16 research outputs found
Spectrum of Normal and Pathologic Findings in the Region of the First Extensor Compartment of the Wrist
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135553/1/jum2009286779.pd
Spectrum of Normal and Pathologic Findings in the Region of the First Extensor Compartment of the Wrist
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135553/1/jum2009286779.pd
Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study
PURPOSE: To evaluate by using B-mode and power Doppler ultrasonography (US) and
clinical assessment the response of hand joint synovitis in patients with active
rheumatoid arthritis (RA) to treatment with the anti-tumor necrosis factor-alpha
agent infliximab. MATERIALS AND METHODS: Wrists, metacarpophalangeal (MCP)
joints, and proximal interphalangeal (PIP) joints in 11 patients with active RA
were assessed before and 6 weeks after three infliximab infusions. US assessment
was performed at a single site in the MCP and PIP joints and at two sites
(radiocarpal and intercarpal) in the wrists. Twenty measurements were performed
in the wrists; 110 measurements, in the MCP joints; and 103 measurements, in the
PIP joints. Two wrists and seven PIP joints were excluded owing to complete joint
destruction. US parameters (synovial thickness, number of US-positive joints [ie,
with synovial thickness > or = 1 mm], cumulative synovial thickness index, and
presence of Doppler signal) and clinical parameters (swollen joint count) were
independently assessed and compared with baseline values by using the McNemar
chi2 and paired Student t tests. RESULTS: After infliximab treatment, there was a
significant decrease in the mean numbers of swollen and US-positive joints and in
the cumulative synovial thickness (P <.05). The mean synovial thickness decreased
in all joints swollen at baseline and in the MCP and PIP joints not swollen at
baseline (P <.01). Change from baseline cumulative synovial thickness correlated
significantly with change in disease activity score (r = 0.69, P <.05). The
number of positive Doppler US signals decreased significantly (in 13 US-positive
joints at baseline, in five after treatment; P <.05). CONCLUSION: US is a
feasible imaging modality for measurement of the response of RA small-joint
synovitis to therapy
F-18-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3
Purpose: The aim of this study was to assess rheumatoid arthritis (RA) synovitis with positron emission tomography (PET) and F-18-fluorodeoxyglucose (F-18-FDG) in comparison with dynamic magnetic resonance imaging (MRI) and ultrasonography (US). Methods: Sixteen knees in 16 patients with active RA were assessed with PET, MRI and US at baseline and 4 weeks after initiation of anti-TNF-alpha treatment. All studies were performed within 4 days. Visual and semi-quantitative (standardised uptake value, SUV) analyses of the synovial uptake of FDG were performed. The dynamic enhancement rate and the static enhancement were measured after i.v. gadolinium injection and the synovial thickness was measured in the medial, lateral patellar and suprapatellar recesses by US. Serum levels of C-reactive protein (CRP) and metalloproteinase-3 (MMP-3) were also measured. Results: PET was positive in 69% of knees while MRI and US were positive in 69% and 75%. Positivity on one imaging technique was strongly associated with positivity on the other two. PET-positive knees exhibited significantly higher SUVs, higher MRI parameters and greater synovial thickness compared with PET-negative knees, whereas serum CRP and MMP-3 levels were not significantly different. SUVs were significantly correlated with all MRI parameters, with synovial thickness and with serum CRP and MMP-3 levels at baseline. Changes in SUVs after 4 weeks were also correlated with changes in MRI parameters and in serum CRP and MMP-3 levels, but not with changes in synovial thickness. Conclusion: F-18-FDG PET is a unique imaging technique for assessing the metabolic activity of synovitis. The PET findings are correlated with MRI and US assessments of the pannus in RA, as well as with the classical serum parameter of inflammation, CRP, and the synovium-derived parameter, serum MMP-3. Further studies are warranted to establish the place of metabolic imaging of synovitis in RA