Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology

• Published in: Annals of the rheumatic diseases Vol. 71; no. 4; pp. 504 - 510
• Main Authors: Werner, Stephanie G, Langer, Hans-Eckhard, Ohrndorf, Sarah, Bahner, Malte, Schott, Peter, Schwenke, Carsten, Schirner, Michael, Bastian, Hans, Lind-Albrecht, Gudrun, Kurtz, Bernward, Burmester, Gerd R, Backhaus, Marina
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.04.2012; BMJ Publishing Group; Elsevier Limited; BMJ Group
• Series: Extended report
• Subjects: Adult; Aged; Aged, 80 and over; Agreements; Arthritis - diagnosis; Arthritis - diagnostic imaging; Arthritis, Psoriatic - diagnosis; Arthritis, Psoriatic - diagnostic imaging; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - diagnostic imaging; Biological and medical sciences; Case-Control Studies; Clinical and Epidemiological Research; Coloring Agents; Confidence intervals; Diagnostic Imaging - methods; Disease; Diseases of the osteoarticular system; Female; Fluorescence; Hand Joints - diagnostic imaging; Hand Joints - pathology; Hands; Humans; Image Interpretation, Computer-Assisted - methods; Indocyanine Green; Inflammation; Integrated software; Laboratories; Magnetic Resonance Imaging - methods; Male; Medical sciences; Microscopy, Fluorescence - methods; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; NMR; Nuclear magnetic resonance; Patients; Sensitivity and Specificity; Statistical analysis; Studies; Synovitis - diagnosis; Synovitis - diagnostic imaging; Ultrasonic imaging; Ultrasonography; Young Adult; Germany; Human; In vivo; Technology; Diseases of the osteoarticular system; Rheumatology; Optical imaging; Arthritis; Inflammation
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/annrheumdis-2010-148288

Background Indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) is an established technology for imaging of inflammation in animal models. In experimental models of arthritis, FOI findings corresponded to histologically proven synovitis. This is the first comparative study of FOI with other imaging modalities in humans with arthritis. Methods 252 FOI examinations (Xiralite system, mivenion GmbH, Berlin, Germany; ICG bolus of 0.1 mg/kg/body weight, sequence of 360 images, one image per second) were compared with clinical examination (CE), ultrasonography (US) and MRI of patients with arthritis of the hands. Results In an FOI sequence, three phases could be distinguished (P1–P3). With MRI as reference, FOI had a sensitivity of 76% and a specificity of 54%, while the specificity of phase 1 was 94%. FOI had agreement rates up to 88% versus CE, 64% versus greyscale US, 88% versus power Doppler US and 83% versus MRI, depending on the compared phase and parameter. FOI showed a higher rate of positive results compared to CE, US and MRI. In individual patients, FOI correlated significantly (p<0.05) with disease activity (Disease Activity Score 28, r=0.41), US (r=0.40) and RAMRIS (Rheumatoid Arthritis MRI Score) (r=0.56). FOI was normal in 97.8% of joints of controls. Conclusion ICG-enhanced FOI is a new technology offering sensitive imaging detection of inflammatory changes in subjects with arthritis. FOI was more sensitive than CE and had good agreement with CE, US in power Doppler mode and MRI, while showing more positive results than these. An adequate interpretation of an FOI sequence requires a separate evaluation of all phases. For the detection of synovitis and tenosynovitis, FOI appears to be as informative as 1.5 T MRI and US.