One of the major aims of therapy in rheumatoid arthritis (RA) is to prevent erosive disease and subsequent disability. One of the important goals of therapy assessment must therefore be the accurate measurement of damage progression. We undertook this study to assess the feasibility, reliability, and validity of measuring magnetic resonance imaging (MRI) erosion volumes and synovial volumes in the wrists of RA patients with the use of a semiautomated computerized method.
Twelve subjects with seropositive RA were chosen to reflect a spectrum of RA severity as determined by the clinical Joint Alignment and Motion (JAM) Scale. MRI of the dominant wrist was performed at the same time of day at baseline and at 48 hours. Images were transferred to a workstation. Erosion volumes and synovial volumes were measured on the coronal images using OSIRIS imaging software. All images were reread in random order at 72 hours by 1 observer. The results were compared with erosion scores and global synovitis scores obtained by the same observer using the Outcome Measures in Rheumatology Clinical Trials MRI RA scoring system. Radiographs were performed at baseline and were read on 2 occasions by 1 observer using the Scott modification of the Larsen method.
Total erosion volume per subject ranged from 0 cm3 to 4.7 cm3. The total synovial membrane volume per subject ranged from 0.1 mm3 to 12.1 cm3. Intraclass correlation coefficients for erosion volumes and synovial volumes demonstrated excellent intraobserver reliability and interoccasion reliability. There was a strong positive correlation between the total erosion volume and the total erosion score. The correlation between the synovial volumes and synovitis score was less favorable (r = 0.53–0.86). Positive correlations were demonstrated between the erosion volumes, the JAM score, and the modified Larsen scores. No significant correlation was demonstrated between the erythrocyte sedimentation rate, C-reactive protein level, swollen joint count, tender joint count, or the Disease Activity Score in 28 swollen and 28 tender joints and the synovial volumes or synovitis scores.
This study is the first to demonstrate the feasibility, reliability, and validity of computerized MRI erosion volume measurements in the wrists of RA patients. The method will require further evaluation in terms of interobserver reliability, with examination of responsiveness in longitudinal studies, but the method demonstrates excellent interoccasion and intraobserver reliability and compares favorably with existing RA clinical outcome measures. Synovial volume measurements demonstrated good intraobserver reliability and appeared to be more responsive to synovial change over a 48-hour period in this group of patients.