: 0.76–0.88) at three months follow-up. After adding MR findings, the AUC was 0.79 (95%CI: 0.71–0.87) at six weeks and 0.79 (95%CI: 0.70–0.88) at three months follow-up. Conclusion: Three out of four patients with a knee trauma in general practice reported return to sports at three months follow-up. A combination of patient/trauma characteristics and knee complaints predicted no return to sports, whereas MR findings had no additive value. Trial registration: Dutch trial registration: registration number: NTR3689. registration date: 7 November 2012.
Collapse
Affiliation(s)
- Nynke M Swart
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kim van Oudenaarde
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul R Algra
- Department of Radiology, Northwest Clinics, location Alkmaar, Alkmaar, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Pim A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Affiliation(s)
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
15
|
Aizenberg E, Roex EA, Nieuwenhuis WP, Mangnus L, van der Helm‐van Mil AH, Reijnierse M, Bloem JL, Lelieveldt BP, Stoel BC. Erratum to: Automatic quantification of bone marrow edema on MRI of the wrist in patients with early arthritis: A feasibility study (Magn Reson Med. 2018; 79:1127‐1134). Magn Reson Med 2019; 82:510. [DOI: 10.1002/mrm.27698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Evgeni Aizenberg
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| | - Edgar A.H. Roex
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
- Department of Biomechanical Engineering Delft University of Technology Delft The Netherlands
| | | | - Lukas Mangnus
- Department of Rheumatology Leiden University Medical Center Leiden The Netherlands
| | - Annette H.M. van der Helm‐van Mil
- Department of Rheumatology Leiden University Medical Center Leiden The Netherlands
- Department of Rheumatology Erasmus Medical Center Rotterdam The Netherlands
| | - Monique Reijnierse
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| | - Johan L. Bloem
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| | - Boudewijn P.F. Lelieveldt
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
- Intelligent Systems Department Delft University of Technology Delft The Netherlands
| | - Berend C. Stoel
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| |
Collapse
|
16
|
Abstract
Although it is possible for any osseous tumor or tumorlike lesion to occur in and around the hip and pelvis, there are preferential lesions. Most tumors share many imaging features with those arising elsewhere in the skeletal system, but some may show specific morphological and imaging features. Furthermore, specific criteria and rules of thumb are related to this anatomical area that radiologists should know, which together with the imaging findings and clinical context will lead to a more confident diagnosis.In this article we review the basic anatomical and imaging principles in the hip and pelvis and their diagnostic criteria, describe the most common regional benign and malignant bone tumors and pseudotumors, and highlight their main imaging features and common differential diagnosis while keep this article as relatively simple and straightforward as possible. Soft tissue tumors are beyond the scope of this article.
Collapse
Affiliation(s)
- P. Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
- Radiology Department, Hospital Beatriz Ângelo, Loures, Portugal
- Radiology Department, Hospital Particular da Madeira, Madeira, Portugal
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Amanda Isaac
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering & Imaging Sciences Department, Kings College London, United Kingdom
| | - Johan L. Bloem
- Radiology Department, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
17
|
van Beest S, Kroon FPB, Kroon HM, Damman W, Liu R, Bloem JL, Reijnierse M, Kloppenburg M. Assessment of osteoarthritic features in the thumb base with the newly developed OMERACT magnetic resonance imaging scoring system is a valid addition to standard radiography. Osteoarthritis Cartilage 2019; 27:468-475. [PMID: 30508599 DOI: 10.1016/j.joca.2018.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the construct validity of the new thumb base OA magnetic resonance imaging (MRI) scoring system (TOMS) by comparing TOMS scores with radiographic scores in patients with primary hand OA. DESIGN In 200 patients (83.5% women, mean (SD) age 61.0 (8.4) years), postero-anterior radiographs and MR scans (1.5 T) of the right first carpometacarpal (CMC-1) and scaphotrapeziotrapezoid (STT) joints, were scored using the OARSI atlas and TOMS, respectively. The distributions of the TOMS scores (specified in results section) were stratified for the OARSI scores of corresponding radiographic features and investigated using boxplots and non-parametric tests. Furthermore, Spearman's rank or Phi correlation coefficients (ρ/φ) were calculated. RESULTS For all features, especially for erosions and osteophytes, the prevalence found with MRI was higher than with radiography. TOMS osteophyte and cartilage loss scores differed statistically significant between corresponding OARSI scores in CMC-1 (0 vs 1; 1 vs 2). TOMS scores were positively correlated with radiographic scores in CMC-1 for osteophytes (coefficient [95% confidence interval], ρ = 0.75 [0.69; 0.81]), cartilage loss/joint space narrowing (ρ = 0.70 [0.62; 0.76]), subchondral bone defects (SBDs)/erosion-cyst (ρ = 0.41 [0.29; 0.52]), bone marrow lesions (BMLs)/subchondral sclerosis (ρ = 0.65 [0.56; 0.73]) and subluxation (φ = 0.65 [0.57; 0.73]); and in STT for osteophytes (ρ = 0.30 [0.17; 0.42]) and cartilage loss/joint space narrowing (ρ = 0.53 [0.42; 0.62]). CONCLUSIONS In patients with hand OA, TOMS scores positively correlated with radiographic scores, indicating good construct validity. However, the prevalence of features on MR images was higher compared to radiographs, suggesting that TOMS might be more sensitive than radiography. The clinical meaning of these extra MR detected cases is currently still unknown.
Collapse
Affiliation(s)
- S van Beest
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - F P B Kroon
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - W Damman
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - R Liu
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| |
Collapse
|
18
|
Kroon FPB, van Beest S, Ermurat S, Kortekaas MC, Bloem JL, Reijnierse M, Rosendaal FR, Kloppenburg M. In thumb base osteoarthritis structural damage is more strongly associated with pain than synovitis. Osteoarthritis Cartilage 2018; 26:1196-1202. [PMID: 29709499 DOI: 10.1016/j.joca.2018.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis in thumb base joints (first carpometacarpal (CMC-1), scaphotrapeziotrapezoid (STT)) is prevalent and disabling, yet focussed studies are scarce. Our aim was to investigate associations between ultrasonographic and magnetic resonance imaging (MRI) inflammatory features, radiographic osteophytes, and thumb base pain in hand osteoarthritis patients. DESIGN Cross-sectional analyses were performed in cohorts with MRI (n = 202) and ultrasound measurements (n = 87). Pain upon thumb base palpation was assessed. Radiographs were scored for CMC-1/STT osteophytes. Synovial thickening, effusion and power Doppler signal in CMC-1 joints were assessed with ultrasound. MRIs were scored for synovitis and bone marrow lesions (BMLs) in CMC-1 and STT joints using OMERACT-TOMS. Associations between ultrasound/MRI features, osteophytes, and thumb base pain were assessed. Interaction between MRI features and osteophytes was explored. RESULTS In 289 patients (mean age 60.2, 83% women) 139/376 thumb bases were painful. Osteophyte presence was associated with pain (MRI cohort: odds ratio (OR) 5.1 (2.7-9.8)). Ultrasound features were present in 25-33% of CMC-1 joints, though no associations were seen with pain. MRI-synovitis and BMLs grade ≥2 were scored in 25% and 43% of thumb bases, and positively associated with pain (OR 3.6 (95% CI 1.7-7.6) and 3.0 (1.6-5.5)). Associations attenuated after adjustment for osteophyte presence. Combined presence of osteophytes and MRI-synovitis had an additive effect. CONCLUSIONS Ultrasonographic and MRI inflammatory features were often present in the thumb base. Osteophytes were more strongly associated with thumb base pain than inflammatory features, in contrast to findings in finger OA studies, supporting thumb base osteoarthritis as a distinct phenotype.
