Extended report
Quantitative magnetic resonance imaging as marker of synovial
membrane regeneration and recurrence of synovitis after arthroscopic
knee joint synovectomy: a one year follow up study
M Østergaard, B Ejbjerg, M Stoltenberg, P Gideon, B Volck, K Skov, C Hjorth Jensen, I Lorenzen
Danish
Research Centre of Magnetic Resonance and the Departments of
Rheumatology, Radiology, and Orthopaedic Surgery, Hvidovre Hospital and
the Department of Rheumatology, Rigshospitalet, University of
Copenhagen, Denmark
Correspondence to: Dr M Østergaard, Danish Research Centre of Magnetic Resonance, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark mo{at}dadlnet.dk
Accepted for publication 12 July 2000
OBJECTIVES
By repeated
magnetic resonance imaging (MRI) to study synovial membrane
regeneration and recurrence of synovitis after arthroscopic knee joint
synovectomy in patients with rheumatoid arthritis (RA) and other
(non-RA) causes of persistent knee joint synovitis.
METHODSContrast
enhanced MRI was performed in 15 knees (nine RA, six non-RA) before and
one day, seven days, two months, and 12 months after arthroscopic
synovectomy. Synovial membrane volumes, joint effusion volumes, and
cartilage and bone destruction were assessed on each MRI set. Baseline
microscopic and macroscopic assessments of synovitis and baseline and
follow up standard clinical and biochemical examinations were available.
RESULTSSynovial
membrane and joint fluid volumes were significantly reduced two and
12 months after synovectomy. However, MRI signs of recurrent synovitis
were already present in most knees at two months. No significant
differences between volumes in RA and non-RA knees were seen. Synovial
membrane volumes at two months were significantly inversely
correlated with the duration of clinical remission, for all knees
considered together (Spearman's correlation rs=
0.67; p<0.05), for RA
knees (rs=0.76; p<0.05), and
for non-RA knees (rs=0.83;
p<0.05). Baseline volumes were not significantly correlated with
clinical outcome. Only three knees (all RA) showed erosive progression.
The rate of erosive progression was not correlated with MRI volumes or
with clinical or biochemical parameters.
CONCLUSIONThe
synovial membrane had regenerated two months after arthroscopic knee
joint synovectomy and despite significant volume reductions compared
with baseline it often showed signs of recurrent synovitis. MRI seems
to be valuable as a marker of inflammation, destruction and, perhaps,
as a predictor of therapeutic outcome in arthritis.
© 2001 by Annals of the Rheumatic Diseases
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