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Extended reports
Measurement of synovial lining volume by magnetic resonance imaging of the knee in chronic synovitis
  1. Gavin Cluniea,
  2. Margaret A Hall-Craggsc,
  3. Martyn N Paleyb,
  4. Anne Kingc,
  5. Iain D Wilkinsond,
  6. Peter J Elle,
  7. Jo C W Edwardsa
  1. aRheumatology Research Unit, Department of Medicine, University College London , bRita Lila Weston Institute of Neurology, Department of Medicine, UCL Medical School , cMR Unit, Department of Radiology, UCL Hospitals Trust , dDepartment of Medical Physics, University College London , eInstitute of Nuclear Medicine, University College London
  1. Dr G Clunie, Rheumatology Research Unit, Arthur Stanley House, Tottenham Street, London W1P 9PG.

Abstract

OBJECTIVES Current methods of monitoring chronic synovitis in a single joint rely on clinical examination derived indices, such as the detection of synovial thickening. This study aimed to develop a reproducible method for quantifying the volume of synovial lining in chronic synovitis using contrast enhanced magnetic resonance (MR) imaging.

METHODS The knees of 18 patients with chronic synovitis were examined (34 studies). A 2D T1 weighted FLASH sequence was used to evaluate the temporal enhancement of synovial structures after intravenous contrast. Synovial lining volume was calculated from subtraction of pre and post-enhancement 3D T1 weighted MP RAGE images with thresholding and pixel counting. Eleven patients were examined before and after intra-articular glucocorticoid (mean interval 14 weeks) and MR data compared with changes in clinical examination derived indices of disease activity.

RESULTS Synovial lining volume varied from 52–267 ml. The coefficient of variation in volume calculation was 3.5% for a single observer and was 3.8% for two observers. Synovial lining volume was quantified in all patients where synovial lining thickening could not be detected clinically. A decrease in synovial lining volume of >40% was associated with an improvement in synovial lining thickening, detected clinically. Decreases in synovial lining volume were quantified by MR in two of three patients where changes in clinical examination derived indices were inconsistent.

CONCLUSIONS A reproducible method of estimating the volume of synovial lining in patients with chronic synovitis has been developed. MR measurement of synovial lining volume may quantify changes in chronic synovitis that remain unidentified by clinical measures.

  • magnetic resonance imaging
  • knee
  • chronic synovitis

https://doi.org/10.1136/ard.56.9.526

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