Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA)

Abstract

BackgroundAs an irreversible disease, a treatment delay can negatively affect treatment response in rheumatoid arthritis (RA). Ultrasound and MRI have played an important role in assessing disease progression and response to treatment in RA for many years. The present study was designed to compare the diagnostic efficacy of ultrasound grading and MRI in early RA.MethodsIn this retrospective study, 62 early RA patients within 12 months of symptom onset were included. DAS28, rheumatoid factor (RF), CRP, ESR, and anti-cyclic citrullinated peptide antibody (CCP) of the patients were measured. Bilateral hand joints and wrists were examined by ultrasonography (US) and MRI; diagnosis outcome was compared. Relationship between DAS28 scores, laboratory parameters, and ultrasound findings were analyzed.ResultsUltrasound and MRI had an equivalent diagnosis value in synovitis, joint effusion, and tenosynovitis. The detection rate of synovitis, arthroedema, and tenosynovitis on ultrasound and MRI was very close (P > 0.05). The detection rate of bone erosion was lower in ultrasonography than that in MRI (P < 0.05). There were significant differences between power Doppler ultrasonography (PDUS) and gray-scale ultrasonography (GSUS) in the diagnosis of synovitis (χ 2 = 3.92, P < 0.05); the sensitivity of GSUS was better than that of PDUS (P < 0.05). PDUS was positively correlated with DAS28, ESR, CRP, and CCP (P < 0.01), but not correlated with RF and disease duration (P > 0.05). GSUS was positively correlated with RF and CRP (P < 0.01), but not correlated with DAS28, CCP, ESR, and disease duration (P > 0.05). Bone erosion was positively correlated with disease duration, CCP, and RF (P < 0.01) and was not correlated with DAS28, ESR, and CRP (P > 0.05).ConclusionUltrasonography has a high reliability in the diagnosis of early RA in synovitis, joint effusion, tenosynovitis, and bone erosion. Ultrasonography and clinical and laboratory parameters had a great correlativity. Both ultrasound and MRI are effective techniques. In view of the advantages of low cost and convenience, ultrasound may be a better choice during early RA diagnosis.

Composite assessment of power Doppler ultrasonography and MRI in rheumatoid arthritis: a pilot study of predictive value in radiographic progression after one year

“…[6][7][8]13,14,17,[26][27][28][29] A recent study showed ultrasound and MRI have an equivalent diagnosis value in synovitis. 30 There seems to be significant association between PDUS and MRI in RA. 31 Moreover, Ogishima et al indicated the qualitative combination of PDUS and MRI was more useful than PDUS or MRI alone for subclinical synovitis and improved the predictive value for bone erosion on radiographs.…”

The changing role of ultrasonography examination in patients with rheumatoid arthritis in light of recent studies

“…In this respect, US is superior to MRI and one should bear in mind that it may become the examination of choice in the diagnostic algorithm that provides for imaging examinations [24]. It is also important to note that the advantages of US testing include the ability to evaluate more joints than MRI and evaluate structures in a dynamic study [25].…”

The Role of Magnetic Resonance Imaging in Diagnosis and Prognosis of Rheumatoid Arthritis

“…So, it is possible to suppress the inflammatory reaction if the disease is recognized early and aggressive treatment is introduced through the first 3 months, known as a therapeutic window. Otherwise, the disease could take on a more chronic, aggressive form, with joint destruction [5] . Over the last two decades, significant improvement has been achieved in its prognosis owing to new strategies for disease management, the emergence of new biologic therapies and better utilization of the conventional disease-modifying antirheumatic drugs.…”

“…Conventional radiography used as a standard tool for evaluation of RA patients in daily practice. However, the X-ray only shows late signs of disease activity when cartilage or bone is already destructed, while other medical imaging techniques such as ultrasonography (US) and Magnetic resonance imaging (MRI) have been used in RA in order to assess the earlier signs [5] . MRI is increasingly being used in the assessment of rheumatoid arthritis due to its ability to directly visualize the bone and soft tissues in three dimensions and has the potential to measure inflammatory activity and joint destruction.…”

“…MRI is increasingly being used in the assessment of rheumatoid arthritis due to its ability to directly visualize the bone and soft tissues in three dimensions and has the potential to measure inflammatory activity and joint destruction. It can detect synovitis, tenosynovitis, bone erosion, and joint effusion [5] . MRI also allows the detection of bone marrow oedema, which is thought to be a precursor for the development of erosions in early RA as well as a marker of active inflammation and can be seen neither on radiographs, ultrasound nor computed tomography (CT).…”