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Abstract Number: 1424

Bone Erosions in Patients with RA: Exploring the Impact of the Anatomy of Interest on the Relationship Between MRI and X-Ray Erosion Detection

Michael Tomizza1, Isabel Rodrigues1, Matthew Jessome1, Joshua Barbosa1, Karen Beattie2, William G. Bensen2, Raja Bobba2, Alfred Cividino2, Patrick D. Emond2, Karen Finlay3, Chris Gordon2, Lawrence Hart2, George Ioannidis2, Erik Jurriaans3, Melissa Koh1, Maggie Larche2, Arthur Lau2, Naveen Parasu3, Ruben Tavares2, Stephen Tytus2, Hao Wu1 and Jonathan D. Adachi1,2, 1McMaster University, Hamilton, ON, Canada, 2St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, 3Radiology, Hamilton Health Sciences, Hamilton, ON, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Bone, Lesions, MRI, rheumatoid arthritis (RA) and x-ray

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Detection of bone erosions in patients with RA is critical in clinical practice, with treatment initiation and effectiveness largely based on limiting erosive progression. While studies have compared the use of MRI and x-ray for the assessment of erosive damage, the potential influence of the anatomy of interest is not always considered. Given that the joints assessed by researchers and clinicians vary and may contribute to differences in the ability of MRI and x-ray to identify erosions, this study focused on describing the relationship between these two modalities while taking into account the anatomy of interest.

Methods:

This was a cross-sectional study. For each participant, MRI scans of both hands (bilateral MCP 2-5 joints) and x-ray scans of the hands, wrists, and feet were acquired. A 1.0T MRI scanner with a 100-mm cylindrical coil was used and multiple sequences were obtained, including T1-weighted images for erosion detection. On x-ray, the conventional erosion definition was applied and three imaging projections were used: posteroanterior, oblique, and lateral. Four radiologists used the RA-MRI scoring system (RAMRIS) and the van der Heijde-modified Sharp scoring system (vdHSS) to semi-quantitatively evaluate the MRI and x-ray images, respectively. For statistical analysis, interval data (RAMRIS) and ordinal data (vdHSS) were classified by erosion presence (yes/no).

Results:

A total of 488 joints from 122 hands of 65 RA patients were included in this analysis [median (interquartile range) age: 59.0 (49.0-66.0) years, sex: 83.1% female, ethnicity: 61% Caucasian, symptom duration: 4.3 (2.6-7.0) years, Rheumatoid Factor positivity: 70.8%, Disease Activity Score (DAS28): 4.5 (3.3-5.7), Clinical Disease Activity Index (CDAI): 62.3 (32.7-91.6)]. 331 individual MCP 2-5 joints were assessed as having erosions on MRI (67.8%), while 134 erosions were detected in the same joints on x-ray (27.5%). MCP 2-5 joints of the hand were also grouped together for analysis. Overall, 2.1-fold the MCP 2-5 joint sets with erosions on x-ray had erosions on MRI.

Per common joint imaged, 2.6- to 8.0-fold the erosions detected on x-ray were detected on MRI. At the patient level of analysis, bilateral MRI of the MCP 2-5 joints resulted in the detection of erosive disease in 1.1-fold the number detected on x-rays of the hands, wrists, and feet. Limiting MRI to the dominant MCP 2-5 joints, the proportion of patients with erosive disease was 66% of the frequency detected on x-rays of the hands, wrists, and feet; the same frequency detected on x-rays of the feet alone; and 1.3-fold the frequency detected on x-rays of the hands and wrists.

Conclusion:

Practically, the results suggest that the relative performance of the two imaging modalities is highly dependent on the anatomy imaged. Technologically, the findings demonstrate the enhanced capacity of MRI to detect erosions per joint imaged. The ability of a single MRI scan of the dominant hand to identify more patients with erosive disease than x-rays of both hands and wrists emphasizes the clinical value of MRI as a tool for detecting and monitoring erosive damage in patients with RA.  


Disclosure:

M. Tomizza,
None;

I. Rodrigues,
None;

M. Jessome,
None;

J. Barbosa,
None;

K. Beattie,
None;

W. G. Bensen,
None;

R. Bobba,
None;

A. Cividino,
None;

P. D. Emond,
None;

K. Finlay,
None;

C. Gordon,
None;

L. Hart,
None;

G. Ioannidis,
None;

E. Jurriaans,
None;

M. Koh,
None;

M. Larche,
None;

A. Lau,
None;

N. Parasu,
None;

R. Tavares,
None;

S. Tytus,
None;

H. Wu,
None;

J. D. Adachi,
None.

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