Collapse
Affiliation(s)
- F P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S van Beest
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Ermurat
- Department of Rheumatology, Uludag University Medical Faculty, Bursa, Turkey
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
19
|
Loef M, van Beest S, Kroon FPB, Bloem JL, Dekkers OM, Reijnierse M, Schoones JW, Kloppenburg M. Comparison of histological and morphometrical changes underlying subchondral bone abnormalities in inflammatory and degenerative musculoskeletal disorders: a systematic review. Osteoarthritis Cartilage 2018; 26:992-1002. [PMID: 29777863 DOI: 10.1016/j.joca.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/22/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Subchondral bone abnormalities (SBAs) on magnetic resonance imaging (MRI) are observed frequently and associated with disease course in various musculoskeletal disorders. This review aims to map the existing knowledge of their underlying histological features, and to identify needs for future research. DESIGN We conducted a systematic review following PRISMA guidelines until September 2017, including all studies correlating histological features to on MRI defined SBAs in patients with osteoarthritis (OA), rheumatoid arthritis (RA), spondyloarthritis (SpA) and degenerative disc disease (DDD). Two authors independently retrieved articles and assessed study quality. RESULTS A total of 21 studies (466 patients) correlated histological features to SBAs in OA (n = 13), RA (n = 3), ankylosing spondylitis (AS) (n = 1) and DDD (n = 4). Reported changes in OA were substitution of normal subchondral bone with fibrosis and necrosis, and increased bone remodeling. In contrast, in RA, AS or DDD fibrosis was not reported and SBAs correlated to an increase in inflammatory cell number. In DDD necrosis was observed. Similar to OA, increased bone remodeling was shown in RA and DDD. The risk of bias assessment showed a lack in described patient criteria, blinding and/or adequate topographic correlation in approximately half of studies. There was heterogeneity regarding the investigated histological features between the different disorders. CONCLUSIONS Current studies suggest that SBAs correlate to various histological features, including fibrosis, cell death, inflammation and bone remodeling. In the majority of studies most quality criteria were not met. Future studies should aim for high quality research, and consistency in investigated features between different disorders.
Collapse
Affiliation(s)
- M Loef
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.
| | - S van Beest
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - F P B Kroon
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - O M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
20
|
Mastboom MJL, Verspoor FGM, Hanff DF, Gademan MGJ, Dijkstra PDS, Schreuder HWB, Bloem JL, van der Wal RJP, van de Sande MAJ. Severity classification of Tenosynovial Giant Cell Tumours on MR imaging. Surg Oncol 2018; 27:544-550. [PMID: 30217317 DOI: 10.1016/j.suronc.2018.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/20/2018] [Accepted: 07/01/2018] [Indexed: 01/26/2023]
Abstract
AIM Current development of novel systemic agents requires identification and monitoring of extensive Tenosynovial Giant Cell Tumours (TGCT). This study defines TGCT extension on MR imaging to classify severity. METHODS In part one, six MR parameters were defined by field-experts to assess disease extension on MR images: type of TGCT, articular involvement, cartilage-covered bone invasion, and involvement of muscular/tendinous tissue, ligaments or neurovascular structures. Inter- and intra-rater agreement were calculated using 118 TGCT MR scans. In part two, the previously defined MR parameters were evaluated in 174 consecutive, not previously used, MR-scans. TGCT severity classification was established based on highest to lowest Hazard Ratios (HR) on first recurrence. RESULTS In part one, all MR parameters showed good inter- and intra-rater agreement (Kappa≥0.66). In part two, cartilage-covered bone invasion and neurovascular involvement were rarely appreciated (<13%) and therefore excluded for additional analyses. Univariate analyses for recurrent disease yielded positive associations for type of TGCT HR12.84(95%CI4.60-35.81), articular involvement HR6.00(95%CI2.14-16.80), muscular/tendinous tissue involvement HR3.50(95%CI1.75-7.01) and ligament-involvement HR4.59(95%CI2.23-9.46). With these, a TGCT severity classification was constructed with four distinct severity-stages. Recurrence free survival at 4 years (log rank p < 0.0001) was 94% in mild localized (n56, 1 recurrence), 88% in severe localized (n31, 3 recurrences), 59% in moderate diffuse (n32, 12 recurrences) and 36% in severe diffuse (n55, 33 recurrences). CONCLUSION The proposed TGCT severity classification informs physicians and patients on disease extent and risk for recurrence after surgical treatment. Definition of the most severe subgroup attributes to a universal identification of eligible patients for systemic therapy or trials for novel agents.
Collapse
Affiliation(s)
- M J L Mastboom
- Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - F G M Verspoor
- Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - D F Hanff
- Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - M G J Gademan
- Epidemiology, Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - P D S Dijkstra
- Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - H W B Schreuder
- Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - J L Bloem
- Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - R J P van der Wal
- Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - M A J van de Sande
- Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
21
|
Bloem JL, Reijnierse M, Huizinga TWJ, van der Helm-van Mil AHM. MR signal intensity: staying on the bright side in MR image interpretation. RMD Open 2018; 4:e000728. [PMID: 29955387 PMCID: PMC6018882 DOI: 10.1136/rmdopen-2018-000728] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 12/21/2022] Open
Abstract
In 2003, the Nobel Prize for Medicine was awarded for contribution to the invention of MRI, reflecting the incredible value of MRI for medicine. Since 2003, enormous technical advancements have been made in acquiring MR images. However, MRI has a complicated, accident-prone dark side; images are not calibrated and respective images are dependent on all kinds of subjective choices in the settings of the machine, acquisition technique parameters, reconstruction techniques, data transmission, filtering and postprocessing techniques. The bright side is that understanding MR techniques increases opportunities to unravel characteristics of tissue. In this viewpoint, we summarise the different subjective choices that can be made to generate MR images and stress the importance of communication between radiologists and rheumatologists to correctly interpret images.
Collapse
Affiliation(s)
- Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
22
|
de Bruin F, Treyvaud MO, Feydy A, de Hooge M, Pialat JB, Dougados M, Gossec L, Bloem JL, van der Heijde D, Reijnierse M. Prevalence of degenerative changes and overlap with spondyloarthritis-associated lesions in the spine of patients from the DESIR cohort. RMD Open 2018; 4:e000657. [PMID: 29955382 PMCID: PMC6018874 DOI: 10.1136/rmdopen-2018-000657] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/11/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives To describe the prevalence of degenerative changes on MRI and conventional radiographs of the spine in a young population with suspicion of axial spondyloarthritis (axSpA) and assess whether it is possible to discriminate between degenerative changes and lesions associated with axSpA. Methods Whole spine MRI and cervical and lumbar radiographs of patients ≥18 years with chronic back pain (≥3 months, ≤3 years, onset <50 years) were assessed for degeneration by two readers, and for SpA lesions by two other readers, all blinded for clinical information and results of the other readers. Degenerative scores were adjudicated in case of disagreement (by a third reader). Patients fulfilling and not fulfilling the Assessment of SpondyloArthritis international Society axSpA criteria were compared for prevalence of degenerative lesions. Scores for degenerative and SpA lesions were compared, and overlap was defined as the presence of both types of lesions in a single vertebral unit (VU). Results In 456/648 (70.4%) patients (46.8% men, mean age 33.6), degenerative lesions were found with similar percentages in patients with no axSpA and with axSpA (72.4% and 69.2%, p=0.45). Modic changes were found more often in patients with no axSpA (29/239, 12.1%) versus patients with axSpA (19/409, 4.6%, p=0.01). Other lesions were evenly distributed. Overlap was minimal in 19 patients (3.0%) and 32/14 674 (0.2%) VUs for SpA reader 1 and in 23 patients (3.6%) and 34/14 674 VUs (0.2%) for SpA reader 2. Conclusion The prevalence of degeneration is high in an early inflammatory back pain cohort. Discrimination between degeneration and axSpA lesions is very well possible with little overlap between degenerative and axSpA readings.
