Knorpelqualität an den Fingergelenken: delayed Gd(DTPA)^2– enhanced MRI of the cartilage (dGEMRIC) bei 3T

Zusammenfassung

Ziel: Beurteilung der Machbarkeit molekularer MR Knorpel-Bildgebung bei erstmaliger Anwendung an Fingergelenken. Material und Methoden: Mittels einer Variablen Flipwinkel-Methode (VFA) wurden delayed Gd(DTPA)^2– enhanced MRI of the cartilage (dGEMRIC)-Untersuchungen vom Metacarpophalangealgelenk (MCP) II und MCP III an 18 Patienten mit rheumatoider Arthritis (RA) und 9 gesunden Probanden durchgeführt und die Knorpeldicke bestimmt. Zusätzlich wurden bei 2 Patienten mit Fingerpolyarthrose dGEMRIC-Untersuchungen der proximalen Interphalangealgelenken (PIP) angefertigt. Ergebnisse: Bei Patienten mit RA lagen im Vergleich zur Kontrollgruppe signifikant erniedrigte dGEMRIC-Indizes in allen untersuchten Knorpelarealen vor: Im MCP II betrug der dGEMRIC-Index im phalangealen Knorpel 389,6 ± 85,5 ms gegenüber 558,7 ± 74,4 ms in der Kontrollgruppe, im metacarpalen Knorpel 357,3 ± 97,1 ms gegenüber 490,0 ± 86,6 ms. Im MCP III wurden phalangeal 436,2 ± 113,6 ms bei RA, 558,8 ± 115,5 ms in der Kontrollgruppe, metacarpal 398,0 ± 97,6 ms bei RA und 529,6 ± 111,0 ms in der Kontrollgruppe gemessen. Signifikante Unterschiede von Alter und Knorpeldicke lagen nicht vor. An den PIP-Gelenken von Patienten mit Fingerpolyarthrose wurden im Vergleich zur Kontrollgruppe ebenfalls erniedrigte dGEMRIC-Indizes gefunden. Schlussfolgerung: Die dGEMRIC-Bildgebung an den Fingergelenken bei RA- und Fingerpolyarthrose-Patienten ist technisch möglich. Trotz morphologisch normalen Knorpels zeigen sich bei RA erniedrigte dGEMRIC-Indizes, was auf eine Schädigung des Knorpels auf molekularer Ebene hindeutet. Die klinische Bedeutung dieser Technik hinsichtlich Früherkennung, Prognoseabschätzung und Monitoring muss durch weitere Studien gezeigt werden.

Abstract

Purpose: To evaluate the feasibility of molecular cartilage MRI in finger joints. Materials and Methods: Delayed Gd(DTPA)2-enhanced MRI of the cartilage (dGEMRIC) using a variable flip angle approach (VFA) was performed for the metacarpophalangeal (MCP) joints II and III in nine healthy volunteers and eighteen patients with rheumatoid arthritis (RA). The cartilage thickness was measured. Additionally, dGEMRIC was performed on proximal interphalangeal joints (PIP) in two patients with finger osteoarthritis (OA). Results: the dGEMRIC index of the four evaluated cartilage areas was significantly decreased in RA patients compared to healthy subjects. The dGEMRIC index of MCP II phalangeal cartilage was 389.6 ± 85.5 msec vs. 558.7 ± 74.4 msec in healthy subjects. The metacarpal MCP II cartilage dGEMRIC index was 357.3 msec ± 97.1 msec vs. 490.0 ± 86.6 msec. The dGEMRIC indices of MCP III were: phalangeal 436.2 ± 113.6 msec in RA, 558.8 ± 115.5 msec in healthy subjects and metacarpal 398.0 ± 97.6 msec in RA and 529.6 ± 111.0 msec in healthy subjects. Age and cartilage thickness were not significantly different. In PIP joints of finger osteoarthritis patients, low dGEMRIC indices were noted, compared to the controls. Conclusion: The dGEMRIC of finger joints is feasible in patients with RA and finger OA. Morphologically normal cartilage shows significantly decreased dGEMRIC values in RA, pointing towards cartilage degeneration on a molecular level. Further studies are needed to establish the usefulness of this technique for early diagnosis, prognosis and therapy monitoring.

Key words

arthritides - MR imaging - hand

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