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Use of Tomosynthesis for Detection of Bone Erosions of the Foot in Patients With Established Rheumatoid Arthritis: Comparison With Radiography and CT. AJR Am J Roentgenol 2015. [PMID: 26204289 DOI: 10.2214/ajr.14.14120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare tomosynthesis with radiography for the detection of bone erosions of the foot in patients with established rheumatoid arthritis (RA) using MDCT as a reference standard. SUBJECTS AND METHODS Eighteen consecutive patients with established RA were included. Each patient underwent radiography, tomosynthesis, and CT examinations of the feet on the same day. Two radiologists independently determined the number of bone erosions and the Sharp-van der Heijde score with each of the three imaging modalities. RESULTS On a total of 216 joints from 18 patients, 216 bone erosions were detected on CT, 215 on tomosynthesis, and 181 with radiography. The mean (± SD) Sharp-van der Heijde score was equivalent for tomosynthesis (18.8 ± 16.8) and CT (19.8 ± 18.5) but was statistically lower for radiography (16.4 ± 18.0) (p = 0.030). The respective overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for tomosynthesis were 80%, 75%, 78%, 76%, and 80%, whereas the respective corresponding values for radiography were 66%, 81%, 74%, 77%, and 71%. The radiation burden of tomosynthesis was almost equivalent to that of radiography. CONCLUSION Tomosynthesis has a higher sensitivity than radiography to detect bone erosions of the foot in patients with established RA and imparts an almost equivalent radiation burden.
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Menashe L, Kerr LD, Hermann G. Mycobacterium kansasii causing chronic monoarticular synovitis in a patient with HIV/AIDS. J Radiol Case Rep 2015; 9:26-35. [PMID: 26629306 DOI: 10.3941/jrcr.v9i9.2542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Mycobacterium kansasii is a nontuberculous mycobacterium that primarily causes pulmonary disease in AIDS patients, however it has also been known, rarely, to result in skeletal infection. When skeletal infection occurs, the time from onset of symptoms to diagnosis is up to 5 years in previously reported cases. We describe a 48-year-old woman with HIV/AIDS who presented with chronic, isolated left knee pain and swelling of over two decades which had recently worsened. Radiographs and magnetic resonance imaging demonstrated marked subarticular erosions, synovial thickening, and bone marrow edema, which had progressed compared with prior imaging done seven years earlier. Synovial biopsy grew Mycobacterium kansasii. Following the presentation of our case, clinical and imaging findings, including the differential diagnosis, of monoarticular arthritis caused by Mycobacterium kansasii are reviewed and discussed.
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Affiliation(s)
- Leo Menashe
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leslie Dubin Kerr
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - George Hermann
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
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Al-Ani Z, Oh TC, Macphie E, Woodruff MJ. Sarcoid tenosynovitis, rare presentation of a common disease. Case report and literature review. J Radiol Case Rep 2015; 9:16-23. [PMID: 26629300 DOI: 10.3941/jrcr.v9i8.2311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is an idiopathic inflammatory disorder characterized by the presence of non-caseating tissue granulomas most commonly affecting lungs, lymph nodes and skin. Sarcoid skeletal involvement is relatively uncommon and in particular tenosynovitis. We describe an unusual case of sarcoidosis presenting with granulomatous tenosynovitis as the only manifestation of the disease, illustrating the radiological findings on different modalities followed by a review of the literature. Radiologists and clinicians should be aware of tenosynovitis as a manifestation of sarcoidosis as early and therefore appropriate treatment significantly alters patient's outcome and prognosis.
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Affiliation(s)
- Zeid Al-Ani
- Northwest Radiology Training Scheme, Royal Preston Hospital, Preston, UK
| | - Teik Chooi Oh
- Radiology Department, Royal Preston Hospital, Preston, UK
| | - Elizabeth Macphie
- Rheumatology Department, Minerva Health Centre, Lancashire Care NHS Foundation Trust, Preston, UK
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Baker JF, Tan YK, Conaghan PG. Monitoring in established RA: Role of imaging and soluble biomarkers. Best Pract Res Clin Rheumatol 2015; 29:566-79. [DOI: 10.1016/j.berh.2015.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Raven EEJ, van den Bekerom MPJ, Beumer A, van Dijk CN. Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review. Open Orthop J 2015; 9:246-54. [PMID: 26448803 PMCID: PMC4591907 DOI: 10.2174/1874325001509010246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 11/22/2022] Open
Abstract
Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in
rheumatoid arthritis RA). Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability
in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment
options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs
in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of
rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several
radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in
patients with RA are described. All with their own indications and limitations. Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation
index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is
most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability
dynamic radiographs are needed. Level of Evidence: Level IV.
