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Quantifying bone marrow inflammatory edema in the spine and sacroiliac joints with thresholding.

ABSTRACT: Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis that develops in patients with psoriasis. Inflammatory edema in the spine may reflect subclinical disease activity and be a predictor of radiographic progression. A semi-quantitative method established by the spondyloarthritis research consortium of Canada (SPARCC) is commonly used to assess the disease activity in MR images of the spine. This study aims to evaluate thresholding for quantification of subtle bone marrow inflammation in the spine and the sacroiliac (SI) joints of patients with PsA and compare it with the SPARCC scoring system.Short tau inversion recovery (STIR) MR images of the spine (N?=?85) and the SI joints (N?=?95) of patients with PsA (N?=?41) were analyzed. A threshold was applied to visible bone marrow in order to mask areas with higher signal intensity, which are consistent with inflammation. These areas were considered as inflammatory lesions. The volume and relative signal intensity of the lesions were calculated. Results from thresholding were compared to SPARCC scores using linear mixed-effects models. The specificity and sensitivity of thresholding were also calculated.A significant positive correlation between the volumes and mean relative signal intensities, which were calculated by thresholding analysis, and the SPARCC scores was detected for both spine (p?

SUBMITTER: Chronaiou I

PROVIDER: S-EPMC5704357 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Quantifying bone marrow inflammatory edema in the spine and sacroiliac joints with thresholding.

Chronaiou Ioanna I Thomsen Ruth S RS Huuse Else M EM Euceda Leslie R LR Pedersen Susanne J SJ Hoff Mari M Sitter Beathe B

BMC musculoskeletal disorders 20171128 1

<h4>Background</h4>Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis that develops in patients with psoriasis. Inflammatory edema in the spine may reflect subclinical disease activity and be a predictor of radiographic progression. A semi-quantitative method established by the spondyloarthritis research consortium of Canada (SPARCC) is commonly used to assess the disease activity in MR images of the spine. This study aims to evaluate thresholding for quantification of subtle bone mar ...[more]

PMID: 29179748

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Project description:Recombinant human bone morphogenic protein-2 (BMP-2)-loaded absorbable collagen sponges (ACS) have been successfully used to enhance bone formation and to induce spinal fusion in humans. However, side effects, such as soft tissue edema and inflammation, have been reported. NEMO binding domain peptide (NBD) inhibits activation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-?B), a central regulator of immune response. In this study, we investigated NBD's potential to reduce BMP-2-induced soft tissue inflammation without affecting BMP-2-mediated spinal fusion in rat. For evaluation of soft tissue inflammation, ACS containing BMP-2, BMP-2+NBD, NBD, or ACS only were implanted into intramuscular paraspinal sites of 32 rats. At day 2 postsurgery, edema formation at the implant sites was assessed using magnetic resonance imaging. T2-weighted relaxation time (T2-RT) values were increased in the BMP-2 group compared with BMP-2+NBD, NBD, and ACS groups. No difference in T2-RT values was detected between BMP-2+NBD versus NBD and ACS controls. Postsacrifice, histological analysis of the implant-surrounding zones showed increased mononuclear cell infiltration in the BMP-2 group compared with BMP-2+NBD and controls. The presence of BMP-2 increased relative NF-?B binding and gene expression of inflammatory markers, interleukin (IL)1?, IL6, IL18, and chemokine ligand (CCL)2 and CCL3 compared with controls. In the BMP-2+NBD group, cytokine expression was blocked. No differences were found between BMP-2+NBD and control groups. For evaluation of spinal fusion, posterolateral intertransverse lumbar fusion procedures were performed on 16 rats. ACS were loaded with BMP-2 or BMP-2+NBD. After sacrifice at week 12, microcomputed tomographic assessment of the fusion site detected a higher bone volume and reduced trabecular spacing in the BMP-2+NBD group compared with BMP-2. Histological analysis did not show any differences in newly formed bone microarchitecture. In summary, addition of NBD to BMP-2-loaded ACS reduces BMP-2-induced soft tissue edema formation and mononuclear cell infiltration, diminishes NF-?B binding, and thus blocks transcription of NF-?B-regulated cytokines in rat. Furthermore, NBD stimulates bone formation in BMP-2-mediated spinal fusion, possibly through crosstalk of the NF-?B pathway with other pathways. The results of this study might provide the basis to develop new therapeutic bone grafting approaches with combinatory administration of BMP-2 and NBD for spinal fusion.

Project description:ObjectiveTo test the impact of inflammation on structural changes occurring in the sacroiliac (SI) joints and the spine detected on magnetic resonance imaging (MRI).MethodsPatients with early axial spondyloarthritis (SpA) from the Devenir des Spondylarthropathies Indifferérenciées Récentes (DESIR) cohort were included. MRIs of the SI joints (MRI-SI joints) and spine (MRI-spine), obtained at baseline, 2 years, and 5 years, were scored by 3 central readers. Inflammation and structural damage on MRI-SI joints and MRI-spine were defined by the agreement of ≥2 of 3 readers (binary outcomes) and by the average of 3 readers (continuous outcomes). The effect of inflammation (MRI-SI joints/MRI-spine) on damage (MRI-SI joints/MRI-spine, respectively) was evaluated in 2 models: 1) a baseline prediction model (the effect of baseline inflammation on damage assessed at 5 years); and 2) a longitudinal model (the effect of inflammation on structural damage assessed during a 5-year period).ResultsA total of 202 patients were included. Both the presence of bone marrow edema on MRI-SI joints and on MRI-spine at baseline were predictive of 5-year damage (≥3 fatty lesions) on MRI-SI joints (odds ratio [OR] 4.2 [95% confidence interval (95% CI) 2.4, 7.3]) and MRI-spine (OR 10.7 [95% CI 2.4, 49.0]), respectively, when adjusted for C-reactive protein level. The association was also confirmed in longitudinal models (when adjusted for Ankylosing Spondylitis Disease Activity Score) both in the SI joints (OR 5.1 [95% CI 2.7, 9.6]) and spine (OR 15.6 [95% CI 4.8, 50.3]). Analysis of other structural outcomes (i.e., erosions) on MRI-SI joints yielded similar results. In the spine, a significant association was found for fatty lesions but not for erosions and bone spurs, which occurred infrequently over time.ConclusionWe found a predictive and longitudinal association between inflammation detected on MRI and several types of structural damage detected on MRI in patients with early axial SpA, which adds to the evidence for a causal relationship.

Dataset Information

Quantifying bone marrow inflammatory edema in the spine and sacroiliac joints with thresholding.

Publications

Quantifying bone marrow inflammatory edema in the spine and sacroiliac joints with thresholding.

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