Collapse
Affiliation(s)
- Freek de Bruin
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco O Treyvaud
- Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Antoine Feydy
- Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Baptiste Pialat
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Lyon, Lyon, France
| | - Maxime Dougados
- Service de Rhumatologie B, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Descartes, Paris, France
| | - Laure Gossec
- Department of Rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
23
|
van Oudenaarde K, Swart NM, Bloem JL, Bierma-Zeinstra SMA, Algra PR, Bindels PJE, Koes BW, Nelissen RGHH, Verhaar JAN, Luijsterburg PAJ, Reijnierse M, van den Hout WB. General Practitioners Referring Adults to MR Imaging for Knee Pain: A Randomized Controlled Trial to Assess Cost-effectiveness. Radiology 2018; 288:170-176. [PMID: 29664339 DOI: 10.1148/radiol.2018171383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To determine the cost-effectiveness of early referral by the general practitioner for magnetic resonance (MR) imaging compared with usual care alone in patients aged 18-45 years with traumatic knee symptoms. Materials and Methods Cost-utility analysis was performed parallel to a prospective multicenter randomized controlled trial in Dutch general practice. A total of 356 patients with traumatic knee symptoms were included from November 2012 to December 2015 (mean age, 33 years ± 8 [standard deviation]; 222 men [62%]). Patients were randomly assigned to usual care (n = 177; MR imaging was not performed, but patients were referred to an orthopedic surgeon when conservative treatment was unsatisfactory) or MR imaging (n = 179) within 2 weeks after injury. Main outcome measures were quality-adjusted life years (QALYs) and costs from a healthcare and societal perspective. Multiple imputation was used for missing data. The Student t test was used to assess differences in mean QALYs, costs, and net benefits. Results Mean QALYs were 0.888 in the MR imaging group and 0.899 in the usual care group (P = .255). Healthcare costs per patient were higher in the MR imaging group (€1109) than in the usual care group (€837) (P = .050), mainly due to higher costs for MR imaging, with no reduction in the number of referrals to an orthopedic surgeon in the MR imaging group. Conclusion MR imaging referral by the general practitioner was not cost-effective in patients with traumatic knee symptoms; in fact, MR imaging led to more healthcare costs, without an improvement in health outcomes.
Collapse
Affiliation(s)
- Kim van Oudenaarde
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Nynke M Swart
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Johan L Bloem
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Sita M A Bierma-Zeinstra
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Paul R Algra
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Patrick J E Bindels
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Bart W Koes
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Rob G H H Nelissen
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Jan A N Verhaar
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Pim A J Luijsterburg
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Monique Reijnierse
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| | - Wilbert B van den Hout
- From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.)
| |
Collapse
|
24
|
Kroon FPB, Peterfy CG, Conaghan PG, Foltz V, Gandjbakhch F, Eshed I, Genant HK, Østergaard M, Reijnierse M, Bloem JL, Haugen IK, Kloppenburg M. Atlas for the OMERACT thumb base osteoarthritis MRI scoring system (TOMS). RMD Open 2018. [PMID: 29531783 PMCID: PMC5845431 DOI: 10.1136/rmdopen-2017-000583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper presents an atlas for the Outcome Measures in Rheumatology Clinical Trials (OMERACT) thumb base osteoarthritis MRI scoring system (TOMS). The atlas includes reference images of each grade of each feature that is assessed in TOMS (synovitis grade 0–3, subchondral bone defects grade 0–3, osteophytes grade 0–3, cartilage assessment grade 0–3, subluxation and bone marrow lesions grade 0–3) in the first carpometacarpal and scapho-trapezio-trapezoid joint. The presented reference images can be used to guide scoring of thumb base MRIs in patients with hand osteoarthritis according to the OMERACT TOMS.
Collapse
Affiliation(s)
- Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and National Institute for Health Research, Leeds Biomedical Research Centre, Leeds, UK
| | - Violaine Foltz
- Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France
| | - Frédérique Gandjbakhch
- Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Harry K Genant
- Department of Radiology, University of California San Francisco, San Francisco, California, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
25
|
Kouijzer IJE, Scheper H, de Rooy JWJ, Bloem JL, Janssen MJR, van den Hoven L, Hosman AJF, Visser LG, Oyen WJG, Bleeker-Rovers CP, de Geus-Oei LF. The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis - a prospective study. Eur J Nucl Med Mol Imaging 2017; 45:798-805. [PMID: 29256136 PMCID: PMC5978906 DOI: 10.1007/s00259-017-3912-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/10/2017] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to determine the diagnostic value of 18F–fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis. Methods From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18F–FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others’ image interpretation. 18F–FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines. Results For 18F–FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F–FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%). Conclusion 18F–FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18F–FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.
Collapse
Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
- MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands.
| | - Henk Scheper
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Jacky W J de Rooy
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcel J R Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Allard J F Hosman
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leo G Visser
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Nuclear Medicine, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
26
|
Nieuwenhuis WP, van Steenbergen HW, Mangnus L, Newsum EC, Bloem JL, Huizinga TWJ, le Cessie S, Reijnierse M, van der Helm-van Mil AHM. Evaluation of the diagnostic accuracy of hand and foot MRI for early Rheumatoid Arthritis. Rheumatology (Oxford) 2017; 56:1367-1377. [PMID: 28460018 DOI: 10.1093/rheumatology/kex167] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives To assess the diagnostic value of MRI for early RA. In some RA patients, a classifiable diagnosis cannot be made at first presentation; these patients present with unclassified arthritis (UA). The use of MRI for early diagnosis of RA is recommended, yet the evidence for its reliability is limited. Methods MRI of hand and foot was performed in 589 early arthritis patients included in the Leiden Early Arthritis Clinic (229 presented with RA, 159 with other arthritides and 201 with UA). Symptom-free controls provided a reference for defining an abnormal MRI. In preliminary investigations, MRI of patients who presented with RA was compared with MRI of symptom-free controls and of patients with other arthritides. Thereafter, the value of MRI in early RA diagnosis was determined in UA patients using the 1-year follow-up on fulfilling the 1987 RA criteria and start of disease-modifying drugs as outcomes. Results Preliminary investigations were promising. Of the UA patients, 14% developed RA and 37% started disease-modifying treatment. MRI-detected tenosynovitis was associated with RA development independent of other types of MRI-detected inflammation [odds ratio (OR) = 7.5, 95% CI: 2.4, 23] and also independent of age and other inflammatory measures (swollen joints, CRP) (OR = 4.2, 95% CI: 1.4, 12.9). Within UA patients, the negative predictive value of abnormal tenosynovitis was 95% (95% CI: 89%, 98%) and the positive predictive value 25% (95% CI: 17%, 35%). The performance was best in the subgroup of UA patients presenting with oligoarthritis (18% developed RA): the positive predictive value was 36% (95% CI: 23%, 52%), the negative predictive value was 98% (95% CI: 88%, 100%), the sensitivity was 93% (95% CI: 70%, 99%) and the specificity was 63% (95% CI: 51%, 74%). Conclusion MRI contributes to the identification of UA patients who will develop RA, mostly in UA patients presenting with oligoarthritis.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Saskia le Cessie
- Department of Clinical Epidemiology.,Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | | | | |
Collapse
|
27
|
Nieuwenhuis WP, van Steenbergen HW, Stomp W, Stijnen T, Huizinga TWJ, Bloem JL, van der Heijde D, Reijnierse M, van der Helm-van Mil AHM. The Course of Bone Marrow Edema in Early Undifferentiated Arthritis and Rheumatoid Arthritis: A Longitudinal Magnetic Resonance Imaging Study at Bone Level. Arthritis Rheumatol 2017; 68:1080-8. [PMID: 26681086 DOI: 10.1002/art.39550] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 12/10/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In patients with rheumatoid arthritis (RA), bone marrow edema (BME) scores are associated with development of erosions. However, little is known about the course and outcome of BME at bone level. We undertook this study to determine the association of BME and synovitis with the development of erosions in the same bone longitudinally. METHODS Using 1.5T magnetic resonance imaging at baseline and at 4- and 12-month follow-up, we studied 1,947 bones of the metacarpophalangeal, wrist, and metatarsophalangeal joints in 59 patients presenting with RA or undifferentiated arthritis. Scanning and scoring of BME, synovitis, and erosions were performed according to the Outcome Measures in Rheumatology Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system. We evaluated the relationship of the course of BME and synovitis with erosive progression at bone level during 1 year. RESULTS Of the bones showing BME at baseline (n = 203), BME persisted in 56%, disappeared in 39%, and disappeared and then reappeared in 5%. Stratified analyses at baseline revealed that BME was associated with erosive progression both in the presence and in the absence of local synovitis, with odds ratios (ORs) of 7.5 (95% confidence interval [95% CI] 3.8-14.9) and 6.9 (95% CI 1.9-25.6), respectively. However, local synovitis was not associated with erosive progression in the presence or in the absence of BME (ORs of 2.0 [95% CI 0.6-7.0] and 1.9 [95% CI 0.8-4.1], respectively). In multivariable generalized estimating equation analyses, persistent BME was strongly associated with erosive progression (OR 60.5 [95% CI 16.8-218.1]) in contrast to persistent synovitis (OR 1.3 [95% CI 0.4-4.4]). CONCLUSION BME frequently persists during the first year. Persistent BME was strongly associated with erosive progression in the same bone, independently of local synovitis. No independent association was observed for persistent synovitis. These findings are relevant for comprehending the development of erosions in RA.
