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Diffusion-weighted imaging is a sensitive biomarker of response to biologic therapy in enthesitis-related arthritis

Bray, TJP; Vendhan, K; Ambrose, N; Atkinson, D; Punwani, S; Fisher, C; Sen, D; ... Hall-Craggs, M; + view all (2016) Diffusion-weighted imaging is a sensitive biomarker of response to biologic therapy in enthesitis-related arthritis. Rheumatology , 56 (3) pp. 399-407. 10.1093/rheumatology/kew429. Green open access

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Abstract

OBJECTIVE: The aim was to evaluate diffusion-weighted imaging (DWI) as a tool for measuring treatment response in adolescents with enthesitis-related arthropathy (ERA). METHODS: Twenty-two adolescents with ERA underwent routine MRI and DWI before and after TNF inhibitor therapy. Each patient’s images were visually scored by two radiologists using the Spondyloarthritis Research Consortium of Canada system, and sacroiliac joint apparent diffusion coefficient (ADC) and normalized ADC (nADC) were measured for each patient. Therapeutic clinical response was defined as an improvement of 5 30% physician global assessment and radiological response defined as 52.5-point reduction in Spondyloarthritis Research Consortium of Canada score. We compared ADC and nADC changes in responders and non-responders using the MannWhitneyWilcoxon test. RESULTS: For both radiological and clinical definitions of response, reductions in ADC and nADC after treatment were greater in responders than in non-responders (for radiological response: ADC: P < 0.01; nADC: P = 0.055; for clinical response: ADC: P = 0.33; nADC: P = 0.089). ADC and nADC could predict radiological response with a high level of sensitivity and specificity and were moderately sensitive and specific predictors of clinical response (the area under the receiver operating characteristic curves were as follows: ADC: 0.97, nADC: 0.82 for radiological response; and ADC: 0.67, nADC: 0.78 for clinical response). CONCLUSION: DWI measurements reflect the response to TNF inhibitor treatment in ERA patients with sacroiliitis as defined using radiological criteria and may also reflect clinical response. DWI is more objective than visual scoring and has the potential to be automated. ADC/nADC could be used as biomarkers of sacroiliitis in the clinic and in clinical trials.

Type: Article
Title: Diffusion-weighted imaging is a sensitive biomarker of response to biologic therapy in enthesitis-related arthritis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/rheumatology/kew429
Publisher version: http://doi.org/10.1093/rheumatology/kew429
Language: English
Additional information: © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. This is a pre-copyedited, author-produced PDF of an article accepted for publication in Rheumatalogy following peer review. The version of record J P Bray, T; Vendhan, K; Ambrose, N; Atkinson, D; Punwani, S; Fisher, C; Sen, D; (2016) Diffusion-weighted imaging is a sensitive biomarker of response to biologic therapy in enthesitis-related arthritis. Rheumatology is available online at: http://dx.doi.org/10.1093/rheumatology/kew429.
Keywords: Magnetic resonance imaging, diffusion-weighted imaging, spondyloarthritis, juvenile idiopathic arthritis, biomarkers, apparent diffusion coefficient, adolescents, inflammation, arthritis
UCL classification: UCL
UCL > Provost and Vice Provost Offices
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
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1513915
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