Bone structure and perfusion quantification of bone marrow edema pattern in the wrist of patients with rheumatoid arthritis: a multimodality study

• Published in: Journal of rheumatology Vol. 41; no. 9; p. 1766
• Main Authors: Teruel, Jose R, Burghardt, Andrew J, Rivoire, Julien, Srikhum, Waraporn, Noworolski, Susan M, Link, Thomas M, Imboden, John B, Li, Xiaojuan
• Format: Journal Article
• Language: English
• Published: Canada 01.09.2014
• Subjects: Adult; Aged; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - pathology; Bone Density; Bone Marrow - diagnostic imaging; Bone Marrow - pathology; Edema - complications; Edema - diagnostic imaging; Edema - pathology; Female; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Multimodal Imaging; Tomography, X-Ray Computed; Wrist Joint - diagnostic imaging; Wrist Joint - pathology; RHEUMATOID ARTHRITIS; COMPUTED TOMOGRAPHY; MAGNETIC RESONANCE IMAGING; BONE EROSIONS; BONE MARROW EDEMA
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.131564

To quantify bone structure and perfusion parameters in regions of bone marrow edema pattern (BMEP), non-edematous bone marrow (NBM), and pannus tissue areas in the wrists of patients with rheumatoid arthritis (RA) using 3-Tesla (3T) magnetic resonance imaging (MRI), and high resolution peripheral quantitative computed tomography (HR-pQCT). Sixteen subjects fulfilling American College of Rheumatology classification were imaged using a HR-pQCT system and a 3T MRI scanner with an 8-channel wrist coil. Coronal T2-weighted and dynamic contrast-enhanced (DCE-MRI) images were acquired. BMEP and pannus tissue areas were segmented semiautomatically in T2-weighted images. NBM areas were placed at a similar distance from the joint space as BMEP regions. MR and HR-pQCT images were registered, and bone variables were calculated within the BMEP and NBM regions. Perfusion parameters in BMEP, pannus tissue, and NBM regions were calculated based on the signal-time curve obtained from DCE-MRI. Eighteen BMEP areas were segmented, 15 of them presented proximal to pannus-filled erosions. Significant increases in bone density and trabecular thickness and number were observed in all BMEP regions compared to NMB (p < 0.05). Significantly elevated perfusion measures were observed in both BMEP and pannus tissue regions compared to NBM (p < 0.05). BMEP regions showed significantly increased bone density and structures as well as perfusion measures, suggesting bone remodeling and active inflammation. Combining MRI and HR-pQCT provides a powerful multimodality approach for understanding BMEP and erosions, and for potentially identifying novel imaging markers for disease progression in RA.