Collapse
Affiliation(s)
| | | | - Wouter Stomp
- Leiden University Medical Center, Leiden, The Netherlands
| | - Theo Stijnen
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johan L Bloem
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | |
Collapse
|
28
|
Abstract
In clinical practice, the conventional radiography is still the radiologic method for the diagnosis of rheumatoid arthritis (RA). Moreover, it provides a quick overview of the symptomatic joints to narrow the differential diagnosis and to evaluate progression. RA is a polyarticular disease with bilateral and symmetric involvement of the peripheral joints, especially small joints, and less frequently, the cervical spine. The radiologic features are soft tissue swelling, periarticular osteoporosis, erosions, loss of joint space, and in advanced disease, osteolysis and typical subluxations or deformities, such as ulnar deviation.
Collapse
Affiliation(s)
- Eva Llopis
- Department of Radiology, Hospital de la Ribera, Carretera Corbera km1, Alzira, Valencia 46600, Spain.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 233 ZA, The Netherlands
| | - Jose Acosta
- Department of Radiology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo KM 9, 100, Madrid 28034, Spain
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 233 ZA, The Netherlands
| |
Collapse
|
29
|
Aizenberg E, Roex EAH, Nieuwenhuis WP, Mangnus L, van der Helm-van Mil AHM, Reijnierse M, Bloem JL, Lelieveldt BPF, Stoel BC. Automatic quantification of bone marrow edema on MRI of the wrist in patients with early arthritis: A feasibility study. Magn Reson Med 2017; 79:1127-1134. [PMID: 28480581 PMCID: PMC5811824 DOI: 10.1002/mrm.26712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 02/03/2023]
Abstract
Purpose To investigate the feasibility of automatic quantification of bone marrow edema (BME) on MRI of the wrist in patients with early arthritis. Methods For 485 early arthritis patients (clinically confirmed arthritis of one or more joints, symptoms for less than 2 years), MR scans of the wrist were processed in three automatic stages. First, super‐resolution reconstruction was applied to fuse coronal and axial scans into a single high‐resolution 3D image. Next, the carpal bones were located and delineated using atlas‐based segmentation. Finally, the extent of BME within each bone was quantified by identifying image intensity values characteristic of BME by fuzzy clustering and measuring the fraction of voxels with these characteristic intensities within each bone. Correlation with visual BME scores was assessed through Pearson correlation coefficient. Results Pearson correlation between quantitative and visual BME scores across 485 patients was r=0.83, P<0.001. Conclusions Quantitative measurement of BME on MRI of the wrist has the potential to provide a feasible alternative to visual scoring. Complete automation requires automatic detection and compensation of acquisition artifacts. Magn Reson Med 79:1127–1134, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Collapse
Affiliation(s)
- Evgeni Aizenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edgar A H Roex
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wouter P Nieuwenhuis
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lukas Mangnus
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn P F Lelieveldt
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Intelligent Systems Department, Delft University of Technology, Delft, The Netherlands
| | - Berend C Stoel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
30
|
Stomp W, Krabben A, van der Heijde D, Huizinga TWJ, Bloem JL, van der Helm-van Mil AHM, Reijnierse M. Erratum to: Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema? Eur Radiol 2017; 27:1331-1332. [DOI: 10.1007/s00330-016-4460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
Damman W, Liu R, Bloem JL, Rosendaal FR, Reijnierse M, Kloppenburg M. Bone marrow lesions and synovitis on MRI associate with radiographic progression after 2 years in hand osteoarthritis. Ann Rheum Dis 2016; 76:214-217. [PMID: 27323771 DOI: 10.1136/annrheumdis-2015-209036] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To study the association of magnetic resonance (MR) features with radiographic progression of hand osteoarthritis over 2 years. METHODS Of 87 primary patients with hand osteoarthritis (82% women, mean age 59 years), baseline distal and proximal interphalangeal joint contrast-enhanced MR images were scored 0-3 for bone marrow lesions (BMLs) and synovitis following the Oslo score. Baseline and 2-year follow-up radiographs were scored following Kellgren-Lawrence (KL) (0-4) and OsteoArthritis Research Society International (OARSI) scoring methods (0-3 osteophytes, joint space narrowing (JSN)). Increase ≥1 defined progression. Associations between MR features and radiographic progression were explored on joint and on patient level, adjusting for age, sex, body mass index, synovitis and BML. Joints in end-stage were excluded. RESULTS Of 696 analysed joints, 324 had baseline KL=0, 28 KL=4 and after 2 years 78 joints progressed. BML grade 2/3 was associated with KL progression (2/3 vs 0: adjusted risk ratio (RR) (95% CI) 3.3 (2.1 to 5.3)) and with osteophyte or JSN progression, as was synovitis. Summated scores were associated with radiographic progression on patient level (RR crude BML 1.08 (1.01 to 1.2), synovitis 1.09 (1.04 to 1.1), adjusted synovitis 1.08 (1.03 to 1.1)). CONCLUSIONS BMLs, next to synovitis, show, already after 2 years, graded associations with radiographic progression, suggesting that both joint tissues could be important targets for therapy.
