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Can Ultrasound (PDUS) Easily Detect Erosions? Evaluation of Physiological and Abnormal Cortical Breaks of Small Joints in Healthy Individuals (HI) and Rheumatoid Arthritis (RA) Patients by PDUS Comparison with Micro Computed Tomography (µCT) Scan Stephanie Finzel 1, Philippe Aegerter2, Georg Schett1, Maria-Antonietta D'Agostino2 and OMERACT Ultrasound Task Force3, 1University of Erlangen-Nuremberg, Erlangen, Germany, 2Versailles-Saint Quentin en Yvelines University- APHP, Ambroise-Paré Hospital, Boulogne-Billancourt, Paris, France, Paris, France, 3Paris, France Presentation Number: 807 Background/Purpose: The correct detection of bone erosions in RA by ultrasound is sometimes delicate due to the presence of pitfalls such as physiological vessel channels, grooves, sesamoids and osteophytes. Thus, ultrasound needs further standardization. Objective: To evaluate by PDUS the size and location of physiological and abnormal cortical breaks in HI and RA patients by using µCT as gold standard. Method: Metacarpophalangeal joints (MCPJ) of both hands of 43 HI (without history of inflammatory joint disease) and 40 RA patients (disease duration > 6 months; fulfilling the new ACR/EULAR classification criteria) were examined by PDUS using a palmar, dorsal and, where possible, a lateral approach. All accessible joint facets were assessed in longitudinal and transversal planes. PDUS was performed by using an ESAOTE MyLab 70 (Genoa Italy) both in B- (linear array probe of 18 MHz) and PD-mode (10.2 MHz; PRF of 500). Cortical break was defined as a break in cortical lining detectable in two perpendicular planes. For each plane the width and the depth were recorded. Physiological and abnormal breaks were defined according to the opinion of ultrasonographer. Additionally, a µCT scan of MCPJ (2 to 5) was performed at a resolution of 82x82x82 µm voxel size of the clinically more affected hands of 26 RA patients and of the dominant hands of 17 HI. The prevalence, sensitivity and specificity of breaks as determined by PDUS and µCT were recorded and compared. Result:
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超声（PDUS）能否容易检出侵蚀？比较PDUS与microCT对正常人群和RA患者小关节生理和皮质断裂的评价 Stephanie Finzel , et al. ACR 2011. Present No: 807 背景/目的: 由于存在生理血管通道、沟槽、籽骨和骨赘等的干扰，要通过超声正确检测RA患者的骨侵蚀有时不太容易。因此,超声需要进一步规范化。摘要目的: 以µCT为金标准，评价PDUS检测正常人群和RA患者正常生理的和异常皮质断裂的大小和部位 。 方法: 对43例正常人（没有炎症关节炎病史）和40例RA患者(病程> 6个月;符合新ACR /EULAR分类标准)双手掌指关节(MCPJ)行PDUS检查，采用掌侧、背侧和侧位（如可行）的方法，对所有可评估的关节面行纵向和横向检测。使用ESAOTE MyLab 70( Genoa 意大利)超声仪，同时用B形（线性阵列探针18MHz）和PD模式 (10.2MHz;PRF 500) 。皮质破坏定义为两个垂直相位同时检测到的皮质线断裂，记录各自的范围和深度。生理或病理形断裂的定义取决超声医生的观点。此外, 对26例RA患者患侧手和17例正常人的优势手MCPJ(2 ~ 5) 进行µCT扫描，参数为82 x82x82µm。记录和比较PDUS和µCT检测的皮质断裂的发生率、敏感性和特异性。 结果: PDUS共检测了430个健康人和390RA患者的MCPJ。µCT检测了48个健康人和81例MCPJ。健康人中，在1118个层面中共发现226(20%)处断裂,222处(98%)生理性的(61%在掌侧)和4处(2%)病理性的(3处在侧面)。RA患者中， 1014扫描中发现255处断裂(25%)，143处(14%)被认为是生理(64%在手掌侧)、112处(11%)是病理性的侵蚀(51%在手侧面)。所有生理性改变都被视为血管通道,尽管缺乏PD信号。总的来说，PDUS 和µCT对于特异性检测健康人和RA患者生理和异常断裂有很好的一致性（Sp.在健康人为1, RA为0.95），背侧MCP 2(κ值在健康人为0，RA为0.1)除外。由于两组样本较小, 灵敏度难以评估。表1显示PDUS和µCT检测健康人和RA患者生理性和异常皮质断裂的平均值(mm) 。 结论:超声是检测和鉴别皮质生理和病理断裂(如侵蚀)的有效方法。营养血管的好发面通过超声和µCT都能发现。该研究可以为正确检测RA骨侵蚀提供指导，可以鉴别皮质的生理和病理性断裂。 |
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Table 1
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