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DWI Useful for Assessing Ankylosing Spondylitis Treatment Efficacy

February 10, 2008
Written by: , Filed in: Musculoskeletal Radiology
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Background
Ankylosing spondylitis (AS) is a chronic inflammatory disease causing enthesitis and osteitis. It manifests itself as sacroiliitis, spondylodiscitis/spondylitis, spondylarthritis, and peripheral inflammatory disease.

The introduction of tumor necrosis factor alpha inhibitors (infliximab), one of the key cytokines that triggers and sustains the inflammatory response, resulted in a major breakthrough in disease management. MRI is now increasingly used to monitor treatment response.

The objective of a recent study was to assess the role of quantitative MRI in the evaluation of AS treatment efficacy.

The study has concluded that inflammatory activity is more precisely shown with DCEI and DWI than with conventional short tau inversion recovery and T1-weighted spin-echo sequences.

Design, Participants and Metholodogy
30 patients with active AS were included and followed up during a 12-month study interval. Patients were assigned to one of three groups.

Group 1 (n=10) received full-dose nonsteroidal anti-inflammatory drugs (NSAIDs).

Group 2 received an additional pulse of IV glucocorticoids (GC).

In group 3, 10 patients were treated with regular infusions of infliximab (INF). Patients were allowed to use additional NSAIDS at their own discretion throughout the study.

Patients were assessed at baseline, 2, and 12 months after the start of the study. Disease activity was measured clinically and with laboratory tests. One inflammatory lesion was selected on the basis of standard short tau inversion recovery and T1-weighted spin-echo sequences.

This lesion was followed up in every patient with diffusion-weighted imaging (DWI), measuring the apparent diffusion coefficient (ADC) and with dynamic contrast-enhanced imaging (DCEI), evaluating the enhancement factor and enhancement gradient.

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Results of the Study
The clinical parameters were not significantly different in the GC and INF groups, but the global scores, function and disease activity scores were significantly lower in the NSAID group. The ADCs were similar at baseline in all three groups.

At 2 months, significant improvements were seen in the INF group concerning disease activity and laboratory parameters, but these parameters were similar to baseline in the GC and NSAIDs groups. These changes persisted and improved or stayed essentially stable at the 12-month follow-up.

The ADC demonstrated a significant decrease in the INF group after 12 months. No improvement was seen in the GC and NSAIDs group.

Conclusions
DCEI and DWI are useful in quantifying inflammatory lesions in AS and monitoring treatment response and efficacy.

Reviewer’s Comments
DWI may become a valuable tool for assessing treatment response because it indicates whether residual inflammation is still present despite improved clinical status. Premature treatment termination can therefore be avoided.

Author: Cornelia Wenokor, MD

Reference:

Gaspersic N, Sersa I, et al. Monitoring Ankylosing Spondylitis Therapy by Dynamic Contrast-Enhanced and Diffusion-Weighted Magnetic Resonance Imaging. Skeletal Radiol; 2008; 37 (February): 123-131

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