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Affiliation(s)
- Eric E J Raven
- Department of Orthopaedic Surgery and Traumatology of the Gelre Hospitals, Postbus 9014, 7300 DS Apeldoorn, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090 HM Amsterdam, The Netherlands
| | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Postbus 90157, 4800 RL Breda, The Netherlands
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, The Netherlands
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Ono Y, Kamishima T, Yasojima N, Tamura K, Tsutsumi K. Detection and measurement of rheumatoid bone and joint lesions of fingers by tomosynthesis: a phantom study for reconstruction filter setting optimization. Radiol Phys Technol 2015; 9:6-14. [PMID: 26092218 DOI: 10.1007/s12194-015-0327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic disease that is caused by autoimmunity. RA causes synovial proliferation, which may result in bone erosion and joint space narrowing in the affected joint. Tomosynthesis is a promising modality which may detect early bone lesions such as small bone erosion and slight joint space narrowing. Nevertheless, so far, the optimal reconstruction filter for detection of early bone lesions of fingers on tomosynthesis has not yet been known. Our purpose in this study was to determine an optimal reconstruction filter setting by using a bone phantom. We obtained images of a cylindrical phantom with holes simulating bone erosions (diameters of 0.6, 0.8, 1.0, 1.2, and 1.4 mm) and joint spaces by aligning two phantoms (space widths from 0.5 to 5.0 mm with 0.5 mm intervals), examining six reconstruction filters by using tomosynthesis. We carried out an accuracy test of the bone erosion size and joint space width, done by one radiological technologist, and a test to assess the visibility of bone erosion, done by five radiological technologists. No statistically significant difference was observed in the measured bone erosion size and joint space width among all of the reconstruction filters. In the visibility assessment test, reconstruction filters of Thickness+- and Thickness-- were among the best statistically in all characteristics except the signal-to-noise ratio. The Thickness+- and Thickness-- reconstruction filter may be optimal for evaluation of RA bone lesions of small joints in tomosynthesis.
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Affiliation(s)
- Yohei Ono
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan.
| | - Nobutoshi Yasojima
- Department of Radiology, NTT East Japan Sapporo Hospital, South-1, West-15, Cyuo-ku, Sapporo, 060 0061, Japan
| | - Kenichi Tamura
- Department of Mechanical Engineering, College of Engineering, Nihon University, Nakagawara, Tokusada, Tamuramachi, Koriyama, Fukushima Prefecture, 963 8642, Japan
| | - Kaori Tsutsumi
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan
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Wawer R, Budzik JF, Demondion X, Forzy G, Cotten A. Carpal pseudoerosions: a plain X-ray interpretation pitfall. Skeletal Radiol 2014; 43:1377-85. [PMID: 24902509 DOI: 10.1007/s00256-014-1907-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/07/2014] [Accepted: 05/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine in detail images of pseudoerosion of the wrist and hand on plain radiographs. MATERIAL AND METHODS The study was conducted with 28 cadaver wrists. During a single imaging session three techniques-plain radiography, tomosynthesis, and computed tomography-were used to visualize the wrist and hand specimens. For each technique, 20 radio-ulno-carpo-metacarpal sites known to present bone erosions in rheumatoid arthritis were analyzed by two radiologists using a standard system to score the cortical bone: normal, pseudoerosion, true erosion, or other pathology. Cohen's concordance analysis was performed to determine inter-observer and intra-observer (for the senior radiologist) agreement by site and by technique. Serial sections of two cadaver specimens were examined to determine the anatomical correlation of the pseudoerosions. RESULTS On the plain radiographs, the radiologists scored many images as pseudoerosion (7.3%), particularly in the distal ulnar portion of the capitate, the distal radial portion of the hamate, the proximal ulnar portion of the base of the third metacarpal, the proximal radial portion of the base of the fourth metacarpal, the distal ulnar portion of the hamate, and the proximal portion of the base of the fifth metacarpal. The computed tomography scan revealed that none of these doubtful images corresponded to true erosions. The anatomical correlation study showed that these images could probably be attributed to ligament insertions, thinner lamina, and enhanced cortical bone transparency. CONCLUSION Knowledge of the anatomical carpal localizations where pseudoerosions commonly occur is a necessary prerequisite for analysis of plain radiographs performed to diagnose or monitor rheumatoid arthritis.
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Affiliation(s)
- Richard Wawer
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Service d'imagerie médicale, Hôpital St Vincent de Paul, Faculté Libre de Médecine, Université Catholique de Lille, boulevard de Belfort, 59000, Lille, France,
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Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EMA, Freeston JE, Emery P, Wakefield RJ. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 2014; 74:897-903. [PMID: 24445255 DOI: 10.1136/annrheumdis-2013-204864] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/27/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone erosion is one of the hallmarks of rheumatoid arthritis (RA), but also seen in other rheumatic diseases. The objective of this study was to determine the specificity of ultrasound (US)-detected bone erosions (including their size) in the classical 'target' joints for RA. METHODS Patients fulfilling the diagnostic criteria for RA, psoriatic arthritis, osteoarthritis or gout in addition to healthy volunteers were included. The following areas were examined by US: distal radius and ulna, 2nd, 3rd and 5th metacarpophalangeal (MCP), 2nd and 3rd proximal interphalangeal (PIP) and 1st and 5th metatarsophalangeal (MTP) joints. All joints were scanned in four quadrants using both semiquantitative (0-3) and quantitative (erosion diameter) scoring systems. RESULTS 310 subjects were recruited. The inter-reader and intrareader agreements were good to excellent. US-detected bone erosions were more frequent but not specific for RA (specificity 32.9% and sensitivity 91.4%). The presence of erosions with semiquantitative score ≥2 in four target joints (2nd, 5rd MCP, 5th MTP joints and distal ulna) was highly specific for RA (specificity 97.9% and sensitivity 41.4%). Size of erosion was found to be associated with RA. Erosions of any size in the 5th MTP joint were both specific and sensitive for RA (specificity 85.4% and sensitivity 68.6%). CONCLUSIONS The presence of US-detected erosions is not specific for RA. However, larger erosions in selected joints, especially 2nd and 5rd MCP, 5th MTP joints and distal ulna, were highly specific for and predictive of RA.
