Musculoskeletal Ultrasound Is a Sensitive Imaging Tool for the Assessment of Dynamic Changes of Bone Erosions in Inflammatory Arthritis: A Comparative Analysis with High-Resolution Peripheral Quantitatve Computed Tomography

Stephanie Finzel^1,2, Marina Backhaus³, Sebastian Kraus⁴, Georg Schett⁵ and Reinhard Voll⁶, ¹Department of Rheumatology and Clinical Immunology, Medical Faculty, University Medical Center, University of Freiburg, Freiburg, Germany, ²Department of Internal Medicine III, Rheumatology and Immunology, University of Erlangen, 91054, Germany, ³Rheumatology, Park-Klinik Weissensee, Berlin, Germany, ⁴Dept of Medicine 3, Rheumatology and Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ⁵Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ⁶Dpt. Rheumatology & Clinical Immunology and Centre for Chronic Immunodeficiency, University Hospital Freiburg, University Medical Center, University of Freiburg, Freiburg, Germany

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: HR-pQCT, imaging techniques, Psoriatic arthritis, rheumatoid arthritis (RA) and ultrasound

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Correct detection of bone erosions is crucial both for diagnosis and for monitoring of treatment response in patients with inflammatory joint diseases. Musculoskeletal ultrasound (MSUS) is known to have a higher sensitivity than conventional radiography regarding detection of bone erosions (1). Therefore, MSUS is increasingly used as an imaging outcome parameter. Standardization and validation of MSUS is a current task of the OMERACT ultrasound working group. Aim: Our study aimed to investigate the sensitivity and specificity of MSUS in the detection of erosions over time compared to HR-pQCT as a gold standard.

Methods: This is a follow-up study on our 2012 cross-sectional comparative analysis on MSUS and HR-pQCT (2). Four of 6 healthy individuals, 6/6 psoriatic arthritis patients and of 9/14 rheumatoid arthritis patients were available for follow-up and received an MSUS and an HR-pQCT scan of the clinically dominant hand. Again, bone erosions at the radial, palmar, and dorsal site of metacarpophalangeal (MCP) joint two, as well as the palmar and dorsal regions MCP joints 3 and 4 were assessed for prevalence and severity. Data were then compared to those taken in 2012. Prevalence and severity of bone erosions as determined by US and by micro-CT were recorded and compared. MSUS was graded as described earlier (2).

Results: After eliminating those datasets without follow-up from the baseline cohort sensitivity of MSUS as compared to HR-pQCT for correct detection of erosions was 95% and specifiity was 74%. For this analysis, grade 1 lesions were included. At follow-up sensitivity was 85% and specifiity 79%. At follow-up, 36 MSUS-lesions were no longer detectable in MSUS; 21/36 were false-positive lesions at baseline. Only one false-positive lesions was detected at both time points. One new lesion was detected by MSUS and confirmed by HR-pQCT. Overall grading in MSUS indicating severity of one erosions regressed; these findings were confirmed by HR-pQCT (p=0.04).

Conclusion: This is the first study assessing change of bone erosions over time using MSUS and HR-pQCT. MSUS was confirmed a sensitive imaging tool able to detect dynamic changes of erosions; it could be used for monitoring of treatment response in inflammatory joint diseases. Knowledge of predilection sites of erosions and physiological cortical breaks might help to correctly differentiate bone erosions from vessel channels and further increases the diagnostic value of MSUS. References: 1. Wakefield RJ, Gibbon WW, Conaghan PG, O’Connor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000 Dec;43(12):2762-70. 2. Finzel S, Ohrndorf S, Englbrecht M, Stach C, Messerschmidt J, Schett G, et al. A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum. May;63(5):1231-6.

Disclosure: S. Finzel, None; M. Backhaus, None; S. Kraus, None; G. Schett, None; R. Voll, None.

To cite this abstract in AMA style:

Finzel S, Backhaus M, Kraus S, Schett G, Voll R. Musculoskeletal Ultrasound Is a Sensitive Imaging Tool for the Assessment of Dynamic Changes of Bone Erosions in Inflammatory Arthritis: A Comparative Analysis with High-Resolution Peripheral Quantitatve Computed Tomography [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/musculoskeletal-ultrasound-is-a-sensitive-imaging-tool-for-the-assessment-of-dynamic-changes-of-bone-erosions-in-inflammatory-arthritis-a-comparative-analysis-with-high-resolution-peripheral-quantita/. Accessed .

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