Collapse
Affiliation(s)
- W Damman
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - R Liu
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| |
Collapse
|
32
|
Visser AW, Mertens B, Reijnierse M, Bloem JL, de Mutsert R, le Cessie S, Rosendaal FR, Kloppenburg M. Bakers' cyst and tibiofemoral abnormalities are more distinctive MRI features of symptomatic osteoarthritis than patellofemoral abnormalities. RMD Open 2016; 2:e000234. [PMID: 27252896 PMCID: PMC4879339 DOI: 10.1136/rmdopen-2015-000234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate which structural MR abnormalities discriminate symptomatic knee osteoarthritis (OA), taking co-occurrence of abnormalities in all compartments into account. METHODS The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort aged 45-65 years. In 1285 participants (median age 56 years, 55% women, median body mass index (BMI) 30 kg/m(2)), MRI of the right knee were obtained. Structural abnormalities (osteophytes, cartilage loss, bone marrow lesions (BMLs), subchondral cysts, meniscal abnormalities, effusion, Baker's cyst) at 9 patellofemoral and tibiofemoral locations were scored following the knee OA scoring system. Symptomatic OA in the imaged knee was defined following the American College of Rheumatology criteria. Logistic ridge regression analyses were used to investigate which structural abnormalities discriminate best between individuals with and without symptomatic OA, crude and adjusted for age, sex and BMI. RESULTS Symptomatic knee OA was present in 177 individuals. Structural MR abnormalities were highly frequent both in individuals with OA and in those without. Baker's cysts showed the highest adjusted regression coefficient (0.293) for presence of symptomatic OA, followed by osteophytes and BMLs in the medial tibiofemoral compartment (0.185-0.279), osteophytes in the medial trochlear facet (0.262) and effusion (0.197). CONCLUSIONS Baker's cysts discriminate best between individuals with and without symptomatic knee OA. Structural MR abnormalities, especially in the medial side of the tibiofemoral joint and effusion, add further in discriminating symptomatic OA. Baker's cysts may present as a target for treatment.
Collapse
Affiliation(s)
- A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Mertens
- Department of Medical Statistics and Bio-informatics,Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
| | - S le Cessie
- Department of Medical Statistics and Bio-informatics,Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
- Department of Thrombosis and Homeostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology,Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
33
|
Huétink K, van der Voort P, Bloem JL, Nelissen RGHH, Meulenbelt I. Genetic Contribution to the Development of Radiographic Knee Osteoarthritis in a Population Presenting with Nonacute Knee Symptoms a Decade Earlier. Clin Med Insights Arthritis Musculoskelet Disord 2016; 9:57-63. [PMID: 27158223 PMCID: PMC4854216 DOI: 10.4137/cmamd.s30657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 12/17/2022]
Abstract
This study examined the contribution of the osteoarthritis (OA) susceptibility genes ASPN, GDF5, DIO2, and the 7q22 region to the development of radiographic knee OA in patients with a mean age of 40.6 ± 7.9 years (standard deviation) and who suffered from nonacute knee complaints a decade earlier. Dose–response associations of four single nucleotide polymorphisms(SNPs) in the susceptibility genes were determined by comparing 36 patients who showed the development of OA on radiographs (Kellgren and Lawrence score ≥1) with 88 patients having normal cartilage with no development of OA on radiographs. Multivariate logistic regression analysis including the variables such as age, gender, body mass index, and reported knee trauma was performed. A dose–response association of DIO2 SNP rs225014: odds ratio (OR) 2.3, 95% confidence interval (CI) 1.1–4.5 (P = 0.019) and GDF5 SNP rs143383: OR 2.0, 95% CI 1.1–3.8 (P = 0.031) was observed with knee OA development. The ASPN and 7q22 SNPs were not associated with OA development.
Collapse
Affiliation(s)
- Kasper Huétink
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul van der Voort
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid Meulenbelt
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
34
|
de Lange-Brokaar BJE, Kloppenburg M, Andersen SN, Dorjée AL, Yusuf E, Herb-van Toorn L, Kroon HM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Toes REM, Ioan-Facsinay A. Characterization of synovial mast cells in knee osteoarthritis: association with clinical parameters. Osteoarthritis Cartilage 2016; 24:664-71. [PMID: 26671522 DOI: 10.1016/j.joca.2015.11.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/29/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the presence of mast cells in the osteoarthritic (OA) synovium and their association with clinical parameters in comparison with rheumatoid arthritis (RA) samples. METHOD Synovial tissues of 56 symptomatic OA and 49 RA patients were obtained. Two to three paraffin slides were used to quantify inflammation using haematoxylin and eosin (H&E) staining (synovitis score 0-9), and numbers of mast cells (per 10 high-power fields) using double immunofluorescence for CD117 and tryptase. Average scores per patient were used for analysis. Knee radiographs of OA patients were scored according to the Kellgren and Lawrence (KL) system and pain was determined in OA patients at baseline by visual analogue scale (VAS). RESULTS Median (range) of mast cells was significantly higher in OA samples 45 (1-168) compared to RA samples 4 (1-47) (P-value < 0.001), despite a lower median (range) synovitis score in OA (2.5 (0-6.0)) compared to 4.6 (0-8.0) in RA samples. The synovitis score was significantly correlated with the number of mast cells (in OA Spearman's rho (P-value) 0.3 (0.023) and RA 0.5 (P-value < 0.001)). Interestingly, we observed a trend towards an association between the number of mast cells and an increased KL-grade (P-value 0.05) in OA patients, independently of synovitis. No associations were found with self-reported pain. CONCLUSION Prevalence of mast cells in OA synovial tissue is relatively high and associates with structural damage in OA patients, suggesting a role of mast cells in this disease.
Collapse
Affiliation(s)
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S N Andersen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A L Dorjée
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - E Yusuf
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - L Herb-van Toorn
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - R G H H Nelissen
- Department Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - R E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
35
|
de Lange-Brokaar BJE, Bijsterbosch J, Kornaat PR, Yusuf E, Ioan-Facsinay A, Zuurmond AM, Kroon HM, Meulenbelt I, Bloem JL, Kloppenburg M. Radiographic progression of knee osteoarthritis is associated with MRI abnormalities in both the patellofemoral and tibiofemoral joint. Osteoarthritis Cartilage 2016; 24:473-9. [PMID: 26471210 DOI: 10.1016/j.joca.2015.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/29/2015] [Accepted: 09/25/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate patterns of MRI abnormalities in the patellofemoral (PFJ) and tibiofemoral joint (TFJ) and their association with radiographic progression, using hypothesis free analyses. DESIGN 205 patients from the GARP study with symptomatic OA at multiple sites (mean age 60 years, 80% woman, median BMI 26 kg/m(2)), underwent knee MRI at baseline. Cartilage damage, osteophytes, cysts, bone marrow lesions (BMLs) and effusion/synovitis were scored according to a validated scoring method. Baseline and 6-year TFJ and PFJ radiographs were scored (0-3) for JSN and osteophytes according to OARSI and Burnett atlases, respectively; progression was defined as ≥1 point increase. Baseline patterns of MRI abnormalities derived from principal component analysis (PCA) were associated with progression using adjusted generalized estimating equations (GEE). RESULTS PCA resulted in extraction of six components, explaining 69% of variance. In 29% and 29% of 133 patients with follow-up the TFJ progressed, whereas in 15% and 9% the PFJ progressed for osteophytes and JSN, respectively. Component 1 (cartilage damage of the PFJ and osteophytes of both joints) was statistically significant associated with TFJ JSN progression and PFJ osteophyte progression. Component 2 (all lateral PFJ abnormalities except osteophytes) was associated with JSN/osteophyte progression in the PFJ alone, whereas component 3 (all medial TFJ abnormalities except osteophytes) was associated with JSN and osteophyte progression in both PFJ and TFJ. CONCLUSION Baseline structural damage and bone turnover activity, as reflected by BMLs, seem to be involved in knee OA progression. Moreover, progression in PFJ and TFJ seems to be related.
