Rheumatoid Arthritis: Scheel AK

Joshua F, Lassere M, Bruyn GA, Szkudlarek M, Naredo E, Schmidt WA, Balint P, Filippucci E, Backhaus M, Iagnocco A, Scheel AK, Kane D, Grassi W, Conaghan PG, Wakefield RJ, D'Agostino MA. · Department of Rheumatology, St. George Hospital, University of NSW, Sydney, Australia. · J Rheumatol. · Pubmed #17407235 No free full text.

Abstract: This report presents the results of a recent systematic review performed by the OMERACT Ultrasound Group on the metric properties of ultrasound for the detection of synovitis in inflammatory arthritis. Reviews were conducted for the hand, wrist, elbow, shoulder, knee, ankle, and foot; most reports were related to the hand and knee, and the most common disease process was rheumatoid arthritis. The review highlights the current gaps in the literature, including a lack of reliability data with respect to intra-occasion and intra- and inter-reader reliability. Current work by our group is addressing these issues.

Schwaighofer A, Tresp V, Mayer P, Krause A, Beuthan J, Rost H, Metzger G, Müller GA, Scheel AK. · Siemens Corporate Technology, Information and Communications, CT IC4, Otto-Hahn-Ring 6, 81739 Munich, Germany. · IEEE Trans Biomed Eng. · Pubmed #12669994 No free full text.

Abstract: We describe a classification system for a novel imaging method for arthritic finger joints. The basis of this system is a laser imaging technique which is sensitive to the optical characteristics of finger joint tissue. From the laser images acquired at baseline and follow-up, finger joints can automatically be classified according to whether the inflammatory status has improved or worsened. To perform the classification task, various linear and kernel-based systems were implemented and their performances were compared. Based on the results presented in this paper, we conclude that the laser-based imaging permits a reliable classification of pathological finger joints, making it a sensitive method for detecting arthritic changes.

Scheel AK, Krause A, Rheinbaben IM, Metzger G, Rost H, Tresp V, Mayer P, Reuss-Borst M, Müller GA. · Georg-August-University Göttingen, Göttingen, Germany. · Arthritis Rheum. · Pubmed #12115221 links to  free full text

Abstract: OBJECTIVE: To evaluate a newly developed laser-based imaging technique for the study of soft tissue changes and acute inflammatory processes of the proximal interphalangeal (PIP) joints in patients with rheumatoid arthritis (RA). METHODS: A novel imaging device was developed which allows the transillumination of PIP joints using laser light in the near-infrared wavelength range. In a first clinical followup study, a total of 72 PIP joints of 22 patients with RA and 64 PIP joints of 8 healthy controls were examined both clinically and with the new laser device. At baseline and at followup after a mean of 6 weeks, clinical signs of synovitis, the joint circumference, and the degree of pain were assessed for each PIP joint in order to determine the clinical degree of inflammation. Different features were extracted from the laser images and evaluated by a neural network. RESULTS: At baseline, 72 PIP joints in the RA patients showed clinical signs of inflammation. At followup, 45 PIP joints showed clinical improvement, 13 showed steady active inflammation, and 14 showed deterioration compared with the first visit. None of the 64 PIP joints in the healthy individuals showed any signs of synovitis. The inflammatory status of 60 of the 72 RA joints examined was classified correctly by laser examination and joint circumference determination, giving a sensitivity of 80%, a specificity of 89%, and an accuracy of 83% in detecting inflammatory changes in affected joints. Laser data and joint circumference determination of healthy joints at followup resulted in an accuracy of 85% in reproducing the image. CONCLUSION: The new laser-based imaging technique allows the transillumination of PIP joints and gives information about the inflammatory status of the joint after processing through a neural network. Our data indicate that laser imaging may provide additional information in the early diagnosis of an inflammatory joint process and may prove particularly useful in assessing acute joint inflammation at followup.

Song R, Klose AD, Scheel AK, Netz U, Beuthan J, Hielscher AH. · Depts. of Biomedical Engineering and Radiology at Columbia University, New York, NY 10027 USA. · Conf Proc IEEE Eng Med Biol Soc. · Pubmed #17959451 No free full text.

Abstract: We have developed an images reconstruction algorithm to recover spatial distribution of optical properties in human finger joints for early diagnosis and monitoring of rheumatoid arthritis (RA). An optimization method iteratively employs a light propagation and scattering coefficients distribution for near-infrared (NIR) light inside the joint tissue. We developed the differences in cross-sectional images obtained by using the reconstruction algorithms with 2-dimensional and 3-dimensional light propagation models. In particular we examined how these different approaches affect the discrimination between healthy and RA joints.

