Reasons for discordances between ultrasonography and magnetic resonance imaging in the evaluation of the ankle, hindfoot and heel of the patients with rheumatoid arthritis

Abstract

Aim: To compare the ultrasonography (US) performance with magnetic resonance imaging (MRI) in identifying pathology in ankles, hindfeet and heels of rheumatoid arthritis (RA) patients and to evaluate the reasons for discordances between the two imaging methods.Material and methods: RA patients were enrolled and evaluated using the Clinical Disease Activity Index (CDAI) and the Disease Activity Score 28 with C-reactive Protein (DAS28-CRP). The ankle (tibiotalar joint, tendons), hindfoot (talonavicular, subtalar joints) and heel of the most symptomatic or dominant foot (for the asymptomatic patient)were evaluated by two pairs of examiners using US and contrast-enhanced MRI.Results: Totally, 105 joints, 245 tendons and 35 heels in 35 patients [mean age 59.2±11.25 years old, median disease duration 36 (16.5-114), mean CDAI 19.87±12.7] were evaluated. The interobserver agreements between the two sonographers, and the two radiologists were good and very good (k=0.624-0.940). The overall agreement between US and MRI was very good for subcalcaneal panniculitis (k=0.928, p<0.001), moderate for synovitis (k=0.463, p<0.001) and tenosynovitis (k=0.514, p<0.001), fair for osteophytes (k=0.260, p=0.004), and poor for erosions (k=0.063, p=0.308) and heel’s structures. MRI found more erosions, synovitis, osteophytes,tenosynovitis and retrocalcaneal bursitis, but US found more enthesophytes and plantar fasciitis. Many of the discordancesbetween the two imaging techniques have explanations related to the technique itself or definition of the pathologic findings.Conclusions: US is comparable to MRI for the evaluation of ankle, hindfoot and heel in RA patients and discordances in theinterpretation of the pathological findings/normal structures must be carefully analyzed.

Do ankle, hindfoot, and heel ultrasound findings predict the symptomatology and quality of life in rheumatoid arthritis patients?

“…Given its complex anatomy and the lack of experience of the examiners, the US evaluation of the ST joint is quite difficult, and requires good training ( 28 , 38 ) . Magnetic resonance imaging (MRI) is a better ankle and hindfoot joint evaluation technique ( 39 , 40 ) , but it is expensive, time-consuming and not easily or widely available.…”

Study on the evaluation of rheumatoid arthritis via doppler ultrasonography and anti-cyclic citrullinated peptide antibody analysis

“…Study on the evaluation of rheumatoid arthritis via doppler ultrasonography and anti-cyclic citrullinated peptide antibody analysis examination and evaluation of RA, but ultrasound needs more careful analysis in the diagnosis and disease assessment of RA. 2 The sensitivity of anti-CCP antibodies to RA is not high, but the specificity is strong. At the same time, anti-CCP antibodies can assess the progress of RA to a certain extent.…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

“…The added value of US in detecting inflammatory lesions [176,179,180] is proven, showing the importance of the method in characterizing disease activity. In the ankle and midfoot, the tibiotarsal (TT) and talonavicular joints are the most frequently affected joints [181][182][183][184] while in the forefoot the metatarsophalangeal (MTP) joints, especially MTP II-V, are most affected [183,185]. Using US, subclinical synovitis was found in 25 % of RA patients in clinical remission [186] and the presence of the power Doppler signal in MTP joints showed predictive value for unstable remission [186] and radiographic progression [187].…”