Collapse
Affiliation(s)
| | - J Bijsterbosch
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - P R Kornaat
- Department of Radiology, Bronovo Hospital, The Hague, The Netherlands
| | - E Yusuf
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - A Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - H M Kroon
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - I Meulenbelt
- Department of Molecular Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
36
|
Noebauer-Huhmann IM, Weber MA, Lalam RK, Trattnig S, Bohndorf K, Vanhoenacker F, Tagliafico A, van Rijswijk C, Vilanova JC, Afonso PD, Breitenseher M, Beggs I, Robinson P, de Jonge MC, Krestan C, Bloem JL. Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging. Semin Musculoskelet Radiol 2016; 19:e1. [PMID: 26841322 DOI: 10.1055/s-0036-1572350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Iris M Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg Im Neuenheimer Feld, Heidelberg, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, United Kingdom
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Klaus Bohndorf
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Filip Vanhoenacker
- Department of Radiology, General Hospital Sint-Maarten, Duffel-Mechelen, Universities of Antwerp and Ghent, Duffel, Belgium
| | - Alberto Tagliafico
- Department of Experimental Medicine -DIMES-, Institute of Anatomy, University of Genova, Genova, Italy
| | - Carla van Rijswijk
- Department of Radiology, Leiden University Medical Center, the Netherlands
| | - Joan C Vilanova
- Clínica Girona, Institut Catalan of Health-IDI, University of Girona, Girona, Spain
| | - P Diana Afonso
- Hospital Beatriz Angelo, Lisbon, Portugal; Hospital da Luz, Grupo Luz Saude, Lisbon, Portugal
| | | | - Ian Beggs
- Department of Radiology, Royal Infirmary, Edinburgh, United Kingdom
| | - Philip Robinson
- Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, United Kingdom; Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, United Kingdom
| | - Milko C de Jonge
- Department of Radiology, Zuwe Hofpoort Hospital, Woerden, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Christian Krestan
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, the Netherlands
| |
Collapse
|
37
|
Peters MJ, Ramos YFM, den Hollander W, Schiphof D, Hofman A, Uitterlinden AG, Oei EHG, Slagboom PE, Kloppenburg M, Bloem JL, Bierma-Zeinstra SMA, Meulenbelt I, van Meurs JBJ. Associations between joint effusion in the knee and gene expression levels in the circulation: a meta-analysis. F1000Res 2016; 5:109. [PMID: 27134727 PMCID: PMC4837985 DOI: 10.12688/f1000research.7763.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 01/16/2023] Open
Abstract
Objective: To identify molecular biomarkers for early knee osteoarthritis (OA), we examined whether joint effusion in the knee associated with different gene expression levels in the circulation. Materials and Methods: Joint effusion grades measured with magnetic resonance (MR) imaging and gene expression levels in blood were determined in women of the Rotterdam Study (N=135) and GARP (N=98). Associations were examined using linear regression analyses, adjusted for age, fasting status, RNA quality, technical batch effects, blood cell counts, and BMI. To investigate enriched pathways and protein-protein interactions, we used the DAVID and STRING webtools. Results: In a meta-analysis, we identified 257 probes mapping to 189 unique genes in blood that were nominally significantly associated with joint effusion grades in the knee. Several compelling genes were identified such as
C1orf38 and
NFATC1. Significantly enriched biological pathways were: response to stress, gene expression, negative regulation of intracellular signal transduction, and antigen processing and presentation of exogenous pathways. Conclusion: Meta-analyses and subsequent enriched biological pathways resulted in interesting candidate genes associated with joint effusion that require further characterization. Associations were not transcriptome-wide significant most likely due to limited power. Additional studies are required to replicate our findings in more samples, which will greatly help in understanding the pathophysiology of OA and its relation to inflammation, and may result in biomarkers urgently needed to diagnose OA at an early stage.
Collapse
Affiliation(s)
| | - Yolande F M Ramos
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Wouter den Hollander
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - P Eline Slagboom
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Margreet Kloppenburg
- Department of Clinical Epidemiology and Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, Rotterdam, Netherlands; Department of Orthopedics, Erasmus MC, Rotterdam, Netherlands
| | - Ingrid Meulenbelt
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | | |
Collapse
|
38
|
Noebauer-Huhmann IM, Weber MA, Lalam RK, Trattnig S, Bohndorf K, Vanhoenacker F, Tagliafico A, van Rijswijk C, Vilanova JC, Afonso PD, Breitenseher M, Beggs I, Robinson P, de Jonge MC, Krestan C, Bloem JL. Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging. Semin Musculoskelet Radiol 2015; 19:475-82. [PMID: 26696086 DOI: 10.1055/s-0035-1569251] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Soft tissue sarcomas are rare, but early, accurate diagnosis with subsequent appropriate treatment is crucial for the clinical outcome. The ESSR guidelines are intended to help radiologists in their decision-making and support discussion among clinicians who deal with patients with suspected or proven soft tissue tumors. Potentially malignant lesions recognized by ultrasound should be referred for magnetic resonance imaging (MRI), which also serves as a preoperative local staging modality, with specific technical requirements and mandatory radiological report elements. Radiography may add information about matrix calcification and osseous involvement. Indeterminate lesions, or lesions in which therapy is dependent on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist sarcoma center, where an interdisciplinary tumor group, with a specialized pathologist, radiologist, and the surgeon are involved. In sarcoma, a CT scan of the chest is mandatory. Additional staging modalities are entity-specific. There are no evidence-based recommendations for routine follow-up in surgically treated sarcomas. However, we would recommend regular follow-up with intervals dependent on tumor grade, for 10 years after the initial diagnosis.
Collapse
Affiliation(s)
- Iris M Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg Im Neuenheimer Feld, Heidelberg, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Klaus Bohndorf
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Filip Vanhoenacker
- Department of Radiology, General Hospital Sint-Maarten, Duffel-Mechelen, Universities of Antwerp and Ghent, Duffel, Belgium
| | - Alberto Tagliafico
- Department of Experimental Medicine -DIMES-, Institute of Anatomy, University of Genova, Genova, Italy
| | - Carla van Rijswijk
- Department of Radiology, Leiden University Medical Center, the Netherlands
| | - Joan C Vilanova
- Clínica Girona, Institut Catalan of Health-IDI, University of Girona, Girona, Spain
| | | | | | - Ian Beggs
- Department of Radiology, Royal Infirmary, Edinburgh, United Kingdom
| | - Philip Robinson
- Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Milko C de Jonge
- Department of Radiology, Zuwe Hofpoort Hospital, Woerden, the Netherlands
| | - Christian Krestan
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, the Netherlands
| |
Collapse
|
39
|
Valdés Olmos RA, de Geus-Oei LF, Ticheler CHJM, Bloem JL. From Incidentaloma to Oncocytoma: A Role for Hybrid Molecular Imaging in Characterising Renal Masses? Eur Urol 2015; 69:417-8. [PMID: 26453374 DOI: 10.1016/j.eururo.2015.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022]
Affiliation(s)
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Johan L Bloem
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
40
|
de Lange-Brokaar BJE, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, van Osch GJVM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Huizinga TW, Kloppenburg M. Association of pain in knee osteoarthritis with distinct patterns of synovitis. Arthritis Rheumatol 2015; 67:733-40. [PMID: 25418977 DOI: 10.1002/art.38965] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 11/13/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine possible patterns of synovitis on contrast-enhanced magnetic resonance imaging (CE-MRI) and its relation to pain and severity in patients with radiographic knee osteoarthritis (OA). METHODS In total, 86 patients (mean age 62 years, 66% women, median body mass index 29 kg/m(2) ) with symptomatic knee OA (Kellgren/Lawrence radiographic score 3) were included. T1-weighted, gadolinium-chelate-enhanced MRI with fat suppression was used to semiquantitatively score the extent of synovitis at 11 knee sites (total score range 0-22). Self-reported pain was assessed with 3 standardized questionnaires. Principal components analysis (PCA) was used to investigate patterns (the location and severity) of synovitis. Subsequently, these patterns were assessed for associations with pain measures and radiographic severity in adjusted logistic regression models. RESULTS Synovitis was observed in 86 patients and was found to be generally mild on CE-MRI (median total synovitis score 7, range 0-16). The median pain scores were 53 (range 0-96) on the visual analog scale for pain, 51.4 (range 2.8-97.2) on the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, 35 (range 0-75) on the Intermittent and Constant Osteoarthritis Pain (ICOAP) score for constant pain, and 40.6 (range 0-87.5) on the ICOAP score for intermittent pain. PCA resulted in extraction of 3 components, explaining 53.4% of the variance. Component 1 was characterized by synovitis at 7 sites (mainly medial parapatellar involvement) and was associated with scores on the KOOS pain subscale and the ICOAP constant pain subscale. Component 2 was characterized by synovitis at 4 sites (mainly the site adjacent to the anterior cruciate ligament), but was not associated with pain measures or with radiographic severity. Component 3, characterized by synovitis at 3 sites (mainly at the loose body site), was associated with radiographic severity. CONCLUSION Different patterns of synovitis in knee OA were observed. The pattern that included several patellar sites was associated with pain, whereas other patterns showed no association, suggesting that pain perception in patients with knee OA is a localized response.
