Reliability and responsiveness of dynamic contrast-enhanced magnetic resonance imaging in rheumatoid arthritis

Scand J Rheumatol. 2013;42(2):115-22. doi: 10.3109/03009742.2012.723745. Epub 2012 Dec 18.


Objectives: To investigate the responsiveness to treatment and the reliability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in rheumatoid arthritis (RA) knee joints.

Methods: DCE-MRI was performed in 12 clinically active RA knee joints before and 1, 7, 30, and 180 days after intra-articular injection with 80 mg methylprednisolone. Using semi-automated image processing software, DCE-MRI parameters, including the initial rate of enhancement (IRE) and maximal enhancement (ME), were generated for three regions of interest (ROIs): 'Whole slice', 'Quick ROI', and 'Precise ROI'. The smallest detectable difference (SDD), the smallest detectable change (SDC), and intra- and inter-reader intraclass correlation coefficients (ICCs) were used to assess the reliability of DCE-MRI. Responsiveness to treatment was assessed by the standardized response mean (SRM).

Results: In all patients clinical remission of the knee was achieved at day 7. All DCE-MRI parameters decreased from day 0 to day 7. Using the Quick and Precise ROI methods, respectively, IRE decreased by 63% and 69%, ME decreased by 11% and 11%, N decreased by 55% and 57%, and IRE × N decreased by 84% and 85%. The intra- and inter-reader ICCs were very high (0.96-1.00). The decrease in DCE-MRI parameters was larger than the SDC for all patients. SRM was large for all parameters, ranging from -1.04 to -2.40. When the Whole slice ROI method was used, no parameters were responsive to treatment.

Conclusions: DCE-MRI analysed using semi-automatic software is a reliable and responsive tool for assessing treatment in RA knees joints. Rough manual delineation of the joint to omit enhancement artefacts is necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / diagnosis*
  • Arthritis, Rheumatoid / drug therapy
  • Cohort Studies
  • Follow-Up Studies
  • Gadolinium DTPA
  • Glucocorticoids / administration & dosage*
  • Humans
  • Image Enhancement
  • Injections, Intra-Articular
  • Knee Joint / drug effects
  • Knee Joint / pathology*
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods*
  • Methylprednisolone / administration & dosage*
  • Middle Aged
  • Recurrence
  • Remission Induction
  • Reproducibility of Results
  • Synovitis / diagnosis*
  • Synovitis / drug therapy
  • Treatment Outcome
  • Young Adult


  • Glucocorticoids
  • Gadolinium DTPA
  • Methylprednisolone