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Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging

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Abstract

Objective

The effects of different therapies on enthesitis/osteitis in active ankylosing spondylitis (AS) were evaluated by magnetic resonance imaging (MRI). The aim was to assess the role of quantitative MRI in the evaluation of AS treatment efficacy.

Materials and methods

Thirty patients with active spondylitis or bilateral sacroilitis were selected and followed up for 1 year. Ten of the patients were treated only with non-steroidal anti-inflammatory drugs, 10 patients additionally received at baseline an intravenous pulse of glucocorticoids and 10 patients were treated with regular infusions of infliximab. Disease activity was measured according to clinical instruments and laboratory tests. For each patient, one selected inflamed lesion was followed from baseline through control visits quantitatively by diffusion-weighted imaging (DWI) measuring the apparent diffusion coefficient (ADC) and by dynamic contrast-enhanced imaging (DCEI) with evaluation of the enhancement factor (fenh) and enhancement gradient (genh).

Results

Clinical and quantitative MRI parameters diminished significantly with regression of the inflammatory activity. The improvement in AS was most pronounced in patients treated with infliximab; after 12 months the ADC diminished from an average of 1.31 to 0.88 × 10−3 mm2/s, fenh from 1.85 to 0.60, and genh from 3.09 to 1.40 %/s.

Conclusion

Diffusion-weighted imaging and DCEI were shown to be effective in quantifying changes in inflammation in skeletal lesions during the treatment of AS, and could therefore be convenient for assessing treatment efficacy. To the best of our knowledge this is the first time DWI was used to evaluate the activity of skeletal inflammation in rheumatic diseases such as AS.

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Authors and Affiliations

  1. Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia

    Nataša Gašperšič, Matija Tomšič & Sonja Praprotnik

  2. Jožef Stefan Institute, Ljubljana, Slovenia

    Igor Serša

  3. Department of Radiology, Medical Faculty, Ljubljana, Slovenia

    Vladimir Jevtič

  4. Department of Rheumatology, University Medical Centre, Vodnikova 62, 1000, Ljubljana, Slovenia

    Nataša Gašperšič

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  1. Nataša Gašperšič
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  2. Igor Serša
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  3. Vladimir Jevtič
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  4. Matija Tomšič
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Correspondence to Nataša Gašperšič.

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Gašperšič, N., Serša, I., Jevtič, V. et al. Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging. Skeletal Radiol 37, 123–131 (2008). https://doi.org/10.1007/s00256-007-0407-2

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  • DOI: https://doi.org/10.1007/s00256-007-0407-2

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