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Affiliation(s)
- Ahmed S Zayat
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Karen Ellegaard
- Department of Rheumatology, Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Jane E Freeston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Stramare R, Coran A, Faccinetto A, Costantini G, Bernardi L, Botsios C, Perissinotto E, Grisan E, Beltrame V, Raffeiner B. MR and CEUS monitoring of patients with severe rheumatoid arthritis treated with biological agents: a preliminary study. Radiol Med 2013; 119:422-31. [DOI: 10.1007/s11547-013-0369-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
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60
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Brown AK. How to interpret plain radiographs in clinical practice. Best Pract Res Clin Rheumatol 2013; 27:249-69. [DOI: 10.1016/j.berh.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ahmadzadeh A, Dehghan P, Rajaee A, Emam M, Enteshari K, Gachkar L. Assessing rheumatologists and radiologists agreement rate regarding the diagnosis of focal bone erosions and osteopenic changes using hand X-rays radiography in patients with rheumatoid arthritis. Rheumatol Int 2013; 33:2019-23. [DOI: 10.1007/s00296-012-2645-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 12/15/2012] [Indexed: 11/25/2022]
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Narváez J, Narváez JA, de Albert M, Gómez-Vaquero C, Nolla JM. Can Magnetic Resonance Imaging of the Hand and Wrist Differentiate Between Rheumatoid Arthritis and Psoriatic Arthritis in the Early Stages of the Disease? Semin Arthritis Rheum 2012; 42:234-45. [DOI: 10.1016/j.semarthrit.2012.03.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/23/2012] [Accepted: 03/29/2012] [Indexed: 01/25/2023]
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Orlandi D, Fabbro E, Ferrero G, Martini C, Lacelli F, Serafini G, Silvestri E, Sconfienza LM. High-resolution ultrasound of the extrinsic carpal ligaments. J Ultrasound 2012; 15:267-72. [PMID: 23730393 DOI: 10.1016/j.jus.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.
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Affiliation(s)
- D Orlandi
- Scuola di Specializzazione in Radiodiagnostica, Dipartimento di Medicina Interna, Università degli Studi di Genova, Italy
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64
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Molecular characterization of rheumatoid arthritis with magnetic resonance imaging. Top Magn Reson Imaging 2012; 22:61-9. [PMID: 22648081 DOI: 10.1097/rmr.0b013e31825c062c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Several recent advances in the field of magnetic resonance imaging (MRI) may transform the detection and monitoring of rheumatoid arthritis (RA). These advances depict both anatomic and molecular alterations from RA. Previous techniques could detect specific end products of metabolism in vitro or were limited to providing anatomic information. This review focuses on the novel molecular imaging techniques of hyperpolarized carbon-13 MRI, MRI with iron-labeled probes, and fusion of MRI with positron emission tomography. These new imaging approaches go beyond the anatomic description of RA and lend new information into the status of this disease by giving molecular information.
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65
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Cha JH, Lee SH, Lee SW, Park K, Moon DH, Kim K, Biswal S. Assessment of collagen-induced arthritis using cyanine 5.5 conjugated with hydrophobically modified glycol chitosan nanoparticles: correlation with 18F-fluorodeoxyglucose positron emission tomography data. Korean J Radiol 2012; 13:450-7. [PMID: 22778567 PMCID: PMC3384827 DOI: 10.3348/kjr.2012.13.4.450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 01/06/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the potential and correlation between near-infrared fluorescence (NIRF) imaging using cyanine 5.5 conjugated with hydrophobically modified glycol chitosan nanoparticles (HGC-Cy5.5) and (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) imaging of collagen-induced arthritis (CIA). MATERIALS AND METHODS We used 10 CIA and 3 normal mice. Nine days after the injecting collagen twice, microPET imaging was performed 40 minutes after the intravenous injection of 9.3 MBq (18)F-FDG in 200 µL PBS. One day later, NIRF imaging was performed two hours after the intravenous injection of HGC-cy5.5 (5 mg/kg). We assessed the correlation between these two modalities in the knees and ankles of CIA mice. RESULTS The mean standardized uptake values of (18)F-FDG for knees and ankles were 1.68 ± 0.76 and 0.79 ± 0.71, respectively, for CIA mice; and 0.57 ± 0.17 and 0.54 ± 0.20 respectively for control mice. From the NIRF images, the total photon counts per 30 mm(2) for knees and ankles were 2.32 ± 1.54 × 10(5) and 2.75 ± 1.51 × 10(5), respectively, for CIA mice, and 1.22 ± 0.27 × 10(5) and 0.88 ± 0.24 × 10(5), respectively, for control mice. These two modalities showed a moderate correlation for knees (r = 0.604, p = 0.005) and ankles (r = 0.464, p = 0.039). Moreover, both HGC-Cy5.5 (p = 0.002) and (18)F-FDG-PET (p = 0.005) imaging also showed statistically significant differences between CIA and normal mice. CONCLUSION NIRF imaging using HGC-Cy5.5 was moderately correlated with (18)F-FDG-PET imaging in the CIA model. As such, HGC-Cy5.5 imaging can be used for the early detection of rheumatoid arthritis.
