High Resolution Ultrasound of the Midfoot: Sonography Is Superior to Conventional Radiography in Detection of Osteophytes and Erosions in Inflammatory and Non-Inflammatory Joint Disease

Mathis Camerer¹, Boris P. Ehrenstein², Martin Fleck³, Patrick Hoffstetter⁴ and Wolfgang Hartung⁵, ¹Rheumatology and Clinical Immunology, Asklepios Clinic Bad Abbach, Bad Abbach, Germany, ²Department of Rheumatology/Clinical Immunology, Asklepios Medical Center, 93077 Bad Abbach, Germany, ³Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany, ⁴Radiology, Asklepios Clinic Bad Abbach, Bad Abbach, Germany, ⁵Rheumatology & Clinical Immunology, Asklepios Clinic Bad Abbach, Bad Abbach, Germany

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Arthritis, Diagnostic imaging, foot disorders, osteoarthritis and ultrasound

Session Information

Date: Sunday, November 8, 2015

Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy

Session Type: ACR Poster Session A

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

Background/Purpose:

Ultrasound (US) as well as conventional radiography (CR) are established imaging modalities for the assessment of cortical bone lesions including erosions and osteophytes. Several studies compared both methods in different joint regions, however, midfoot joints have not been addressed so far. Therefore, the diagnostic value of high resolution US was compared to CR in the detection of osteophytes and erosions in the midfoot joints in patients suffering from inflammatory (IJD) and non-inflammatory joint disease (NIJD).

Methods:

Patients with current foot radiographs were included and stratified in two cohorts: IJD and NIJD. The midfoot joints of both feet (talonavicular, calcaneocuboid, medial / intermediate / lateral naviculocuneiform, and 1st to 5th tarsometatarsal joints) were evaluated by US and CR. US was performed with a high end ultrasound device (Logiq E 9, GE Healthcare, Buckinghamshire, UK) with a linear hockey stick probe with 8-18 MHz by one author (W.H.) with long standing experience in musculoskeletal US, whereas CR images were evaluated by an expert in musculoskeletalal radiology (P.H.). Both investigators were blinded to diagnoses and results of the complementary imaging modality. US: Presence of osteophytes (cortical protrusions > 1 mm) and erosions (a cortical break > 1 mm according to the OMERACT definition) were analysed for each joint utilizing a dorsal longitudinal scan. Power Doppler (PD) activity was scored on a semi quantitative scale from 0 to 3. CR: X-rays of each foot (posterior–anterior and lateral view) were performed and presence of osteophytes, erosions and joint space narrowing (JSN) were analysed for each joint.

Results:

A total of 2445 joints in 124 patients (90 with IJD, 34 with NIJD) were assessed. US detected significantly more osteophytes (n=344; 14.1%) than CR (n=13; 0.5%), p<.001 by Chi². Only 8 osteophytes were observed by both methods. Osteophytes were most frequently detected in the intermediate and lateral naviculocuneiform joints (19.5% and 17.3%) by US, whereas no osteophytes could be identified in these joints by CR. Of the 13 osteophytes dectected by CR, 5 were present in the 1st tarsometatarsal joint and 4 in the talonavicular joint. US identified 60 vs. 3 erosions by CR, only 1 erosion was detected by both methods. There was no significant agreement between US and CR in detecting erosions and osteophytes (κ-statistic .029 – .035). While CR demonstrated a higher prevalence of JSN in IJD (14.8%) compared to NIJD (8.8%), p<.001 by Chi², there were more erosions observed by US in IJD (2.9%) than in NIJD (1.3%), p=.026 by Chi². Contrary to results from other joint regions, PDUS demonstrated no significant difference of the rate of midfoot joints with hyperperfusion comparing patients with IJD (8.5%) and NIJD (7.8%), p=.839 by Chi².

Conclusion:

High resolution US of the midfoot is a valuable tool for the detection of structural bony lesions in the midfoot. Sonography is superior to CR in the identification of osteophytes and erosions in patients suffering from IJD and NIJD.

Disclosure: M. Camerer, None; B. P. Ehrenstein, None; M. Fleck, None; P. Hoffstetter, None; W. Hartung, None.

To cite this abstract in AMA style:

Camerer M, Ehrenstein BP, Fleck M, Hoffstetter P, Hartung W. High Resolution Ultrasound of the Midfoot: Sonography Is Superior to Conventional Radiography in Detection of Osteophytes and Erosions in Inflammatory and Non-Inflammatory Joint Disease [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/high-resolution-ultrasound-of-the-midfoot-sonography-is-superior-to-conventional-radiography-in-detection-of-osteophytes-and-erosions-in-inflammatory-and-non-inflammatory-joint-disease/. Accessed .

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