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Kubassova O.,Image Analysis | Boesen M.,The Parker Institute | Cimmino M.A.,University of Genoa | Bliddal H.,The Parker Institute
European Journal of Radiology | Year: 2010

Rational and objective: Disease assessment and follow-up of rheumatoid arthritis (RA) patients require objective evaluation and quantification. Magnetic resonance imaging (MRI) has a large potential to supplement such information for the clinician, however, time spent on data reading and interpretation slow down development in this area. Existing scoring systems of especially synovitis are too rigid and insensitive to measure early treatment response and quantify inflammation. This study tested a novel automated, computer system for analysis of dynamic MRI data acquired from patients with RA, Dynamika-RA, which incorporates efficient data processing and analysis techniques. Materials and methods: 140 MRI scans from hands and wrists of 135 active RA patients and 5 healthy controls were processed using Dynamika-RA and evaluated with RAMRIS. To reduce patient motion artefacts, MRI data were processed using Dynamika-RA, which removed motion in 2D and 3D planes. Then synovial enhancement was visualised and qualified using a novel fully automated voxel-by-voxel analysis based algorithm. This algorithm was used to replace traditional region-of-interest (ROI) and subtraction methods, yielding observer independent quantitative results. Results: Conventional scoring performed by an observer took 30-45 min per dataset. Dynamika-RA reduced motion artefacts, visualised inflammation and quantified disease activity in less than 3 min. Data processing allowed increasing signal to noise ratio by a factor 3. Due to fully automated procedure of data processing, there was no intertest variation in the results. Conclusions: Algorithms incorporated into Dynamika-RA allow for the significant enhancement of data quality through eliminating motion artefacts and reduction of time for evaluation of synovial inflammation. © 2009 Elsevier Ireland Ltd. All rights reserved.

Boesen M.,Frederiksberrg | Boesen M.,Parker Institute | Kubassova O.,Image Analysis | Bouert R.,Frederiksberrg | And 6 more authors.
Rheumatology | Year: 2012

Objective: To test the correlation between assessment of inflammation using dynamic contrast-enhanced MRI (DCE-MRI) analysed by a novel computer-aided approach and semi-quantitative scores of synovitis and bone marrow oedema (BME) using the OMERACT-RA MRI Scoring (RAMRIS) system, in the wrist of patients with RA. Methods: Fifty-four RA patients had conventional and DCE-MRI of a symptomatic wrist using a low-field 0.2T extremity scanner. RAMRIS synovitis and BME of the wrist joint were done. DCE-MRI data were analysed in three ways: (i) in all images (fully automated approach), (ii) within a large extended region of interest (ROI) placed around the wrist joint (semi-automated approach) and (iii) within a small ROI placed in the area with most visual enhancement (semi-automated approach). Time spent on each procedure was noted. Spearman's rank correlation test was applied to assess the correlation between RAMRIS and the computer-generated dynamic parameters. Results. RAMRIS synovitis (range 2-9), BME (range 0-39) and the dynamic parameters reflecting the number of enhancing voxels were significantly correlated, especially when an extended ROI around the wrist was used (ρ = 0.74; P < 0.01 for synovitis and ρ = 0.82; P < 0.01 for BME). The observer spent on average 20 min (range 12-25 min) to perform RAMRIS, including acquisition of the results in the database, and 8 min (range 7-10 min) to perform all above-mentioned computer-aided analyses.Conclusion. Computer-aided analysis of DCE-MRI data correlated with RAMRIS synovitis and BME and was twice as fast to perform. This technique may be useful for quick semi-automated assessment of joint inflammation, but needs further validation. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Cimmino M.A.,University of Genoa | Barbieri F.,University of Genoa | Boesen M.,Parker Institute | Paparo F.,E.O. Ospedali Galliera | And 4 more authors.
Journal of Rheumatology | Year: 2012