Collapse
|
41
|
Nieuwenhuis WP, Krabben A, Stomp W, Huizinga TWJ, van der Heijde D, Bloem JL, van der Helm-van Mil AHM, Reijnierse M. Evaluation of Magnetic Resonance Imaging-Detected Tenosynovitis in the Hand and Wrist in Early Arthritis. Arthritis Rheumatol 2015; 67:869-76. [DOI: 10.1002/art.39000] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Wouter Stomp
- Leiden University Medical Center; Leiden The Netherlands
| | | | | | - Johan L. Bloem
- Leiden University Medical Center; Leiden The Netherlands
| | | | | |
Collapse
|
42
|
de Lange-Brokaar BJE, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, Andersen SN, Herb-van Toorn L, van Osch GJVM, Zuurmond AM, Stojanovic-Susulic V, Bloem JL, Nelissen RGHH, Huizinga TWJ, Kloppenburg M. Degree of synovitis on MRI by comprehensive whole knee semi-quantitative scoring method correlates with histologic and macroscopic features of synovial tissue inflammation in knee osteoarthritis. Osteoarthritis Cartilage 2014; 22:1606-13. [PMID: 24365722 DOI: 10.1016/j.joca.2013.12.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/25/2013] [Accepted: 12/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the association between synovitis on contrast enhanced (CE) MRI with microscopic and macroscopic features of synovial tissue inflammation. METHOD Forty-one patients (mean age 60 years, 61% women) with symptomatic radiographic knee OA were studied: twenty underwent arthroscopy (macroscopic features were scored (0-4), synovial biopsies obtained), twenty-one underwent arthroplasty (synovial tissues were collected). After haematoxylin and eosin staining, the lining cell layer, synovial stroma and inflammatory infiltrate of synovial tissues were scored (0-3). T1-weighted CE-MRI's (3 T) were used to semi-quantitatively score synovitis at 11 sites (0-22) according to Guermazi et al. Spearman's rank correlations were calculated. RESULTS The mean (SD) MRI synovitis score was 8.0 (3.7) and the total histology grade was 2.5 (1.6). Median (range) scores of macroscopic features were 2 (1-3) for neovascularization, 1 (0-3) for hyperplasia, 2 (0-4) for villi and 2 (0-3) for fibrin deposits. The MRI synovitis score was significantly correlated with total histology grade [r = 0.6], as well as with lining cell layer [r = 0.4], stroma [r = 0.3] and inflammatory infiltrate [r = 0.5] grades. Moreover, MRI synovitis score was also significantly correlated with macroscopic neovascularization [r = 0.6], hyperplasia [r = 0.6] and villi [r = 0.6], but not with fibrin [r = 0.3]. CONCLUSION Synovitis severity on CE-MRI assessed by a new whole knee scoring system by Guermazi et al. is a valid, non-invasive method to determine synovitis as it is significantly correlated with both macroscopic and microscopic features of synovitis in knee OA patients.
Collapse
Affiliation(s)
| | - A Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - E Yusuf
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - H M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S N Andersen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - L Herb-van Toorn
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - G J V M van Osch
- Department of Orthopaedics and Otorhinolarynogology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | | | | | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - R G H H Nelissen
- Department Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
43
|
Huétink K, Stoel BC, Watt I, Kloppenburg M, Bloem JL, Malm SH, van’t Klooster R, Nelissen RGHH. Identification of factors associated with the development of knee osteoarthritis in a young to middle-aged cohort of patients with knee complaints. Clin Rheumatol 2014; 34:1769-79. [DOI: 10.1007/s10067-014-2774-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/25/2014] [Accepted: 09/03/2014] [Indexed: 01/21/2023]
|
44
|
Krabben A, Stomp W, van Nies JAB, Huizinga TWJ, van der Heijde D, Bloem JL, Reijnierse M, van der Helm-van Mil AHM. MRI-detected subclinical joint inflammation is associated with radiographic progression. Ann Rheum Dis 2014; 73:2034-7. [DOI: 10.1136/annrheumdis-2014-205208] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
45
|
Stomp W, Krabben A, van der Heijde D, Huizinga TW, Bloem JL, van der Helm-van Mil AH, Reijnierse M. Are Rheumatoid Arthritis Patients Discernible from Other Early Arthritis Patients Using 1.5T Extremity Magnetic Resonance Imaging? A Large Cross-sectional Study. J Rheumatol 2014; 41:1630-7. [DOI: 10.3899/jrheum.131169] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Magnetic resonance imaging (MRI) is increasingly used in rheumatoid arthritis (RA) research. A European League Against Rheumatism (EULAR) task force recently suggested that MRI can improve the certainty of RA diagnosis. Because this recommendation may reflect a tendency to use MRI in daily practice, thorough studies on the value of MRI are required. Thus far no large studies have evaluated the accuracy of MRI to differentiate early RA from other patients with early arthritis. We performed a large cross-sectional study to determine whether patients who are clinically classified with RA differ in MRI features compared to patients with other diagnoses.Methods.In our study, 179 patients presenting with early arthritis (median symptom duration 15.4 weeks) underwent 1.5T extremity MRI of unilateral wrist, metacarpophalangeal, and metatarsophalangeal joints according to our arthritis protocol, the foot without contrast. Images were scored according to OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) by 2 independent readers. Tenosynovitis was also assessed. The main outcome was fulfilling the 1987 American College of Rheumatology (ACR) criteria for RA. Test characteristics and areas under the receiver-operator-characteristic curves (AUC) were evaluated. In subanalyses, the 2010 ACR/EULAR criteria were used as outcome, and analyses were stratified for anticitrullinated protein antibodies (ACPA).Results.The ACR 1987 criteria were fulfilled in 43 patients (24.0%). Patients with RA had higher scores for synovitis, tenosynovitis, and bone marrow edema (BME) than patients without RA (p < 0.05). ACPA-positive patients had more BME (median scores 6.5 vs. 4.25, p = 0.016) than ACPA-negative patients. For all MRI features, the predictive value for the presence of RA was low (< 50%). For all MRI features the AUC were < 0.70. Patients who fulfilled ACR/EULAR 2010 criteria but not ACR87 criteria for RA had less synovitis than patients who were positive for RA according to both sets of criteria (p = 0.029).Conclusion.Although patients with RA had higher scores of MRI inflammation and ACPA-positive patients had more BME, the severity of MRI inflammation assessed according to RAMRIS does not accurately differentiate patients with RA from other early arthritis patients.
