Session Type: Abstract Submissions (ACR)
Background/Purpose: In rheumatoid arthritis (RA), disparities between erosive bone lesion detection on magnetic resonance imaging (MRI) and X-ray require reconciliation. It is hypothesized that early erosions detectable on MRI increase in size with disease progression to become detectable on radiography (X-ray). The study’s objectives were 1) to compare the relative diagnostic test accuracy of X-ray for MRI-detected erosions; and 2) to determine if MRI erosions develop into X-ray erosions over time.
Methods: A systematic review was conducted. Medline (Jan 1996-Apr 2011) and EMBASE (Jan 1998-Apr 2011) citation indexes were searched using the PICO strategy. RA studies with paired comparisons of erosion detection on X-ray and MRI at the joint or more precise level of analysis were included. Two reviewers independently screened the titles, abstracts and full articles to determine eligibility. Disagreements on eligibility between reviewers were mutually resolved by discussion or arbitrated by a third, independent reviewer if mutual resolution was not achieved. Cross-sectional comparisons were examined overall and then sorted by study sample symptom duration. Temporal explorations sorted data by time between initial MRI and subsequent X-ray. Study quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) and reported. Cochrane Collaboration Review Manager software was used to manage and analyze the data collected.
Results: Sixteen eligible studies reporting 34 unique datasets comprising 10,953 paired observations were included. The relative diagnostic test accuracy results were heterogeneous across studies. Sensitivity results ranged from 0.00 (95% CI: 0.00-0.04) to 0.87 (95% CI: 0.60-0.98). Average sensitivity weighted by study sample size was 0.28 (95% CI: 0.28-0.29). Specificity ranged from 0.38 (95% CI: 0.14-0.68) to 1.00 (95% CI: 0.99-1.00). The weighted mean specificity was 0.97 (95%CI: 0.97-0.97). The sensitivity of X-ray for MRI erosions appeared to increase with increasing symptom duration. Sensitivity ranged from 0.07 (95% CI: 0.01-0.24) for patients with a mean symptom duration of 0.25 years, to 0.34 (95% CI: 0.20-0.51) for patients with 14 years symptom duration. Specificity decreased slightly with increasing symptom duration. Specificity ranged from approximately 0.99 (95% CI: 0.97-1.00) to 0.92 (95% CI: 0.88-0.95) for symptom durations ranging from 0.25 to 9.5 years, respectively. Studies varied by sample symptom duration, anatomy investigated, MRI magnetic strength, definition of erosion, number of X-ray projections, use of prescribed scoring systems, number of raters, unit of analysis, and QUADAS parameters.
Conclusion: X-ray has low sensitivity and high specificity for MRI erosions. The relationship between X-ray and MRI erosion detection is dependent on symptom duration and the time interval between imaging interventions. As the time between initial MRI and follow-up X-ray increases, there is decreasing specificity of X-ray for MRI erosions. This suggests that erosive progression is not limited to joints initially detected on MRI. Sources of study heterogeneity and potential bias warrant attention in future comparative investigations.
S. R. Tytus,
K. A. Beattie,
C. E. Webber,
L. E. Hart,
J. D. Adachi,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-review-of-the-association-between-magnetic-resonance-imaging-and-radiographic-detection-of-erosions-in-rheumatoid-arthritis/