LAUSR

Digital Ulcer Disease is a main vascular manifestation of Systemic Sclerosis (SSc) caused by progressive narrowing of digital arteries with consequent tissue ischemia. Time of flight angiography (TOF) is an MRI technique based on flow-related enhancement of spins entering into an imaging slice. It can visualise flow within vessels, without the need to administer contrast. Here we measured Digital Artery Volume index (DAVIX ©) as an MRI TOF quantitative score of digital arteries flow and determined its value in predicting the onset of digital ulcers (DUs) in patients with SSc. We studied 91 consecutive patients, 63 of which fulfilled the 2013 ACR/EULAR classification criteria for SSc and 28 had a score <9. The data collected included: clinical examination, pulmonary function tests (PFTs), echocardiography, nailfold capillaroscopy. DAVIX of the dominant hand was calculated as % mean of the 4 fingers, employing MeVisLab software. The distribution was analysed with D’Agostino-Pearson normality test. Correlation with clinical parameters was performed using Spearman’s or Pearson test, as appropriate (Prism 7). 78/91 patients were females and median disease duration was 4 years (IQR 1.91-9). Complete historical and prospective follow-up data were available for 68 patients. At baseline 7 patients had DUs (5 with a positive history for DUs). 12 patients developed DUs within 12 months, 3 of them had DUs at baseline. 38 patients did not have either previous or current DUs, neither did they develop new DUs within 12 months. The median of DAVIX in this population was 0.65 (IQR 0.46-0.82). DAVIX of patients with current DUs was 3-fold lower than DAVIX of patients without DUs (0.18 vs 0.63 p = 0.0093). Further, DAVIX of patients with positive history of DUs was 50% lower than in patient with a negative history (median 0.34 vs 0.64, p = 0.0052). In patients without current DUs who developed new DUs within 12 months of follow-up the DAVIX was 3-fold lower than in patients who didn’t develop (0.21 vs 0.65, p = 0.0156). Most importantly in patients with no current DUs a DAVIX <0.47 gave a 35% risk of developing DUs ( vs 15% overall risk). Outcome measures of vascular involvement in SSc are scanty. We demonstrated that DAVIX© is a promising and feasible surrogate outcome measure of neointima proliferation in SSc. Furthermore, the predictive value of DAVIX for the future onset of DUs could be employed as a useful stratification tool in Clinical trials. K. Gjeloshi None. F. Danzo None. G. Lettieri None. G. Abignano None. M. Hinton None. A. Dean None. G. Cuomo None. O. Kubassova None. F. del Galdo None.