Multi-Modal Imaging to Assess the Interaction Between Inflammation and Bone Damage Progression in Inflammatory Arthritis

Justin J Tse; Scott C Brunet; Peter Salat; Glen S Hazlewood; Cheryl Barnabe; Sarah L Manske

doi:10.3389/fmed.2020.545097

Multi-Modal Imaging to Assess the Interaction Between Inflammation and Bone Damage Progression in Inflammatory Arthritis

Front Med (Lausanne). 2020 Sep 25:7:545097. doi: 10.3389/fmed.2020.545097. eCollection 2020.

Authors

Justin J Tse^{1

2}, Scott C Brunet^{1

2

3}, Peter Salat^{1

2}, Glen S Hazlewood^{2

4}, Cheryl Barnabe^{2

4}, Sarah L Manske^{1

2

3}

Affiliations

¹ Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
² Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
³ Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada.
⁴ Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Abstract

Combining results from multiple imaging techniques (i.e., multi-modal imaging) through image registration can result in the better characterization of joint tissue characteristics. In the context of inflammatory arthritis conditions, high-resolution peripheral quantitative computed tomography (HR-pQCT) provides excellent bone contrast while magnetic resonance imaging (MRI) provides superior contrast and resolution of soft tissue and inflammatory characteristics. Superimposing these imaging results upon each other provides a robust characterization of the joint. In a preliminary study of nine rheumatoid arthritis (RA) participants in clinical remission, we acquired HR-pQCT and MR images of their 2nd and 3rd metacarpophalangeal (MCP) joints at two timepoints 6 months apart. We present the benefits of a multi-modal imaging approach, in which we demonstrate the ability to localize regions of inflammation with subtle changes in bone erosion volume. Using HR-pQCT and MRI to visualize bone damage and inflammation, respectively, will improve our understanding of the impact that subclinical inflammation has on bone damage progression, and demonstrating if bone repair occurs where inflammation is resolved. The presented multi-modal imaging technique has the potential to study the progression of bone damage in relation to inflammation that otherwise would not be possible with either imaging technique alone. The multi-modal image registration technique will be helpful to understanding the development and pathogenesis of RA-associated bone erosions. Additionally, multi-modal imaging may provide a technique to probe the tissue-level changes that occur as a result of treatment regimes.

Keywords: high resolution peripheral quantitative computed tomography (HR-pQCT); image registration; magnetic resonance imaging; multi-modal imaging; rheumatoid arthritis; subclinical inflammation.