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Affiliation(s)
- Ji Hyeon Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Bortolotto C, Gregoli B, Coscia DR, Draghi F. Septic complications involving hand and wrist in patients with pre-existing rheumatoid arthritis: The role of magnetic resonance imaging and sonography. J Ultrasound 2012; 15:115-20. [PMID: 23396420 DOI: 10.1016/j.jus.2012.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Septic arthritis (SA), frequently involving hand and wrist, is common in rheumatoid arthritis (RA) patients due to immunomediated etiology of RA and immunosuppressive drug use. Clinical and laboratory features might not be useful to differentiate between RA relapse and superimposed SA. The role of magnetic resonance imaging (MRI) has been described in several studies. Our aim is to evaluate the role of ultrasonography (US). MATERIAL AND METHODS In the last 4 years 31 MRI of hand and wrist has been performed in the suspect of SA complicating RA. A 1.5 T unit (Siemens Symphony, Erlangen, Germany) with standardized protocol, involving the administration of contrast medium, was used. Also US with power Doppler evaluation was performed. A Philips IU22 US scanner was used. RESULTS Eleven points (according to Graif's study) were analyzed for every MRI and US. At MRI joint effusion (37.5% of RA relapse vs 100% superimposed SA) and soft tissue edema (25% vs 100%) were indicative of SA. At US joint effusion (31.3% of RA relapse vs 73.3% superimposed SA) and soft tissue edema (12.5% vs 60%) were indicative of SA. CONCLUSION Our results suggest that joint effusion and soft tissue edema are markers suggestive for superimposed SA and that MRI is more sensitive in their evaluation. Although US is less sensitive than MRI, the former is important in guiding invasive procedure and evaluating patients that cannot undergo MRI.
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Affiliation(s)
- C Bortolotto
- Foundation IRCCS, Policlinico San Matteo, Institute of Radiology, University of Pavia, Italy
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67
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Tan YK, Conaghan PG. Imaging in rheumatoid arthritis. Best Pract Res Clin Rheumatol 2012; 25:569-84. [PMID: 22137925 DOI: 10.1016/j.berh.2011.10.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 09/10/2011] [Indexed: 01/29/2023]
Abstract
The optimal management of rheumatoid arthritis (RA) requires tools that allow early and accurate disease diagnosis, prediction of poor prognosis and responsive monitoring of therapeutic outcomes. Conventional radiography has been widely used in both clinical and research settings to assess RA joint damage due to its feasibility, but it has limitations in early disease detection and difficulty distinguishing between active treatments in modern trials. Imaging modalities such as magnetic resonance imaging (MRI) and ultrasound (US) have the advantage of detecting both joint inflammation and damage and hence they can provide additional and unique information. This can be especially useful in the context of early and/or undifferentiated joint disease when detection of soft tissue and bone marrow abnormalities is desirable. This review focusses on the recent literature concerning modern imaging, and provides clinicians with an insight into the role of imaging in modern RA diagnosis, prognosis and monitoring.
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Affiliation(s)
- York Kiat Tan
- Division of Musculoskeletal Disease, University of Leeds, UK
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68
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High-resolution ultrasound evaluation of extrinsic wrist ligaments in patients affected by rheumatoid arthritis. Eur Radiol 2012; 22:1586-91. [PMID: 22367473 DOI: 10.1007/s00330-012-2402-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/17/2011] [Accepted: 12/24/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the ultrasound features of the extrinsic wrist ligaments in rheumatoid arthritis (RA) patients in comparison with healthy volunteers. METHODS Twenty-one consecutive patients affected by RA (12 men, 9 women; mean age 57 ± 14.6 years) were compared with 21 controls (12, 9; 54 ± 12.1, respectively). Wrists were evaluated using ultrasound on both palmar and dorsal sides along each ligament, using carpal bones as references. The following ligaments were studied: radioscaphocapitate, radiolunotriquetral, palmar ulnolunate, palmar ulnotriquetral, dorsal radiotriquetral, dorsal ulnotriquetral, and radial collateral ligament. Ligament number and thickness were noted. Echotexture was rated as fibrillar, fragmented, or heterogeneous; the surface was rated as smooth or blurred. RESULTS The number of palmar ulnolunate and palmar ulnotriquetral ligaments detected by ultrasound in patients was significantly lower than in controls (P = 0.031 and P = 0.037, respectively). All ligaments had significantly more fragmented or heterogeneous echotexture and blurred surface and were significantly thinner in patients than in controls (P < 0.001). No correlation was found between ligament thickness and RA duration or clinical parameters. CONCLUSIONS Extrinsic wrist ligaments were less detectable and thinner in patients affected by RA compared with healthy volunteers matched for age and sex. Ligament thinning did not directly correlate with RA duration and clinical parameters. KEY POINTS • Ultrasound is increasingly used to evaluate normal anatomy of extrinsic wrist ligaments. • Extrinsic wrist ligaments are thinner in rheumatoid arthritis patients than in controls. • Extrinsic wrist ligaments are less easy to detect in rheumatoid arthritis patients. • Ligament thinning and detectability are not related to clinical parameters.
