Comparison of the Heel Enthesitis MRI Scoring System (HEMRIS) with clinical enthesitis and local metabolic activity on PET-CT

Abstract

ObjectiveTo compare the Heel Enthesitis MRI Scoring model (HEMRIS) with clinical and PET/CT outcomes in patients with cutaneous psoriasis (Pso), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).MethodsThis prospective, observational study included 38 patients with Pso, PsA and AS. Patients were included regardless of presence or absence of clinical heel enthesitis. MRI-scans of both ankles and a whole-body 18F-FDG PET/CT were acquired. MRIs were assessed for enthesitis by two independent and blinded observers according to the HEMRIS. A physician, blinded for imaging results, performed clinical evaluations of enthesitis at the Achilles tendon and plantar fascia.ResultsIn total, 146 entheses were scored according to the HEMRIS and clinically assessed for enthesitis (6 entheses were clinically affected). In Achilles tendons with clinical enthesitis, the HEMRIS structural damage score was significantly higher, compared to Achilles tendons without clinical enthesitis (respective median scores 1.0 and 0.5; p=0.04). In clinically unaffected entheses, HEMRIS abnormalities occurred in 44/70 (63%) of Achilles tendons and in 23/70 (33%) of plantar fascia. At the Achilles tendon, local metabolic activity measured on PET/CT was weakly associated with the structural (rs=0.25, p=0.03) and total HEMRIS (rs=0.26, p=0.03).ConclusionThis study revealed a high prevalence of subclinical HEMRIS abnormalities and discrepancy between HEMRIS and clinical and PET/CT findings. This may suggest that the HEMRIS is a sensitive method for detection of inflammatory and structural disease of enthesitis at the Achilles tendon and plantar fascia, although the clinical significance of these MRI findings remains to be determined in longitudinal studies.

Observation of Clinical Efficacy of Anisodamine and Chlorpromazine in the Treatment of Intractable Hiccup after Stroke

“…The patients with intractable hiccups after stroke undergo a CT scan; then an unsupervised multilayer image threshold segmentation algorithm with the combined effect of two-dimensional (2D) K-L divergence and MPSO was proposed to perform the multiple segmentation of CT images. The clinical efficacy of anisodamine combined with chlorpromazine had been investigated by injecting it at bilateral Neiguan acupoint in patients [ 23 , 24 ]. The intelligent algorithm was introduced into CT imaging to enhance the clarity of images, which was conducive to the diagnosis of patients' diseases.…”

A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis

“…By using the heel as the prototype, the OMERACT MRI group put forward the Heel Enthesitis MRI Scoring System (HEMRIS), which categorized the pathologies of enthesitis on MRI into inflammatory lesions and structural lesions ( Table 6 ) ( 78 , 79 ). This scoring system has been validated in patients with enthesitis at the Achilles tendon and plantar fascia and proved to be reliable ( 80 ). The inflammatory parameters evaluated intra-tendon hypersignal on T2w/short-tau inversion recovery (STIR) sequences, peri-tendon hypersignal, bone marrow edema, and bursitis, whereas structural lesions were defined as enthesophyte, bone erosion, and tendon thickening.…”

“…It was hypothesized that, because the regional accumulation of 18F-FDG could reflect certain extent of tissue inflammation status, PET/CT could potentially be a promising tool in diagnosing enthesitis ( 80 ). However, studies showed that enthesitis as observed on MRI images was not correlated with the accumulation of 18F-FDG ( 80 ). Only the structural damage of the Achilles tendon was weakly correlated with the metabolic activity on PET/CT.…”

Update on Imaging of Inflammatory Arthritis and Related Disorders

“…72 Finally, a recent study confirmed the superiority of MRI, using the Heel Enthesitis MRI Scoring (HEMRIS) score, in detecting subclinical lesions is spondyloarthropathies (AS and PsA), at the level of Achilles tendon and plantar fascia: again FDG uptake was subtle or moderate. 73 Relatively little has been described in psoriatic arthritis, often in series combining other types of spondylarthritis. The important issue with this disorder is the peculiar distribution with asymmetric distribution and oligoarticular FDG uptake in hands and feet with row or ray distribution.…”