Session Information
Date: Sunday, October 21, 2018
Session Title: Imaging of Rheumatic Diseases Poster I: MRI
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: In the diagnostic process of RA, the use of advanced imaging techniques like musculoskeletal ultrasound (US) and magnetic resonance imaging (MRI) has been recommended. Unfortunately, research on its comparability is scarce. Therefore we aimed to compare findings of synovitis and tenosynovitis by US with MRI on joint- and tendon-levels in patients presenting with early inflammatory arthritis (IA) and clinically suspect arthralgia (CSA).
Methods: Seventy patients newly presenting to the rheumatology outpatient clinic (40 with recent-onset CSA, 30 with IA) underwent US and MRI of MCPs, wrist and MTPs at the same day. Grey-scale (GS) and power Doppler (PD) synovitis were scored according to Szkudlarek et al (combining synovial effusion and hypertrophy) and tenosynovitis by GS/PDUS was scored according to the OMERACT definition. Static images were also re-scored for GS synovitis according to the recently published EULAR/OMERACT score (considering synovial hypertrophy regardless of the presence of effusion) by two readers (ICC 0.92). MRI scans were scored according to the RAMRIS method. All scores ranged from 0-3. Analyses were performed on joint/tendon level. Synovitis and tenosynovitis scores were compared and test characteristics determined with MRI as reference. Cut-off for dichotomization were scores ≥1 and ≥2 for US and ≥1 for MRI.
Results: Compared to MRI, GSUS synovitis according to the EULAR/OMERACT (US cut-off ≥1) had a sensitivity ranging from 27-75% for the different locations (MCP, wrist, MTP joints) and a specificity of 80-98%. For the method according to Szkudlarek et al the sensitivity was between 68-91% and specificity 52-70%. When a US cut-off ≥2 was used, the sensitivity and specificity were 6-23% and 99-100%, respectively for the ‘EULAR/OMERACT method’ and 39-64% and 92-97% for the ‘Szkudlarek method’. Synovitis by PDUS had a sensitivity of 30-54% and specificity of 97-99%. The sensitivity to detect tenosynovitis by GSUS ranged between 42-65% and the specificity 81-92%. For tenosynovitis by PDUS the sensitivity ranged between 16-35% and the specificity from 98-100%.
Conclusion: Ultrasound is less sensitive to detect synovitis and tenosynovitis compared to MRI in early arthritis and arthralgia. The high specificity implies that there were few ‘false positive’ results. The new EULAR/OMERACT method had a higher specificity than the method according to Szkudlarek et al, with MRI as a reference. Thus current data showed that MRI is more sensitive for the early detection of synovitis and tenosynovitis. However, US is more readily available to rheumatologists in many countries, it is inexpensive and logistically easier to arrange.
To cite this abstract in AMA style:
Boer AC, Ohrndorf S, Boeters DM, ten Brinck RM, Burmester GR, Kortekaas M, van der Helm-van Mil AHM. Do Musculoskeletal Ultrasound and Magnetic Resonance Imaging Identify Synovitis and Tenosynovitis at the Same Joints and Tendons? – a Comparative Study in Patients Presenting with Early Arthritis and Clinically Suspect Arthralgia [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/do-musculoskeletal-ultrasound-and-magnetic-resonance-imaging-identify-synovitis-and-tenosynovitis-at-the-same-joints-and-tendons-a-comparative-study-in-patients-presenting-with-early-arthri/. Accessed January 24, 2020.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-musculoskeletal-ultrasound-and-magnetic-resonance-imaging-identify-synovitis-and-tenosynovitis-at-the-same-joints-and-tendons-a-comparative-study-in-patients-presenting-with-early-arthri/