AJR: Contrast-enhanced MRI may offer differential diagnosis between arthritis types
Contrast-enhanced MRI can bring forth statistically significant differences between rheumatoid arthritis and psoriatic arthritis that might play an important role in differentiating and treating the two diseases, according to a recent study published online in the March issue of the American Journal of Roentgenology.
Lead author Nina F. Schwenzer, MD, of the department of diagnostic and interventional radiology at the University Hospital of Tübingen in Tübingen, Germany, and colleagues, sought to determine if a differential diagnosis of two kinds of arthritis of the hand and wrist could be determined using dynamic contrast-enhanced MRI.
“Clinically, it may be difficult to distinguish psoriatic arthritis from rheumatoid arthritis because the symptoms of both diseases are similar and the diagnostic tests currently available to aid in the differentiation of psoriatic and rheumatoid arthritis are not always sufficient,” said Schwenzer.
The study was performed at the University Hospital of Tübingen and included 45 patients (31 patients with rheumatoid arthritis and 14 with psoriatic arthritis). Each patient was examined using a 3T whole-body MRI and injected with a contrast medium.
Noting that the uptake of contrast media varies for each person, the authors recorded signs of early enhancement after 35 and 52 seconds and relative enhancement rates were calculated after 35 seconds, 52 seconds and three minutes. Late enhancement was considered to be at the 15-minute mark.
Perfusion rates of patients with rheumatoid and psoriatic arthritis were compared to prior laboratory and clinical data.
A significant difference in the rate of perfusion between both patients with rheumatoid arthritis and psoriatic arthritis after 15 minutes was noted, wrote Schwenzer and colleagues. However, no difference in the relative enhancement rate was found 35 seconds, 52 seconds, or three minutes after contrast injection for either the rheumatoid or psoriatic arthritis groups.
Moreover, the authors found significant correlations between inflammatory parameters and dynamic contrast-enhanced parameters in patients with rheumatoid arthritis, but not in those with psoriatic arthritis.
Despite the differences observed in uptake rates during contrast-enhanced MRI, the researchers emphasized that “[a] diagnosis could not be led by contrast-enhanced MRI alone,” and noted an overlap in perfusion values between both types of arthritis and the small patient sample size as limitations of the study.
“In the past, the treatment strategy for patients with psoriatic arthritis was based on that for patients with rheumatoid arthritis,” wrote the authors. “Recent research indicates that the therapeutic management, including medication and therapy monitoring, has to be adapted for each type of arthritis.”
Lead author Nina F. Schwenzer, MD, of the department of diagnostic and interventional radiology at the University Hospital of Tübingen in Tübingen, Germany, and colleagues, sought to determine if a differential diagnosis of two kinds of arthritis of the hand and wrist could be determined using dynamic contrast-enhanced MRI.
“Clinically, it may be difficult to distinguish psoriatic arthritis from rheumatoid arthritis because the symptoms of both diseases are similar and the diagnostic tests currently available to aid in the differentiation of psoriatic and rheumatoid arthritis are not always sufficient,” said Schwenzer.
The study was performed at the University Hospital of Tübingen and included 45 patients (31 patients with rheumatoid arthritis and 14 with psoriatic arthritis). Each patient was examined using a 3T whole-body MRI and injected with a contrast medium.
Noting that the uptake of contrast media varies for each person, the authors recorded signs of early enhancement after 35 and 52 seconds and relative enhancement rates were calculated after 35 seconds, 52 seconds and three minutes. Late enhancement was considered to be at the 15-minute mark.
Perfusion rates of patients with rheumatoid and psoriatic arthritis were compared to prior laboratory and clinical data.
A significant difference in the rate of perfusion between both patients with rheumatoid arthritis and psoriatic arthritis after 15 minutes was noted, wrote Schwenzer and colleagues. However, no difference in the relative enhancement rate was found 35 seconds, 52 seconds, or three minutes after contrast injection for either the rheumatoid or psoriatic arthritis groups.
Moreover, the authors found significant correlations between inflammatory parameters and dynamic contrast-enhanced parameters in patients with rheumatoid arthritis, but not in those with psoriatic arthritis.
Despite the differences observed in uptake rates during contrast-enhanced MRI, the researchers emphasized that “[a] diagnosis could not be led by contrast-enhanced MRI alone,” and noted an overlap in perfusion values between both types of arthritis and the small patient sample size as limitations of the study.
“In the past, the treatment strategy for patients with psoriatic arthritis was based on that for patients with rheumatoid arthritis,” wrote the authors. “Recent research indicates that the therapeutic management, including medication and therapy monitoring, has to be adapted for each type of arthritis.”