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69
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Demertzis JL, Rubin DA. MR imaging assessment of inflammatory, crystalline-induced, and infectious arthritides. Magn Reson Imaging Clin N Am 2011; 19:339-63. [PMID: 21665094 DOI: 10.1016/j.mric.2011.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of magnetic resonance imaging in evaluating patients with inflammatory arthritides has evolved with the recent introduction of drugs capable of modifying disease activity and natural history. In conditions like rheumatoid arthritis, active synovitis and bone marrow inflammation precede and predict bone and cartilage erosion. These imaging findings identify patients who can be treated early and aggressively to prevent future morbidity. Similarly, in gout and other crystalline disorders, specific diagnosis aided by imaging may lead to earlier medical and surgical management. Infected joints need the most rapid identification to institute immediate therapy and prevent irreversible cartilage destruction.
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Affiliation(s)
- Jennifer L Demertzis
- Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110, USA.
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Abstract
The concept of osteoimmunology is based on growing insight into the links between the immune system and bone at the anatomical, vascular, cellular, and molecular levels. In both rheumatoid arthritis (RA) and ankylosing spondylitis (AS), bone is a target of inflammation. Activated immune cells at sites of inflammation produce a wide spectrum of cytokines in favor of increased bone resorption in RA and AS, resulting in bone erosions, osteitis, and peri-inflammatory and systemic bone loss. Peri-inflammatory bone formation is impaired in RA, resulting in non-healing of erosions, and this allows a local vicious circle of inflammation between synovitis, osteitis, and local bone loss. In contrast, peri-inflammatory bone formation is increased in AS, resulting in healing of erosions, ossifying enthesitis, and potential ankylosis of sacroiliac joints and intervertebral connections, and this changes the biomechanical competence of the spine. These changes in bone remodeling and structure contribute to the increased risk of vertebral fractures (in RA and AS) and non-vertebral fractures (in RA), and this risk is related to severity of disease and is independent of and superimposed on background fracture risk. Identifying patients who have RA and AS and are at high fracture risk and considering fracture prevention are, therefore, advocated in guidelines. Local peri-inflammatory bone loss and osteitis occur early and precede and predict erosive bone destruction in RA and AS and syndesmophytes in AS, which can occur despite clinically detectable inflammation (the so-called 'disconnection'). With the availability of new techniques to evaluate peri-inflammatory bone loss, osteitis, and erosions, peri-inflammatory bone changes are an exciting field for further research in the context of osteoimmunology.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P, Debyelaan 25 Postbus 5800, 6202 AZ Maastricht, The Netherlands.
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71
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Wells AF, Haddad RH. Emerging role of ultrasonography in rheumatoid arthritis: optimizing diagnosis, measuring disease activity and identifying prognostic factors. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1173-1184. [PMID: 21645962 DOI: 10.1016/j.ultrasmedbio.2011.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/06/2011] [Accepted: 04/17/2011] [Indexed: 05/30/2023]
Abstract
Ultrasonography is a sensitive imaging modality that provides valuable information regarding early inflammatory changes that are not detected by clinical examination or X-rays, such as subclinical synovitis and erosions. This information may improve the management of rheumatoid arthritis by providing a more timely and accurate diagnosis, identifying poor prognostic factors, more accurately monitoring response to therapeutic intervention, improving treatment decisions and more accurately assessing remission. Ultrasonography could play a critical role in minimizing disease activity through strict monitoring and aggressive therapeutic adjustment, which has emerged as an approach to improve long-term outcomes for patients with rheumatoid arthritis.
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Affiliation(s)
- Alvin F Wells
- Rheumatology and Immunotherapy Center, Oak Creek, WI 53154, USA.
