Jones, Alexis;
(2022)
Assessing disease activity and response to treatment in axial spondyloarthritis: The unmet clinical need and potential role for quantitative imaging.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
BACKGROUND: Objective assessments of disease activity and response to treatment in axial spondyloarthritis (axSpA) remain an area of unmet clinical need. Quantitative magnetic resonance imaging (qMRI) offers potential for more accurate measures of disease activity and therapeutic response. PURPOSE: To critically appraise current methods of disease activity in axSpA and determine the responsiveness and validity of quantitative imaging biomarkers (QIBs) in patients with axSpA undergoing biologic therapy. METHODS: An observational cohort study was carried out to assess the specificity of our current disease activity measure on patients with axSpA. A systematic literature review was performed to assess the use of MRI in the assessment of axSpA. A prospective cohort study was carried out on 30 patients with axSpA undergoing biologic therapy or switching biologic therapy. Conventional and qMRI scans, including diffusion-weighted imaging (DWI) and chemical shift-encoded imaging (CSI) were carried out at baseline and after 12-16 weeks of treatment. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) maps were analysed using the partially-automated Bone Edema and Adiposity Characterisation with Histograms (BEACH) tool, which derives a series of quantitative imaging biomarkers (QIBs) for both ADC and PDFF. Conventional MR images were assessed using established visual scoring methods. QIBs were assessed in terms of change after treatment and correlation with clinical and conventional MRI measures of disease activity. RESULTS: Current disease activity measures are not specific to axSpA and can be increased in a number of other spinal pathologies. ADC biomarkers are sensitive to changes in inflammation and show significant reductions following biologic therapy, while PDFF-based QIBs showed nonsignificant reductions. Responsiveness to therapy was moderate for ADC based biomarkers and small for conventional scoring systems. ADC and PDFF correlated well with conventional MRI scoring methods. CONCLUSION: Quantitative MRI offers promise for a more accurate assessment of disease activity in axSpA.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Assessing disease activity and response to treatment in axial spondyloarthritis: The unmet clinical need and potential role for quantitative imaging |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10161782 |
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