Detection of bone erosion in early rheumatoid arthritis: ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging

Abstract

Nowadays, there is a trend toward early diagnosis and treatment of rheumatoid arthritis (RA) especially in patients with early signs of bone erosion which can be detected by magnetic resonance imaging (MRI). The aim of following study is to compare the sensitivity and specificity of ultrasonography (US) and conventional radiography (CR) compared to MRI for early detection of bone erosion in RA patients. In 12 patients with RA diagnosis, 120 first to fifth metacarpophalangeal joints and 96 second to fifth proximal interphalangeal joints were examined. Non-contrast MRI, US and CR were performed for bone erosion evaluation. For further analysis, the patients were divided in two equal groups according to disease activity score (DAS28). The overall sensitivity and specificity of US compared to MRI in detecting bone erosion were 0.63 and 0.98, respectively with a considerable agreement (kappa = 0.68, p < 0.001). Sensitivity and specificity of CR compared to MRI in detecting bone erosion were 0.13 and 1.00, respectively (kappa = 0.20, p < 0.001). In patients with more active disease, the sensitivity and specificity were 0.67 and 0.99 (kappa = 0.74, p < 0.001) compared to 0.59 and 0.97 (kappa = 0.61, p < 0.001) for the rest of patients according to DAS28. Conclusively, these findings reveal an acceptable agreement between US and MRI for detection of bone erosion in patients with early RA but not CR. US might be considered as a valuable tool for early detection of bone erosion especially when MRI is not available or affordable. Besides, it seems the US could be more reliable when the disease is more active.

Consenso da Sociedade Brasileira de Reumatologia 2011 para o diagnóstico e avaliação inicial da artrite reumatoide

“…64 Ultrasonography, when performed by an expert in musculoskeletal diseases, is useful for the early detection and monitoring of infl ammatory activity and signs of joint destruction. 65 When compared to magnetic resonance, it is a less expensive exam, and not contraindicated for patients with metallic implants or claustrophobia. Moreover, it allows a dynamic joint examination, a comparative contralateral assessment, as well as the assessment of other anatomic structures.…”

“…Moreover, it allows a dynamic joint examination, a comparative contralateral assessment, as well as the assessment of other anatomic structures. [64][65][66][67] The use of power Doppler and color Doppler can complement the exam and aid in characterizing infl ammatory activity. 68 …”

“…69 In addition to RA conventional radiographic fi ndings, magnetic resonance can detect bone edema, which proved to be a predictor of bone erosion. 65 In Brazil, factors such as its high cost and method standardization have limited its use in clinical practice. Table 2 shows the advantages and disadvantages of the imaging techniques used to assess patients with RA.…”

Dichotomous versus semi-quantitative scoring of ultrasound joint inflammation in rheumatoid arthritis using novel individualized joint selection methods

“…DS of ultrasound joint inflammation was found to correlate well with MRI findings in two studies [11,12] demonstrating evidence of construct validity. In the first study involving 22 RA subjects, ultrasound joint inflammation scored dichotomously on the feet [11] had higher percentage exact agreement with MRI findings than clinical examination (63.6-77.3% versus 45.5-59.1%, respectively).…”

“…In the first study involving 22 RA subjects, ultrasound joint inflammation scored dichotomously on the feet [11] had higher percentage exact agreement with MRI findings than clinical examination (63.6-77.3% versus 45.5-59.1%, respectively). In the second study involving 12 RA subjects, ultrasound detected joint effusion and synovitis scored dichotomously at the finger joints had sensitivity and specificity of 0.83 and 0.94, respectively, when compared to MRI [12].…”