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72
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Emond PD, Inglis D, Choi A, Tricta J, Adachi JD, Gordon CL. Volume measurement of bone erosions in magnetic resonance images of patients with rheumatoid arthritis. Magn Reson Med 2011; 67:814-23. [DOI: 10.1002/mrm.23037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 05/03/2011] [Accepted: 05/14/2011] [Indexed: 11/09/2022]
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73
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Snekhalatha U, Anburajan M. Evaluation of functional ability of rheumatoid arthritis based on HAQ score and BMD among South Indian patients. Rheumatol Int 2011; 32:1997-2004. [DOI: 10.1007/s00296-011-1906-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
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74
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Klauser AS, Franz M, Arora R, Feuchtner GM, Gruber J, Schirmer M, Jaschke WR, Gabl MF. Detection of vascularity in wrist tenosynovitis: power doppler ultrasound compared with contrast-enhanced grey-scale ultrasound. Arthritis Res Ther 2010; 12:R209. [PMID: 21062450 PMCID: PMC3046516 DOI: 10.1186/ar3185] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 09/08/2010] [Accepted: 11/09/2010] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION We sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS). METHODS Twenty-six tendons of 24 patients (nine men, 15 women; mean age ± SD, 54.4 ± 11.8 years) with a clinical diagnosis of tenosynovitis were examined with B-mode ultrasonography, PDUS, and CEUS by using a second-generation contrast agent, SonoVue (Bracco Diagnostics, Milan, Italy) and a low-mechanical-index ultrasound technique. Thickness of synovitis, extent of vascularized pannus, intensity of peritendinous vascularisation, and detection of intratendinous vessels was incorporated in a 3-score grading system (grade 0 to 2). Interobserver variability was calculated. RESULTS With CEUS, a significantly greater extent of vascularity could be detected than by using PDUS (P < 0.001). In terms of peri- and intratendinous vessels, CEUS was significantly more sensitive in the detection of vascularization compared with PDUS (P < 0.001). No significant correlation between synovial thickening and extent of vascularity could be found (P = 0.089 to 0.097). Interobserver reliability was calculated to be excellent when evaluating the grading score (κ = 0.811 to 1.00). CONCLUSIONS CEUS is a promising tool to detect tendon vascularity with higher sensitivity than PDUS by improved detection of intra- and peritendinous vascularity.
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Affiliation(s)
- Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Anichstr, 35, Innsbruck, 6020, Austria.
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75
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Abstract
New MRI techniques have been developed to assess not only the static anatomy of synovial hyperplasia, bone changes and cartilage degradation in patients with rheumatoid arthritis (RA), but also the activity of the physiological events that cause these changes. This enables an estimation of the rate of change in the synovium, bone and cartilage as a result of disease activity or in response to therapy. Typical MRI signs of RA in the pre-erosive phase include synovitis, bone marrow edema and subchondral cyst formation. Synovitis can be assessed by T2-weighted imaging, dynamic contrast-enhanced MRI or diffusion tensor imaging. Bone marrow edema can be detected on fluid-sensitive sequences such as short-tau inversion recovery or T2-weighted fast-spin echo sequences. Detection of small bone erosions in the early erosive phase using T1-weighted MRI has sensitivity comparable to CT. Numerous MRI techniques have been developed for quantitative assessment of potentially pathologic changes in cartilage composition that occur before frank morphologic changes. In this Review, we summarize the advances and new directions in the field of MRI, with an emphasis on their current state of development and application in RA.
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Affiliation(s)
- Camilo G Borrero
- Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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76
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Canella C, Philippe P, Pansini V, Salleron J, Flipo RM, Cotten A. Use of tomosynthesis for erosion evaluation in rheumatoid arthritic hands and wrists. Radiology 2010; 258:199-205. [PMID: 21045184 DOI: 10.1148/radiol.10100791] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare tomosynthesis with radiography for the detection of hand and wrist bone erosions in patients with rheumatoid arthritis (RA), using multidetector computed tomography (CT) as the reference method. MATERIALS AND METHODS The study was approved by the local ethics committee, and written consent was obtained from all patients. From December 2008 to April 2009, 30 consecutive patients with RA were included in this prospective study. They underwent radiography, tomosynthesis, and CT of the most symptomatic hand and wrist on the same day. Two radiologists and one rheumatologist independently read images from the three imaging modalities. RESULTS A total of 232 erosions were detected with CT, while 199 and 140 erosions, respectively, were detected with tomosynthesis and radiography. More erosions were revealed with CT than with tomosynthesis and radiography (P < .0001); significantly more erosions were shown with tomosynthesis than with radiography (P < .0001). With CT as the reference method for bone erosions, the overall sensitivity, specificity, and accuracy of tomosynthesis were, respectively, 77.6%, 89.9%, and 83.1%. The corresponding values for radiography were 53.9%, 92%, and 70.9%. The sensitivity of each reader increased by roughly 20% with use of tomosynthesis. CONCLUSION The depiction of bone erosions of the hands and wrists is significantly greater with tomosynthesis than with radiography.
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Affiliation(s)
- Clarissa Canella
- Department of Musculoskeletal Radiology, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Centre Hospitalier Régional Universitaire de Lille, Rue du Professeur Emilie Laine, Lille 59000, France.