Netz UJ, Scheel AK, Beuthan J, Hielscher AH. · Inst. fur Medizinische Phys. & Lasermedizin, Charite-Universitatsmedizin Berlin. · Conf Proc IEEE Eng Med Biol Soc. · Pubmed #17946924 No free full text.

Abstract: For development and test of new optical imaging devices, phantoms are widely used to emulate the tissue to be imaged. Phantom design gets more difficult the more complex the tissue is structured. We report on developing and testing a solid, stable finger joint phantom to simulate transillumination of finger joints in frequency-domain imaging systems. The phantom consists of the bone, capsule, skin, the capsule volume, and the joint gap. Silicone was used to build the solid parts and a glycerol-water solution for the fluid in the capsule volume and joint gap. The system to test the phantom is an optical frequency-domain scanning set-up. Different stages of joint inflammation as they occur in rheumatoid arthritis (BA) were emulated by assembling the phantom with capsule and fluid having different optical properties. Reliability of the phantom measurement was investigated by repeated assembling. The results show clear discrimination between different stages of joints within the signal deviation due to reassembling of the phantom.

Backhaus M, Scheel AK. · Medizinische Klinik, Universitätsmedizin Berlin. · MMW Fortschr Med. · Pubmed #17621797 No free full text.

Abstract: Because of the good contrast obtained in soft tissues, ultrasound permits differentiation of the exudative and proliferative synovial tissue changes, as well as tenosynovitis. Superficial cartilage and bone lesions or erosions can be detected through ultrasound earlier than with conventional radiodiagnostics. The use of power Doppler sonography with ultrasound contrast agents is especially helpful in the further differentiation of the synovial inflammatory process and hence, progression of the destructive processes in the joint can be more clearly evaluated. Arthrosonography aids in the diagnosis of early arthritis, particularly in patients without pathological radiological findings and suspicious clinical results. Moreover, it permits sound assessment of the disease progression and hence, therapeutic monitoring.The method is patient friendly, has high diagnostic value and is an integral component in the clarification of arthritic symptoms.

Wakefield RJ, D'Agostino MA, Iagnocco A, Filippucci E, Backhaus M, Scheel AK, Joshua F, Naredo E, Schmidt WA, Grassi W, Moller I, Pineda C, Klauser A, Szkudlarek M, Terslev L, Balint P, Bruyn GA, Swen WA, Jousse-Joulin S, Kane D, Koski JM, O'Connor P, Milutinovic S, Conaghan PG, Anonymous00480. · Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK. · J Rheumatol. · Pubmed #17407236 No free full text.

Abstract: Ultrasound (US) is a relatively new imaging modality in rheumatology that offers great potential as a diagnostic and management tool. In 2004, an OMERACT Ultrasound Special Interest Group was formed to address the metric qualities of US as a potential outcome measure. A preliminary systematic review highlighted the deficiencies in the literature, particularly with regard to the reliability of interpreting and acquiring images; as a consequence, a number of exercises were proposed to address these issues. This report describes a series of iterative studies that have resulted in improved intra- and inter-reader reliability for detecting and scoring synovitis from both static and real-time images of the hand joints of patients with rheumatoid arthritis. The reliability of acquiring images was also enhanced using standardized positions. Future studies will assess the value of US in clinical trials.

Schirmer C, Scheel AK, Althoff CE, Schink T, Eshed I, Lembcke A, Burmester GR, Backhaus M, Hamm B, Hermann KG. · Department of Radiology, Charité Medical School, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. · Ann Rheum Dis. · Pubmed #17068069 No free full text.

Abstract: OBJECTIVE: To compare dedicated low-field MRI (lfMRI) with conventional MRI (cMRI) in the detection and scoring of synovitis, tenosynovitis and erosions in patients with rheumatoid arthritis. PATIENTS AND METHODS: The wrist and finger joints of 17 patients with rheumatoid arthritis (median (range) disease duration 8 years (7-12); Disease Activity Score 3.3 (2.6-4.5)) were examined by 0.2 T lfMRI and 1.5 TcMRI. The protocols comprised coronal spin-echo and three-dimensional gradient-echo sequences before and after contrast medium administration. Synovitis of the metacarpophalangeal and proximal interphalangeal joints 2-5 and the wrist joints was scored according to Outcome Measures in Rheumatology recommendations. Tenosynovitis and erosions were scored using 4-point and 6-point scales, respectively. The results were analysed by calculating kappa values and performing McNemar's test intra-individually on a joint-by-joint basis. RESULTS: Agreement between the two MRI techniques was good to excellent for synovitis and erosions, and moderate for tenosynovitis. Of the 306 joints evaluated, 245 and 200 joints showed synovitis in lfMRI and cMRI, respectively. Scoring of synovitis of the finger joints yielded kappa values from 0.69 to 0.94. Of the 68 flexor tendons evaluated, tenosynovitis was diagnosed by lfMRI in 24 and by cMRI in 33 instances. Of the 391 bones evaluated, 154 and 139 showed erosions in lfMRI and cMRI, respectively. kappa values for erosion scores were between 0.65 and 1. CONCLUSION: Dedicated, lfMRI shows high agreement with cMRI in diagnosing and scoring synovitis, tenosynovitis and erosions in rheumatoid arthritis when using standardised scoring systems.