Objective. Dynamic, contrast-enhanced magnetic resonance imaging (DCE-MRI), the quantification of enhancement within the synovial membrane and bone by extracting curves using fast T1-weighted sequences during intravenous administration of contrast agent, evaluates synovitis and bone marrow edema in psoriatic arthritis (PsA). In this pilot study, we looked at possible differences between joint synovitis and tenosynovitis in PsA as compared with rheumatoid arthritis (RA). Methods. Seven patients with PsA and 10 with RA were studied. After DCE-MRI was performed on 3 axial slices of the wrist, the enhancement ratio was calculated on 6 different regions of interest (ROI) of the synovial membrane outlined by the operator: the wrist compartment, 3 extensor tendon compartments, and 2 flexor compartments. DCE-MRI results were quantitatively analyzed using the Dynamika software, a computer-aided semiautomated method. Results. In PsA, the area of the ROI outlined around the first and second extensor compartments was larger than in RA; the opposite was true for the extensor carpi ulnaris region. The volume of inflammation was significantly higher in RA than in PsA for all the extensor compartments except the second, and in the joint synovial membrane. The DCE-MRI indicators of the degree of inflammation were higher for PsA in the joint synovial membrane (p = 0.002 and p < 0.001, respectively). There was a significant correlation between volume of inflammation but not its degree and 28-joint Disease Activity Score at the level of the wrist joint (r = 0.6; p = 0.01). Conclusion. DCE-MRI can reveal useful and potentially clinically important information on the characteristics of different types of arthritis. The Journal of Rheumatology Copyright © 2012. All rights reserved.

Cimmino M.A.,University of Genoa | Parodi M.,University of Genoa | Zampogna G.,University of Genoa | Boesen M.,Copenhagen University | And 5 more authors.
Clinical and Experimental Rheumatology | Year: 2014

Objective The aim of this study is to assess prospectively the effect of rituximab (RTX) on MRI features of wrist joint disease in patients affected by rheumatoid arthritis (RA). Methods Ten patients (6F/4M, mean age 52.9±15.5 years) diagnosed with IgM rheumatoid factor, anti-CCP positive, RA according to the 1987 ACR criteria were treated with a single course of RTX (2 infusions of 1000 mg, 15 days apart). MRI of the dominant hand was performed with a 0.2T extremity-dedicated machine using pre and post contrast T1 weighted SE, turbo 3D, and STIR sequences at baseline, and after 4 and 24 weeks. MRI was analysed using the OMERACT-RAMRIS score and the dynamic contrast-enhanced (DCE-MRI) technique for wrist synovitis, which calculates the enhancement ratio as both rate of early enhancement (REE) and relative enhancement (RE). The corresponding ME and IRE parameters were calculated also through a computer-aided semi-automated method on the mean of three MRI slices and on a small ROI positioned in the area of maximum enhancement. Results DAS significantly decreased during the study period (ANOVA for repeated measures, p=0.005). The RAMRIS score did not change along the study, whereas the dynamic MRI values RE, IRE and ME on the small ROI significantly decreased. RE, but not the RAMRIS synovitis score, significantly correlated with DAS at baseline, 1 and 6 months (p=0.005, 0.04, and 0.0007, respectively). Conclusion RTX confirmed good clinical efficacy, which was paralleled by a significant decrease in dynamic MRI results for wrist synovitis. On the contrary, the traditional RAMRIS measures did not change. © Clinical and Experimental Rheumatology 2014.

Agency: GTR | Branch: Innovate UK | Program: | Phase: Smart - Development of Prototype | Award Amount: 250.00K | Year: 2011

MRI is a major tool in clinical routine since it enables early diagnosis and reliable assessment of treatment, especially in arthritis and oncology studies, where timely diagnosis can make a difference between a disability or even death and a recovery to a relatively normal lifestyle. However, the cost of MRI procedures limits its use, which impacts on patient outcomes. To limit costs and to increase use of MRI radiologists need the best tools to aid their diagnostic procedures. Computer Aided Detection (CAD) solutions automate clinical routine, optimise treatment pathways, and enable earlier diagnosis, leading to overall costs savings in healthcare organisations and improvement of patient outcomes. However, CAD originates in academia and rarely finds its way to clinical routine. This project will extend functionality of IA’s proprietary solution Dynamika, widely deployed in rheumatoid arthritis into detection of prostate and breast cancer. We will further to deliver a prototype of an infrastructure for a faster deployment of this first multi-disease comprehensive MRI CAD solution in clinical routine. Centres of excellence (Oxford, Imperial, UCLH) will be used for R&D guidance, development of this innovative solution and its validation. IA will partner with key service providers (Agfa, Accenture) to build up the infrastructure, enabling academics to transfer their research into clinical practice and clinicians to have access to the latest cutting edge scientific findings. The grant will aid the significant technical development required to build and validate this infrastructure. IA has a track record of successful collaborative work with academia and hands on experience in developing innovative CAD tools. The output of the project will be a UK-wide deployment of MRI CAD solutions for better clinical diagnosis in rheumatoid arthritis, breast, and prostate cancer. The grant will facilitate intense R&D and to allow rapid development and growth of the company.

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