Imaging in rheumatology: reconciling radiology and rheumatology

Tins, Bernhard; Butler, Robin

doi:10.1007/s13244-013-0293-1

Cited by 28 publications

(12 citation statements)

References 70 publications

(88 reference statements)

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“…However, to our knowledge, there is no app currently available that transports 3D imaging of real patients in combination with actual patient data on a technological VR basis. Given the recognized importance of IA imaging for diagnosis, monitoring, and prognosis, such a VR app can be valuable in the future to reliably train key players of the health care system for clinical routine practice and training to improve the care of IA patients [14,26,27].…”

Section: Principal Findingsmentioning

confidence: 99%

A Virtual Reality–Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study

Klemm¹,

Kleyer²,

Tascilar³

et al. 2021

JMIR Serious Games

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Background Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography–generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the χ2 or Fisher test was used as appropriate. Two-sided P values ≤.05 were regarded as significant. Results A total of 125 individuals participated in this study. Among them, 56% of the participants identified as female, 43% identified as male, and 1% identified as nonbinary; 59% of the participants were 18-30 years of age, 18% were 31-40 years old, 10% were 41-50 years old, 8% were 51-60 years old, and 5% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions The data show that IA-targeting innovative teaching approaches based on VR technology are feasible.

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Section: Principal Findingsmentioning

confidence: 99%

A Virtual Reality–Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study

Klemm¹,

Kleyer²,

Tascilar³

et al. 2021

JMIR Serious Games

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“…Sacroiliitis should be suspected if there is a history of inflammatory back pain or demonstration of positive SI provocation tests [6]. MRI is considered the gold standard for imaging of SI joints with a high sensitivity and specificity compared to plain radiography and bone scanning respectively [7,8]. It demonstrates early features of inflammation and effusion, as well as chronic changes such as sclerosis, erosions, ankylosis and bone marrow changes.…”

Section: Introductionmentioning

confidence: 99%

“…It demonstrates early features of inflammation and effusion, as well as chronic changes such as sclerosis, erosions, ankylosis and bone marrow changes. Although plain radiography can still be accepted if patients fulfill the New York criteria for sacroiliitis [7,8], it can lead to a delay in diagnosis as x-rays are often normal at disease onset [9].…”

Section: Introductionmentioning

confidence: 99%

Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study

et al. 2020

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Background: Sacroiliitis is commonly seen in enthesitis-related arthritis (ERA), a subtype of juvenile idiopathic arthritis (JIA). Sacroiliitis is characterized by the inflammation of the sacroiliac (SI) joints (+/− adjacent tissues). The treatment options include systemic therapy with or without corticosteroid SI joint injections. Image guided SI joint injections are frequently requested in pediatric patients with sacroiliitis. The purpose of this study was to evaluate the feasibility and efficacy of SI joint injections in children with sacroiliitis. Methods: A retrospective study of patients referred to Interventional Radiology (IR) for SI joint corticosteroid injections (2000-2018). Clinical information was collected from Electronic Patient Charts and procedural details from PACS. Efficacy was determined clinically, by MRI, or both when available. Results: 50 patients (13.8 years; M:F = 35:15) underwent image-guided SI joint corticosteroid injections. Most common indications were JIA (84%) and inflammatory bowel disease (14%). 80% had bilateral injections. 80% were performed under general anesthesia and 20% under sedation. The corticosteroid of choice was triamcinolone hexacetonide in 98% of patients. Needle guidance and confirmation was performed using CT and fluoroscopy (54%), Cone Beam CT (CBCT, 46%), with initial ultrasound assistance in 34%. All procedures were technically successful without any complications. 32/50 patients had long-term follow-up (2 years); 21/32 (66%) had clinical improvement within 3-months. Of 15 patients who had both pre-and post-procedure MRIs, 93% showed shortterm improvement. At 2 years, 6% of patients were in remission, 44% continued the same treatment and 47% escalated treatment. Conclusion: Image-guided SI joint injections are safe and technically feasible in children. Imaging modalities for guidance have evolved, with CBCT being the current first choice. Most patients showed short-term clinical and imaging improvement, requiring long-term maintenance or escalation of medical treatment.

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“…Imaging modalities used in assessment of cervical spine arthritis include radiography, computer tomography and magnetic resonance imaging (MRI) [ 4 – 6 ]. Radiography has been most evaluated imaging modality for assessment of cervical spine lesions and is particularly useful for evaluation of malalignment, functional impairment, morphological changes of bones, and vertebral body growth disturbances [ 3 , 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

et al. 2017

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BackgroundsThe purpose of the study was to evaluate the clinical and magnetic resonance imaging (MRI) outcome of cervical spine arthritis in children with juvenile idiopathic arthritis (JIA), who received anti-TNFα early in the course of cervical spine arthritis.MethodsMedical charts and imaging of JIA patients with cervical spine involvement were reviewed in this retrospective study. Data, including age at disease onset, JIA type, disease activity, treatment and clinical outcome were collected. Initial and followup MRI examinations of cervical spine were performed according to the hospital protocol to evaluate the presence of inflammation and potential chronic/late changes.ResultsFifteen JIA patients with MRI proved cervical spine inflammation (11 girls, 4 boys, median age 6.3y) were included in the study: 9 had polyarthritis, 3 extended oligoarthritis, 2 persistent oligoarthritis and 1 juvenile psoriatic arthritis. All children were initially treated with high-dose steroids and methotrexate. In addition, 11 patients were treated with anti-TNFα drug within 3 months, and 3 patients within 7 months of cervical spine involvement confirmed by MRI. Mean observation time was 2.9y, mean duration of anti-TNFα treatment was 2.2y. Last MRI showed no active inflammation in 12/15 children, allowing to stop biological treatment in 3 patients, and in 3/15 significant reduction of inflammation. Mild chronic changes were found on MRI in 3 children.ConclusionsEarly treatment with anti-TNFα drugs resulted in significantly reduced inflammation or complete remission of cervical spine arthritis proved by MRI, and prevented the development of serious chronic/late changes. Repeated MRI examinations are suggested in the follow-up of JIA patients with cervical spine arthritis.

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Imaging in rheumatology: reconciling radiology and rheumatology

Cited by 28 publications

References 70 publications

A Virtual Reality–Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study

A Virtual Reality–Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study

Image guided sacroiliac joint corticosteroid injections in children: an 18-year single-center retrospective study

Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

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