Eshed I, Althoff CE, Schink T, Scheel AK, Schirmer C, Backhaus M, Lembcke A, Bollow M, Hamm B, Hermann KG. · Department of Radiology, Charité Medical School, Campus Mitte, Schumannstrasse 20-21, 10117 Berlin, Germany. · Scand J Rheumatol. · Pubmed #16882591 No free full text.

Abstract: OBJECTIVE: To investigate the impact of a double dose compared to a single dose of contrast material in low-field magnetic resonance imaging (MRI) on semi-quantitative scoring of synovitis in patients with rheumatoid arthritis (RA). METHODS: This prospective study included 38 RA patients (23 women and 15 men, mean age 51 years). All patients underwent low-field MRI of the hand before administration of contrast medium, after intravenous injection of 0.1 mmol/kg gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA), and after another dose of 0.1 mmol/kg Gd-DTPA. Two readers (A and B) blinded to dosage independently scored the single dose and double dose image sets for synovitis according to outcome measures in rheumatology (OMERACT) recommendations. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were also calculated for each set. RESULTS: 149 metacarpophalangeal (MCP) joints were evaluated. There was good inter-reader agreement for each of the two sets (intra-class correlation coefficient of 0.75 for the single dose set and 0.83 for the double dose). Median CNR and SNR values were 5.4 and 15.9, respectively, for the single dose set and 8.5 and 16.6, respectively, for the double dose set (p<0.0001). Single dose set mean synovitis scores were 1.7 and 1.6 for readers A and B, respectively. Double dose set scores were 1.9 and 2.0, respectively. Thus, higher synovitis scores were recorded for the double dose sets than the single dose sets (p<0.005). CONCLUSION: In low-field MRI, when evaluating RA, the dose of the contrast material influences synovitis scoring. Therefore, dosage of contrast material should be taken into consideration when using extremity dedicated low-field MRI.

Scheel AK, Hermann KG, Ohrndorf S, Werner C, Schirmer C, Detert J, Bollow M, Hamm B, Müller GA, Burmester GR, Backhaus M. · Department of Medicine, Nephrology and Rheumatology, Georg-August-University Göttingen, Germany. · Ann Rheum Dis. · Pubmed #16192290 links to  free full text

Abstract: OBJECTIVE: To perform a prospective long term follow up study comparing conventional radiography (CR), ultrasonography (US), and magnetic resonance imaging (MRI) in the detection of bone erosions and synovitis in rheumatoid arthritis (RA) finger joints. METHODS: The metacarpophalangeal and proximal interphalangeal joints II-V (128 joints) of the clinically dominant hand of 16 patients with RA were included. Follow up joint by joint comparisons for erosions and synovitis were made. RESULTS: At baseline, CR detected erosions in 5/128 (4%) of all joints, US in 12/128 (9%), and MRI in 34/128 (27%). Seven years later, an increase of joints with erosions was found with CR (26%), US (49%) (p<0.001 each), and MRI (32%, NS). In contrast, joint swelling and tenderness assessed by clinical examination were decreased at follow up (p = 0.2, p<0.001). A significant reduction in synovitis with US and MRI (p<0.001 each) was seen. In CR, 12 patients did not have any erosions at baseline, while in 10/12 patients erosions were detected in 25/96 (26%) joints after 7 years. US initially detected erosions in 9 joints, of which two of these joints with erosions were seen by CR at follow up. MRI initially found 34 erosions, of which 14 (41%) were then detected by CR. CONCLUSION: After 7 years, an increase of bone erosions was detected by all imaging modalities. In contrast, clinical improvement and regression of synovitis were seen only with US and MRI. More than one third of erosions previously detected by MRI were seen by CR 7 years later.