Collapse
|
46
|
Stomp W, Krabben A, van der Heijde D, Huizinga TWJ, Bloem JL, van der Helm-van Mil AHM, Reijnierse M. Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema? Eur Radiol 2014; 24:2614-22. [PMID: 24972953 DOI: 10.1007/s00330-014-3272-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/23/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA). MATERIAL AND METHODS In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference. RESULTS Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80-0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %). CONCLUSION T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA. KEY POINTS • Bone marrow oedema scores are equal on T2 and T1-Gd-chelate enhanced sequences. • Agreement between scores based on T2 and T1-Gd-chelate images was excellent. • Sensitivity and specificity for presence of bone marrow oedema were high. • A short protocol without T2 images suffices in rheumatoid arthritis patients.
Collapse
Affiliation(s)
- Wouter Stomp
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
| | | | | | | | | | | | | |
Collapse
|
47
|
Brakenhoff LKPM, Stomp W, van Gaalen FA, Hommes DW, Bloem JL, van der Heijde DMFM, Fidder HH, Reijnierse M. Magnetic resonance imaging of the hand joints in patients with inflammatory bowel disease and arthralgia: a pilot study. Scand J Rheumatol 2014; 43:416-8. [PMID: 24720480 DOI: 10.3109/03009742.2014.882407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To assess whether subclinical inflammatory changes are present on magnetic resonance imaging (MRI) in patients with inflammatory bowel disease (IBD) and arthralgia. METHOD In this pilot study, painful hand joints [metacarpophalangeal (MCP), proximal interphalangeal (PIP), and/or distal interphalangeal (DIP)] of 11 IBD patients (age 18-45 years) with continuous pain for > 6 weeks were scanned on a 1.5-T extremity MRI system. A control group of 11 IBD patients without joint pain who were matched for type and disease duration of IBD, gender, and age was included. All patients were clinically examined by a rheumatologist for the presence of pain and arthritis. Imaging was performed according to a standard arthritis protocol with intravenous contrast administration on the same day. Images (blinded for clinical information) were evaluated by two readers in consensus for the presence of joint fluid, synovitis, tenosynovitis, enthesitis, erosions, cartilage defects, and bone marrow oedema. RESULTS Enthesitis was seen in three hand joints (MCP 2, MCP 3, PIP 3) of 2/11 (18%) arthralgia patients and in none of the control group (p = 0.48). A small amount of subchondral bone marrow oedema was seen in the metacarpal head of two controls. No other abnormalities were observed. CONCLUSIONS Several young IBD patients with chronic hand pain had subclinical inflammation on MRI, which invites for further study in a larger group of patients.
Collapse
Affiliation(s)
- L K P M Brakenhoff
- Departments of Gastroenterology and Hepatology, Leiden University Medical Centre , The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
48
|
van Steenbergen HW, van Nies JAB, Huizinga TWJ, Bloem JL, Reijnierse M, van der Helm-van Mil AHM. Characterising arthralgia in the preclinical phase of rheumatoid arthritis using MRI. Ann Rheum Dis 2014; 74:1225-32. [PMID: 24718962 DOI: 10.1136/annrheumdis-2014-205522] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/21/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND The phase of arthralgia is the earliest moment to clinically recognize patients who may develop Rheumatoid Arthritis (RA). Previous imaging studies in the arthralgia phase have shown that inflammation precedes RA development. It is unknown which symptoms/characteristics relate to subclinical joint inflammation as measured by MRI. Among all patients with arthralgia, those with clinically suspect arthralgia (CSA) are suspected to progress to arthritis according to the clinical judgement of their rheumatologists. We determined the symptoms/characteristics of patients with CSA who had inflammation on MRI. METHODS 102 patients with CSA and without clinical arthritis were included. They completed questionnaires, underwent joint counts and unilateral 1.5 T MRI of MCP joints 2-4, wrist and MTP joints 1-5. Synovitis, bone marrow oedema (BME) and tenosynovitis were scored according to the OMERACT rheumatoid arthritis MRI scoring system. Symptoms and signs were related to MRI inflammation (based on MRI scores in symptom-free controls; a sum of synovitis, BME and tenosynovitis scores ≥3 was considered positive). Whether certain clinical characteristics frequently occurred together with MRI inflammation was studied by partial least squares analysis. RESULTS MRI was performed in 93 patients with CSA, 44% of whom had subclinical MRI inflammation. Synovitis was the most prevalent inflammatory feature on MRI (20%). Patients with MRI inflammation were older and were more frequently positive for anti-citrullinated peptide antibodies than patients without MRI inflammation (p<0.001 and 0.049). In PLS analysis, including 16 clinical and serological characteristics as independent variables and MRI inflammation as dependent variable, no clear clusters of patients with and without MRI inflammation were identified. CONCLUSIONS Subclinical inflammation as measured by MRI is present in 44% of patients with CSA. A combination of symptoms/characteristics incompletely differentiated patients with and without MRI inflammation.
Collapse
Affiliation(s)
| | - Jessica A B van Nies
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
49
|
Krabben A, Stomp W, Huizinga TWJ, van der Heijde D, Bloem JL, Reijnierse M, van der Helm-van Mil AHM. Concordance between inflammation at physical examination and on MRI in patients with early arthritis. Ann Rheum Dis 2013; 74:506-12. [PMID: 24336009 DOI: 10.1136/annrheumdis-2013-204005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND MRI is increasingly used to measure inflammation in rheumatoid arthritis (RA) research, but the correlation to clinical assessment is unexplored. This study determined the association and concordance between inflammation of small joints measured with MRI and physical examination. METHODS 179 patients with early arthritis underwent a 68 tender joint count and 66 swollen joint count and 1.5T MRI of MCP (2-5), wrist and MTP (1-5) joints at the most painful side. Two readers scored synovitis and bone marrow oedema (BME) according to the OMERACT RA MRI scoring method and assessed tenosynovitis. The MRI data were first analysed continuously and then dichotomised to analyse the concordance with inflammation at joint examination. RESULTS 1790 joints of 179 patients were studied. Synovitis and tenosynovitis on MRI were independently associated with clinical swelling, in contrast to BME. In 86% of the swollen MCP joints and in 92% of the swollen wrist joints any inflammation on MRI was present. In 27% of the non-swollen MCP joints and in 66% of the non-swollen wrist joints any MRI inflammation was present. Vice versa, of all MCP, wrist and MTP joints with inflammation on MRI 64%, 61% and 77%, respectively, were not swollen. BME, also in case of severe lesions, occurred frequently in clinically non-swollen joints. Similar results were observed for joint tenderness. CONCLUSIONS Inflammation on MRI is not only present in clinically swollen but also in non-swollen joints. In particular BME occurred in clinically non-inflamed joints. The relevance of subclinical inflammation for the disease course is a subject for further studies.
Collapse
Affiliation(s)
- A Krabben
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Stomp
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
50
|
Krabben A, Stomp W, Heijde DMFMVD, Nies JABV, Bloem JL, Huizinga TWJ, Reijnierse M, van der Helm-van Mil AHM. A1.8 Magnetic Resonance Imaging of Hand and Foot Joints of Patients with ACPA Positive Arthralgia without Clinical Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203214.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|