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77
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Magarelli N, Simone F, Amelia R, Leone A, Bosello S, D’Antona G, Zoli A, Ferraccioli G, Bonomo L. MR imaging of atlantoaxial joint in early rheumatoid arthritis. Radiol Med 2010; 115:1111-20. [DOI: 10.1007/s11547-010-0574-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
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Narváez JA, Narváez J, De Lama E, De Albert M. MR imaging of early rheumatoid arthritis. Radiographics 2010; 30:143-63; discussion 163-5. [PMID: 20083591 DOI: 10.1148/rg.301095089] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Early diagnosis and treatment have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. However, diagnosis is somewhat difficult in the early stages of the disease because the diagnostic criteria were developed from data obtained in patients with established rheumatoid arthritis and therefore are not readily applicable. Magnetic resonance (MR) imaging is increasingly being used in the assessment of rheumatoid arthritis due to its capacity to help identify the key pathologic features of this disease entity at presentation. MR imaging has demonstrated greater sensitivity for the detection of synovitis and erosions than either clinical examination or conventional radiography and can help establish an early diagnosis of rheumatoid arthritis. It also allows the detection of bone marrow edema, which is thought to be a precursor for the development of erosions in early rheumatoid arthritis as well as a marker of active inflammation. In addition, MR imaging can help differentiate rheumatoid arthritis from some clinical subsets of peripheral spondyloarthropathies by allowing identification of inflammation at the insertions of ligaments and tendons (enthesitis).
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Affiliation(s)
- José A Narváez
- Departments of Radiology and Rheumatology, Hospital Universitario de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Spain.
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80
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McGonagle D, Tan AL, Møller Døhn U, ØStergaard M, Benjamin M. Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis. ACTA ACUST UNITED AC 2009; 60:1042-51. [DOI: 10.1002/art.24417] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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81
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Abstract
Whether magnetic resonance imaging (MRI) or ultrasound (US) are chosen for the purposes of musculoskeletal interrogation depends upon a variety of factors ranging from the anatomy targeted to cost considerations and the time of acquisition. Newer technologies such as higher-strength MRI or 3D-US promise to help overcome some of the disadvantages of each option. Improving technical proficiency is the thrust of efforts to support more widespread application of sonographic assessment in various clinical arenas. Finally, these technologies offer the opportunity to diagnose inflammatory conditions at early stages of their disease progression.
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Affiliation(s)
- James D Katz
- Departments of Medicine and Radiology, The George Washington University, Washington, DC, USA
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83
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Kubassova O, Boesen M, Peloschek P, Langs G, Cimmino MA, Bliddal H, Torp-Pedersen S. Quantifying Disease Activity and Damage by Imaging in Rheumatoid Arthritis and Osteoarthritis. Ann N Y Acad Sci 2009; 1154:207-38. [DOI: 10.1111/j.1749-6632.2009.04392.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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84
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Boss A, Martirosian P, Fritz J, Kötter I, Henes JC, Claussen CD, Schick F, Horger M. Magnetic resonance spin-labeling perfusion imaging of synovitis in inflammatory arthritis at 3.0 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2009; 22:175-80. [PMID: 19172323 DOI: 10.1007/s10334-008-0162-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/18/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to test the feasibility of arterial spin labeling (ASL) perfusion imaging of synovitis in inflammatory joint diseases on a clinical 3.0 T whole-body scanner. MATERIALS AND METHODS Fifteen patients (geometric mean 47 years, range 8-69 years) with different types of inflammatory arthritis of the finger or wrist joints participated in the study. In addition to conventional spin-echo and dynamic contrast-enhanced FLASH3D sequences, a novel spin-labeling technique (FAIR-TrueFISP) for quantitative assessment of tissue perfusion was applied. Perfusion maps were calculated pixel-wise by means of the extended Bloch equations. RESULTS Perfusion maps showed good image quality with clear visualization of hyperaemia in synovitis. The computed perfusion maps corresponded best to subtraction images of the dynamic series from 30 to 60 s after contrast-medium injection. The quantitative perfusion values of synovitis showed a good correlation with the disease activity. Perfusion values for inflamed synovium in phase of high activity were up to 230 ml/100 g tissue/min. CONCLUSION The proposed modality allows for the assessment of disease activity in arthritis without the application of contrast-medium offering a new tool for therapy monitoring. As the technique provides quantitative information on hyperaemia, it potentially offers new insights in the pathophysiology of arthritic diseases.
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Affiliation(s)
- Andreas Boss
- Section of Experimental Radiology, Department of Diagnostic and Interventional Radiology, Eberhard-Karls University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, Germany.