Scheel AK, Hermann KG, Kahler E, Pasewaldt D, Fritz J, Hamm B, Brunner E, Müller GA, Burmester GR, Backhaus M. · Georg-August-University Göttingen, Germany. <> · Arthritis Rheum. · Pubmed #15751062 links to  free full text

Abstract: OBJECTIVE: To develop an ultrasonographic (US) synovitis scoring system suitable for evaluation of finger joint inflammation in patients with active rheumatoid arthritis (RA) and to compare semiquantitative US scoring with quantitative US measurements. METHODS: US was performed at the palmar and dorsal sides of the second through fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in 10 healthy subjects and in the clinically more affected hand in 46 RA patients. Ten patients additionally underwent magnetic resonance imaging (MRI). Synovitis was measured, standardized, and scored according to a semiquantitative method. The 2 methods (semiquantitative US scoring, quantitative US) were compared and statistical cutoffs were identified using receiver operating characteristic (ROC) curve analysis. MRI results were compared with semiquantitative US scoring and quantitative US results. The optimal US scoring method from 6 joint combinations was identified (ROC curve analysis). RESULTS: Synovitis was most frequently detected in the palmar proximal area (86% of affected joints). We found no significant differences between individual PIP joints or between individual MCP joints, indicating that all fingers within each of these joint groups should be treated equally for statistical calculations, although each joint group as a whole should be treated separately. The optimal cutoff point to distinguish between "health" and "pathology" was 0.6 mm both for MCP joints (sensitivity 94%, specificity 89%) and for PIP joints (sensitivity 90%, specificity 88%). There was no significant difference between semiquantitative US scores and quantitative US measurements. The best results for joint combinations were achieved using the "sum of 4 fingers" (second through fifth MCP and PIP joints) and "sum of 3 fingers" (second through fourth MCP and PIP joints) methods. Comparison of MRI results with semiquantitative US scores revealed high concordance. CONCLUSION: US evaluation of finger joint synovitis can be considerably simplified by focusing on the palmar side and by applying semiquantitative grading instead of quantitative measurements. For evaluation of treatment efficacy based on synovitis in RA patients, we recommend using the "sum of 3 fingers" method in longitudinal trials.

Scheel AK, Backhaus M, Klose AD, Moa-Anderson B, Netz UJ, Hermann KG, Beuthan J, Müller GA, Burmester GR, Hielscher AH. · Department of Medicine, Nephrology and Rheumatology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. · Ann Rheum Dis. · Pubmed #15297282 links to  free full text

Abstract: OBJECTIVE: To identify classifiers in images obtained with sagittal laser optical tomography (SLOT) that can be used to distinguish between joints affected and not affected by synovitis. METHODS: 78 SLOT images of proximal interphalangeal joints II-IV from 13 patients with rheumatoid arthritis were compared with ultrasound (US) images and clinical examination (CE). SLOT images showing the spatial distribution of scattering and absorption coefficients within the joint cavity were generated. The means and standard errors for seven different classifiers (operator score and six quantitative measurements) were determined from SLOT images using CE and US as diagnostic references. For classifiers showing significant differences between affected and non-affected joints, sensitivities and specificities for various cut off parameters were obtained by receiver operating characteristic (ROC) analysis. RESULTS: For five classifiers used to characterise SLOT images the mean between affected and unaffected joints was statistically significant using US as diagnostic reference, but statistically significant for only one classifier with CE as reference. In general, high absorption and scattering coefficients in and around the joint cavity are indicative of synovitis. ROC analysis showed that the minimal absorption classifier yields the largest area under the curve (0.777; sensitivity and specificity 0.705 each) with US as diagnostic reference. CONCLUSION: Classifiers in SLOT images have been identified that show statistically significant differences between joints with and without synovitis. It is possible to classify a joint as inflamed with SLOT, without the need for a reference measurement. Furthermore, SLOT based diagnosis of synovitis agrees better with US diagnosis than CE.

Hielscher AH, Klose AD, Scheel AK, Moa-Anderson B, Backhaus M, Netz U, Beuthan J. · Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA. · Phys Med Biol. · Pubmed #15128195 No free full text.

Abstract: We present a novel optical tomographic imaging system that was designed to determine two-dimensional spatial distribution of optical properties in a sagittal plane through finger joints. The system incorporates a single laser diode and a single silicon photodetector into a scanning device that records spatially resolved light intensities as they are transmitted through a finger. These data are input to a model-based iterative image reconstruction (MOBIIR) scheme, which uses the equation of radiative transfer (ERT) as a forward model for light propagation through tissue. We have used this system to obtain tomographic images of six proximal interphalangeal finger joints from two patients with rheumatoid arthritis. The optical images were compared to clinical symptoms and ultrasound images.

Scheel AK, Backhaus M. · No affiliation provided · Arthritis Rheum. · Pubmed #15022347 links to  free full text

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