Boesen Mikael, Iakimov Aleksandr, Shakoor Delaram, Carrino John A, Kubassova Olga
Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Image Analysis Group, London, UK.
Skeletal Radiol. 2025 Jun 10. doi: 10.1007/s00256-025-04966-7.
Arthritis of the appendicular skeleton encompasses various inflammatory and degenerative joint diseases, where active inflammation in the soft tissues and bones significantly affects patients' quality of life and prognosis. Therefore, effective arthritis management depends on early diagnosis and treatment initiation, which rely on sensitive methods for detecting and monitoring inflammatory activity. Conventional MRI techniques, such as fluid-sensitive MRI using static 2D or 3D fat-saturated T2-weighted, proton density-weighted, STIR, and particularly T1-weighted images after intravenous Gadolinium contrast injection, have been widely used as reference standards for detecting inflammation and monitoring the response to treatment in clinical trials and clinical practice. However, several studies have indicated that these static imaging sequences may have problems capturing the degree of inflammation, detecting early treatment responses and associating the imaging scores with clinical findings. As a result, T1-weighted dynamic contrast-enhanced MRI (DCE-MRI), which captures and maps vascularity and tissue perfusion, has been increasingly used as a more sensitive surrogate measure for detecting and monitoring the inflammatory treatment response in arthritis. This review outlines the rationale for utilising DCE-MRI in arthritis imaging. It will discuss the advantages and limitations of current acquisition and analysis methods and highlight which DCE-MRI-derived parameters correlate with clinical findings, histological results and responses to inflammatory treatments in common forms of appendicular arthritis.
四肢骨骼关节炎包括各种炎症性和退行性关节疾病，其中软组织和骨骼中的活动性炎症会显著影响患者的生活质量和预后。因此，有效的关节炎管理依赖于早期诊断和开始治疗，而这又依赖于检测和监测炎症活动的敏感方法。传统的MRI技术，如使用静态二维或三维脂肪饱和T2加权、质子密度加权、短T1反转恢复（STIR）序列，特别是静脉注射钆对比剂后的T1加权图像的液体敏感MRI，已被广泛用作临床试验和临床实践中检测炎症和监测治疗反应的参考标准。然而，多项研究表明，这些静态成像序列在捕捉炎症程度、检测早期治疗反应以及将成像评分与临床发现相关联方面可能存在问题。因此，能够捕捉并绘制血管分布和组织灌注情况的T1加权动态对比增强MRI（DCE-MRI）已越来越多地被用作检测和监测关节炎炎症治疗反应的更敏感替代指标。本综述概述了在关节炎成像中使用DCE-MRI的基本原理。它将讨论当前采集和分析方法的优缺点，并强调哪些DCE-MRI衍生参数与常见四肢关节炎的临床发现、组织学结果以及炎症治疗反应相关。
