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Abstract Number: 927

Ultrasound Assessment of Heel Entheses in Spondyloarthritis Patients: A Comparative Study with Radiography and Magnetic Resonance Imaging

Rodrigo Aguila Maldonado1, Santiago Ruta2, Claudia Elizabeth Pena1, Maria Laura Valuntas3, Gisela Pendón4, Dora Pereira4 and Mercedes Argentina García5, 1Rheumatology Unit, HIGA San Martín La Plata, La Plata, Argentina, 2Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 3Servicio de Tomografía Computada y Resonancia Magnética, Sanatorio IPENSA, La Plata, Argentina, 4Hospital Ricardo Gutierrez, La Plata, La Plata, Argentina, 5Rheumatology Unit, HIGA San Martín, La Plata, Argentina

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Enthesopathy, Magnetic resonance imaging (MRI), radiography, spondylarthritis and ultrasound

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Session Information

Date: Sunday, November 8, 2015

Session Title: Imaging of Rheumatic Diseases I: Ultrasound

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: enthesitis is one of the main hallmarks of Spondyloarthritis (SpA), being heel entheses frequently involved. Different imaging modalities, such as conventional radiography (CR), ultrasound (US) and magnetic resonance imaging (MRI) are commonly used for the detection of enthesopathy. The aim was to determine the agreement between US, CR and MRI for the detection of enthesopathy in SpA.

Methods: forty patients with a diagnosis of SpA (axial or peripheral ASAS criteria) were included. All patients underwent all imaging modalities in the same day, in order to assess bilaterally both Achilles tendon and plantar fascia insertions into the calcaneous bone.

US examinations were performed using a MyLab 60 machine (6-18 MHz multifrequency broad band linear transducer). The following US findings indicative of enthesopathy were dichotomously assessed: thickening, structural changes (hypoechoic areas with loss of the typical “fibrillar” echotexture), bursitis, abnormal vascularization by power Doppler (PD), bone erosions and enthesophytes.

MRI were performed with a Signa HDe 1.5 Tesla machine (General Electric) and read by a radiologist. The following MRI findings indicative of enthesopathy were dichotomously assessed: thickening, signal intensity changes of the entheses (structural changes), adjacent bone marrow edema, bursitis, bone erosions and enthesophytes.

CR were read by a rheumatologist in order to assess the presence of bone erosions and/or enthesophytes.

Both rheumatologists and the radiologist were blinded to clinical and to the others imaging data.  

Results: a total of 160 heel entheses were examined. At least one sign indicative of enthesopathy was found in 68.1% (109/160), 65.6% (105/160) and 26.9% (43/160) entheses with MRI, US and CR, respectively. Tables 1 and 2 show a detailed description about the agreement between US and MRI and between CR, US and MRI, respectively. Among non-comparable findings, US detected abnormal vascularization by PD in 57 out of 160 (35,6%) entheses while MRI revealed adjacent bone marrow edema in 36 out of 160 (22,5%) entheses.

Table1.Agreement between US and MRI, unweighted kappa (k) values (95% coefficient interval) and absolute agreement (%).

 

Thickenning

US

 

k= 0.80

(0.69-0.90),

(91,8%)

absence

presence

MRI

absence

108

4

presence

9

39

Structural changes

US

 

k= 0.66

(0.51-0.81),

(90%)

absence

presence

MRI

absence

123

7

presence

9

21

Bursitis

US

 

k= 0.68

(0.45-0.91),

(92,5%)

absence

presence

MRI

absence

66

0

presence

6

8

Bone erosions

 

US

 

k= 0.69

(0.57-0.82),

(87,5%)

absence

presence

MRI

absence

103

10

presence

10

37

Enthesophytes

US

 

k= 0.70

(0.58-0.82),

(86,9%)

absence

presence

MRI

absencee

96

10

presence

11

43

 

 

 

 

 

 

 

 

 

 

 

Table 2.Agreement between CR with US and MRI, unweighted kappa (k) values (95% coefficient interval) and absolute agreement (%).

 

Bone erosions

CR

 

k= 0.45

(0.29-0.60),

(79,5%)

absence

presence

US

absence

104

9

presence

24

23

Enthesophytes

 

CR

 

k= 0.78

(0.68-0.88),

(90,6%)

absence

presence

US

absence

102

4

presence

11

43

Bone erosions

CR

 

k= 0.38

(0.22-0.54),

(76,9%)

absence

presence

MRI

absence

102

11

presence

26

21

Enthesophytes

 

CR

 

k= 0.76

(0.66-0.87),

(91,2%)

absence

presence

MRI

absence

102

5

presence

11

42

Conclusion: a good agreement between US and MRI was found for all abnormal comparable findings at heel entheses in SpA patients. Agreement was also good between the three imaging modalities concerning detection of enthesophytes, with a lower agreement in the recognition of bone erosions.


Disclosure: R. Aguila Maldonado, None; S. Ruta, None; C. E. Pena, None; M. L. Valuntas, None; G. Pendón, None; D. Pereira, None; M. A. García, None.

To cite this abstract in AMA style:

Aguila Maldonado R, Ruta S, Pena CE, Valuntas ML, Pendón G, Pereira D, García MA. Ultrasound Assessment of Heel Entheses in Spondyloarthritis Patients: A Comparative Study with Radiography and Magnetic Resonance Imaging [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/ultrasound-assessment-of-heel-entheses-in-spondyloarthritis-patients-a-comparative-study-with-radiography-and-magnetic-resonance-imaging/. Accessed May 26, 2022.
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