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Langs G, Peloschek P, Bischof H, Kainberger F. Automatic quantification of joint space narrowing and erosions in rheumatoid arthritis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:151-164. [PMID: 19116197 DOI: 10.1109/tmi.2008.2004401] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic disease that affects and potentially destroys the joints of the appendicular skeleton. The precise and reproducible quantification of the progression of joint space narrowing and the erosive bone destructions caused by RA is crucial during treatment and in imaging biomarkers in clinical trials. Current manual scoring methods exhibit high interreader variability, even after intensive training, and thus, impede the efficient monitoring of the disease. We propose a fully automatic quantitative assessment of the radiographic changes that result from RA, to increase the accuracy, reproducibility, and speed of image interpretation. Initial joint location estimates are obtained by local linear mappings based on texture features. Bone contours are delineated by active shape models comprised of statistical models of bone shape and local texture. These models are refined by snakes which increase the accuracy and allow for a fitting of pathological deviations from the training population. The method then measures joint space widths and detects erosions on the bone contour. Joint space widths are measured with a coefficient of variation of 2%-7% for repeated measurements and erosion detection exhibits an area under the receiver operating characteristic (ROC) curve of 0.89. Model landmarks serve as a reference system along the contour. These landmarks enable the definition of joint regions and more specific follow-up monitoring. The automatic quantification allows for a remote analysis, relevant for multicenter clinical trials, and reduces the workload of clinical experts since parts of the process can be managed by nonexpert personnel.
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Affiliation(s)
- Georg Langs
- Applied Mathematics and Systems Laboratory (MAS), Ecole Centrale de Paris, Grande Voie des Vignes, 92 295 Chatenay-Malabry, France.
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86
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MR Imaging and Ultrasound of Metatarsalgia—The Lesser Metatarsals. Radiol Clin North Am 2008; 46:1061-78, vi-vii. [DOI: 10.1016/j.rcl.2008.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sanders CJ, Schucany WG. Tuberculous Tenosynovitis. Proc (Bayl Univ Med Cent) 2008; 21:71-2. [DOI: 10.1080/08998280.2008.11928362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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De Zordo T, Mlekusch SP, Feuchtner GM, Mur E, Schirmer M, Klauser AS. Value of contrast-enhanced ultrasound in rheumatoid arthritis. Eur J Radiol 2007; 64:222-30. [PMID: 17768022 DOI: 10.1016/j.ejrad.2007.07.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 07/24/2007] [Indexed: 11/20/2022]
Abstract
The purpose of this review is to describe the spectrum of sonographic findings in rheumatic diseases with respect to the diagnostic potential using US contrast media which prove activity or inactivity in synovial tissue where new treatment regimes target. Synovial activity can be found in non-erosive and erosive forms of primary and secondary osteoarthritis, and in inflammatory forms of joint diseases like rheumatoid arthritis and peripheral manifestations of spondyloarthritis including, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis and enteropathic arthritis. It can also be present in metabolic and endocrine forms of arthritis, in connective tissue arthropathies like systemic lupus erythematosus or scleroderma and in infectious arthritis. Ultrasound should be used as first-line imaging modality in suspected early cases of RA and other forms of arthritis, whereas contrast-enhanced ultrasound (CEUS) can further enable for sensitive assessment of vascularity which correlates with disease activity.
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Affiliation(s)
- Tobias De Zordo
- Department of Radiology II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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89
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Alturfan AA, Uslu E, Alturfan EE, Hatemi G, Fresko I, Kokoglu E. Increased Serum Sialic Acid Levels in Primary Osteoarthritis and Inactive Rheumatoid Arthritis. TOHOKU J EXP MED 2007; 213:241-8. [PMID: 17984621 DOI: 10.1620/tjem.213.241] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A. Ata Alturfan
- Vocational School Health Services, Cerrahpasa Medical Faculty, Istanbul University
| | - Ezel Uslu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University
| | | | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University
| | - Izzet Fresko
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University
| | - Emine Kokoglu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University
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Guimarães MC, Yamaguchi CK, Aihara AY, Hartmann LG, Pröglhöf J, Fernandes ADRC. Metatarsalgias: diagnóstico diferencial por meio da ressonância magnética. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Várias lesões podem causar metatarsalgia, cujas manifestações clínicas podem ser inespecíficas. As imagens de ressonância magnética, associadas a outros métodos de imagem e dados clínicos, freqüentemente podem contribuir na detecção dessas lesões e possibilitar que um diagnóstico relativamente preciso seja considerado. Nosso objetivo é descrever e ilustrar, por meio de imagens de ressonância magnética, as principais doenças que causam metatarsalgia.
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Sommer OJ, Sekyra K. [Arthroplasty of the rheumatoid hand. Pre- and postoperative imaging with special consideration of biomechanical and pathobiomechanical aspects and its radiological evaluation]. Radiologe 2006; 46:760-7. [PMID: 16612603 DOI: 10.1007/s00117-006-1362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Radiology plays a key role when the indications for arthroplasties of the hand and finger joints are determined and for the postoperative follow-up. On the one hand, the degree of inflammatory changes in all affected compartments is to be evaluated and graded; on the other hand, conventional radiograms allow for a first assessment of possible joint instability and impaired biomechanics. Both aspects influence the choice of the proper surgical therapeutic strategy. Osteolysis, deformity, fracture, prosthesis loosening or failure, heterotopic ossification, and foreign body-associated formation of granulation tissue are complications which can be detected on follow-up radiographs early on.
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Affiliation(s)
- O J Sommer
- Zentralröntgeninstitut mit Schnittbildzentrum, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, 1130 Wien.
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