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. 2024 Nov;53(11):2389-2398.
doi: 10.1007/s00256-024-04652-0. Epub 2024 Mar 21.

Quantitative MRI assessment of joint effusion using T2-relaxometry at 3 Tesla: a feasibility and reproducibility study

Flora H P van Leeuwen  1 , Beatrice Lena  2 , Eline D P van Bergen  3 , Janoah J van Klei  2 , Merel A Timmer  3 , Lize F D van Vulpen  3 , Kathelijn Fischer  3 , Pim A de Jong  2 , Clemens Bos  2 , Wouter Foppen  2
Affiliations

Quantitative MRI assessment of joint effusion using T2-relaxometry at 3 Tesla: a feasibility and reproducibility study

Flora H P van Leeuwen et al. Skeletal Radiol. 2024 Nov.

Abstract

Objective: T2-relaxometry could differentiate between physiological and haemorrhagic joint effusion (≥ 5% blood) in vitro. Are quantitative T2-relaxation time measurements of synovial fluid feasible and reproducible in vivo in clinically bleed-free joints of men with haemophilia?

Materials and methods: In this cross-sectional study, we measured T2-relaxation times of synovial fluid in clinically bleed-free ankles, knees or elbows of men with severe haemophilia A using a T2-mapping sequence (duration ≤ 7 min) at 3 Tesla MRI. Manual and circular regions of interest (ROI) were drawn in the synovial fluid of each joint by two independent observers to measure T2-relaxation times. Measurement feasibility was expressed as the success rate of the measurements by both observers. The interobserver and intraobserver reproducibility of the measurements were evaluated by the intraclass correlation coefficient of absolute agreement (ICC) and the limits of agreement (LoA) from Bland Altman analysis.

Results: We evaluated 39 clinically bleed-free joints (11 ankles, 12 knees, 16 elbows) of 39 men (median age, 24 years; range 17-33) with severe haemophilia A. The success rate of the T2-measurements was ≥ 90%. Interobserver reliability was good to excellent (manual ROI: ICC = 0.92, 95% CI 0.76-0.97; circular ROI: ICC = 0.82, 95% CI 0.66-0.91) and interobserver agreement was adequate (manual ROI: LoA = 71 ms; circular ROI: LoA = 146 ms). Intraobserver reliability was good to excellent (manual ROI: ICC = 0.78, 95% CI - 0.06-0.94; circular RO: ICC = 0.99, 95% CI 0.98-0.99) and intraobserver agreement was good (manual ROI: LoA = 63 ms; circular ROI: LoA = 41 ms).

Conclusion: T2-relaxometry of synovial fluid in haemophilia patients is feasible with good interobserver and intraobserver reproducibility.

Keywords: Haemarthrosis; Haemophilia; Magnetic resonance imaging; Reproducibility of results; Synovial fluid.

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Conflict of interest statement

This study was funded by an independent clinical research grant from NovoNordisk (Access to Insight 2018) received by W. Foppen which was paid to the institution. M.A. Timmer, and L.F.D. van Vulpen have also received research grants from NovoNordisk. K. Fischer has performed consultancy for NovoNordisk and has received speaker’s fees and research support from NovoNordisk. The other authors declare no financial relationship with NovoNordisk.

In addition, F.H.P. van Leeuwen, B. Lena, E.D.P. van Bergen, J.J. van Klei and C. Bos declare no conflicts of interest. M.A. Timmer has received research grants from SOBI, which were paid to the institution. L.F.D. van Vulpen has received research grants from CSL Behring and Grifols; and has performed consultancy for Sobi, CSL Behring, and Octapharma; all fees paid to the institution. K. Fischer has received speaker’s fees from Bayer, Baxter/Shire, Sobi/Biogen, CSL Behring; has performed consultancy for Bayer, Biogen, CSL Behring, Freeline, Roche and Sobi; and has received research support from Bayer, Baxter/Shire, Pfizer and Biogen; all fees were paid to the institution. P.A. de Jong declares a research collaboration with Vifor Pharma. W. Foppen has received a research grant from Pfizer, which was paid to the institution, and consultancy fees from Pfizer. The Department of Radiology & Nuclear Medicine of the UMC Utrecht has received research support from Philips Healthcare.

Figures

Fig. 1
Fig. 1
A Flowchart summarizing patient inclusion in the current study
Fig. 2
Fig. 2
Two examples of a transversal T2-map of a knee with a manual region of interest (ROI) and a circular ROI drawn in the synovial fluid
Fig. 3
Fig. 3
Bland–Altman plots regarding the interobserver agreement of T2-relaxation measurements for the manual and circular regions of interest (ROI)
Fig. 4
Fig. 4
Bland–Altman plots regarding the intraobserver agreement of T2-relaxation measurements for the manual and circular regions of interest (ROI)
Fig. 5
Fig. 5
Boxplots showing mean T2-relaxtion times measured with manual and circular regions of interest (ROI) in the different joint types. Asterisk (*) means significant p-values from multivariate linear regression adjusted for amount of effusion and presence of haemosiderin deposits in the synovial membrane. The central thick horizontal lines represent the median values, the boxes contain the 1st to 3rd quartiles. The end of the vertical line represents the minimum and maximum values, excluding outliers. Outliers are shown as dots
See this image and copyright information in PMC

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