Early-stage rheumatoid arthritis: diagnostic accuracy of MR imaging.

Sugimoto, Hideharu; Takeda, Atsushi; Masuyama, Jun-Ichi; Furuse, Makoto

doi:10.1148/radiology.198.1.8539375

Cited by 145 publications

(75 citation statements)

References 20 publications

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“…This can prolong imaging and hereby increase the risk of motion artifacts; however, this was not the case in the present study. Furthermore, low-field MRI cannot perform fat-suppressed techniques, which provide higher post-Gd contrast between synovium and surrounding tissue [22,35]. On the other hand, 3D gradient-echo sequences allow very thin slices, which is useful in arthritic disease [36].…”

Section: Discussionmentioning

confidence: 99%

MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)

et al. 2001

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The aim of this study was to compare the diagnostic capabilities of extremity MRI (E-MRI) with high-field MRI in arthritic small joints, and to evaluate the patients' acceptance and perceptions of the two MR systems. One hundred three patients (group 1 = 28 patients with RA < 3 years, group 2 = 25 patients with reactive and psoriatic arthritis and mixed connective tissue disease, group 3 = 25 patients with rheumatoid arthritis (RA) more than 3 years and group 4 = 25 patients with arthralgia) underwent dedicated E-MRI and high-field MRI of the wrist and finger joints. Coronal short tau inversion recovery and transversal 3D T1-weighted images before and after gadodiamide (Gd) were performed in both cases to outline the volume of the synovial membrane (Vsm) and to evaluate joints with enhancement, effusion, bone edema, and erosions. Investigators blinded to the clinical findings evaluated the images. Patients' compliance and acceptance of E-MRI and high-field MRI were evaluated. The median Vsm obtained on E-MRI did not differ significantly from that obtained on high-field MRI. Vsm = 1 ml (E-MRI) and 1.1 ml (high-field MRI) before Gd and Vsm = 0.1 ml (E-MRI) and 0 ml (high-field MRI) after Gd (Wilcoxon test, p > 0.05). The difference in agreement was 8% for joint enhancement, 2% for joint effusion, 3% for bone edema, and 4% for bone erosions. Of the patients, 64% preferred E-MRI due to more comfortable positioning and less claustrophobia and noise. Extremity MRI of the small arthritic joints is comparable to high-field MRI and more readily accepted than high-field MRI by this patient group.

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Section: Discussionmentioning

confidence: 99%

MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T)

et al. 2001

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“…REACH was used as a background cohort in which the new diagnostic tests were simulated. (17)(18)(19)(20). MRI also adds information on bone marrow edema (21) and tenosynovitis (21)(22)(23).…”

Section: Methodsmentioning

confidence: 99%

Cost‐Effectiveness Model for Evaluating New Diagnostic Tests in the Evaluation of Patients With Inflammatory Arthritis at Risk of Having Rheumatoid Arthritis

Luime

Buisman

Oppe

et al. 2016

Arthritis Care & Research

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Objective. New opportunities have emerged for early diagnosis with the arrival of new technologies that assess the impact of genomics, proteomics, metabolomics, and cytomics on rheumatoid arthritis (RA) risk. This early health technology assessment study assesses the short-term cost effectiveness of 4 add-on diagnostic tests in early inflammatory arthritis patients at risk of RA. Methods. We modeled 4 diagnostic add-on tests to the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, covering the first year after diagnosis, using Rotterdam Early Arthritis Cohort data. Sensitivity, specificity, and costs were assigned to the magnetic resonance imaging of hands and feet (sensitivity 0.90, specificity 0.60, cost e756), interleukin-6 (IL-6) serum level test (sensitivity 0.70, specificity 0.53, cost e50), B cell-related gene expression (sensitivity 0.60, specificity 0.90, cost e150), and gene assay for RA (sensitivity 0.40, specificity 0.85, cost e750), based on literature and expert opinion. Outcomes were evaluated using the unweighted diagnostic net benefit (UDNB) and the incremental costeffectiveness ratio (ICER) in all patients (n 5 552), intermediate-risk patients (n 5 263), and seronegative patients (n 5 329). Results. The highest UDNB was found when using the B cell assay in intermediate-risk patients (43%, ICER e5,314), while the IL-6 test in seronegative patients resulted in the lowest UDNB (211.4%, ICER e7,650). If a threshold of e20,000 is applied, the B cell assay would be preferred over the other alternatives, with a 78% probability of being cost effective for intermediate-risk patients, 57% for all patients, and 73% for seronegative patients. Conclusion. Diagnostic add-on tests favoring specificity over sensitivity with a headroom less than e370 per test are cost effective, with the largest diagnostic benefit occurring in intermediate-risk patients.

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“…In addition, satisfactory results have been reported on the sensitivity and specificity of ultrasonography, especially for contrastenhanced ultrasonography for assessments of joint vascularity, a parameter of disease activity. [19][20][21][22][23][24][25][26] …”

Section: Anatomy and Pathomechanismmentioning

confidence: 99%