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[2011] [FRI0092] DETECTION OF BONE
EROSIONS IN EARLY RHEUMATOID ARTHRITIS: 3D ULTRASONOGRAPHY COMPARED
WITH COMPUTED TOMOGRAPHY SHOWS A HIGH SPECIFICITY AND SENSITIVITY
FOR MCP JOINTS
G. Peluso1, S.L. Bosello1, A.
Michelutti1, F. Di Gregorio2, G.
Bozzo2, E. Bock2, G. Ferraccioli1
1Division of Rheumatology; 2Department of
Bioimaging and Radiological Sciences, Catholic University, Rome,
Italy
Background: Tree-dimensional (3D)
volumetric ultrasonography (US) is an interesting new tool, that
improves the traditional approach to musculoskeletal US in
rheumatology, due to its virtual operator independence and
shortening of the examination time (1).
Objectives: The aim of this study was to investigate the
specificity and sensitivity of 3D US in the detection of bone
erosions in early rheumatoid arthritis (ERA) hand and wrist joints,
with computed tomography (CT) as the reference method.
Methods: Seventeen ERA patients underwent 3D US and CT
evaluation of eleven joints: radio-carpal, inter-carpal,
ulno-carpal, second to fifth metacarpophalangeal (MCP) and second
to fifth proximal interphalangeal (PIP) joints of dominant hand.
The 3D US examinations was done using a Logiq 9 (General Electrics
Medical Systems, Milwaukee, WI) equipped with a high-frequency
(8-15 MHz) volumetric probe, while CT was performed on a Philips
Mx8000 IDT multidetector unit (Philips Medical Systems). Images
were evaluated for presence of erosions by separate investigators,
blinded to clinical and other imaging data.
Results: Eleven (64.7%) patients were erosive either with CT
either with 3D US. A total of 37 erosions were detected with CT,
while 30 with 3D US. All the patients that presented erosions with
CT were erosive also in 3D US; only one patient presented one
erosion in ulno-carpal joint that was detected with 3D US, but not
with CT. Twenty-two (73.3%) erosions detected with 3D US were
confirmed by CT evaluation; 15 erosions (40.5%) were identified
only with CT; 8 (26.7%) erosions were recognized only with 3D US.
With CT as the standard reference method, a specificity of 94.6%
and a sensitivity of 59.4% for 3D US tool emerged. Considering
separately wrist joints, MCP and PIP joints, 3DUS method had a high
specificity (>90%) compared with CT, while the
sensitivity decrease from 84.1% for MCP joints, 60.0% for PIP
joints to only 35.7% at the wrist joints.
Conclusions: To our knowledge, this is the first report that
compared 3D US method with others imaging reference methods. We
suggest that 3D US could be helpful to detect early erosions,
mainly at MCP joints.
References:
1.
E. Filippucci, G. Meenagh, A. Delle
Sedie, F. Salaffi, L. Riente, A. Iagnocco, C.A. Scirè, C.
Montecucco, S. Bombardieri, G. Valesini, W. Grassi. Ultrasound
imaging for the rheumatologist XX. Sonographic assessment of hand
and wrist joint involvement in rheumatoid arthritis: comparison
between two- and three-dimensional ultrasonography. Clin Exp
Rheumatol 2009;27:197-200.
Disclosure of
Interest: None Declared
Citation: Ann Rheum Dis 2011;70(Suppl3):375
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比较3D超声与CT检测早期RA的手关节侵蚀病变
Peluso G, et al. EULAR 2011. Present
No: FRI0092.
背景:
三维超声(3D-US)容积检测是一个令人感兴趣的新工具，它改善了风湿病领域骨骼肌肉超声检查结果，这要归因于减少了对操作者的依赖以及缩短了检查时间(1)。
目的:
本研究旨在以计算机断层扫描(CT)检查为对照，探讨3D-US检测早期类风湿关节炎(ERA)患者手和腕关节骨侵蚀的特异性和敏感性。
方法:
共17例病人接受了3D-US以及CT检查，所查关节包括优势手的桡掌关节、掌骨间关节、尺掌关节、第2至第5掌指关节(MCP)以及第2至第5的近端指间关节(PIP)。
本研究所用超声检查仪型号为Logiq
9 (通用电气医疗系统,
密尔沃基,美国威斯康辛州)，它配备了高频(8-15
MHz)容积探头。CT型号为飞利浦Mx8000
IDT(飞利浦医疗系统)。对病人临床和影像检查日期等信息不知情的多位研究者分别独立地评估影像学资料。
结果:
通过CT或3D-US共发现11例(64.7%)患者出现侵蚀病灶。CT发现的侵蚀病灶总数为37个，3D-US发现总数为30个。所有CT侵蚀阳性的病人均为3D-US阳性，仅有1例病人的一个尺掌关节侵蚀灶被3D-US发现但未见于CT。CT证实了23个3D-US侵蚀灶(73.3%)，有15个侵蚀灶(40.5%)仅见于CT，有8个侵蚀灶(26.7%)仅见于3D-US。用CT为标准参照，分析发现3D-US发现侵蚀灶的特异性为94.6%，敏感性为59.4%。如果分别考察腕关节、MCP及PIP，则3D-US特异性(>
90%)高于CT但敏感性下降(从MCP的84.1%、PIP的60.0%降至腕关节的35.7%)。
结论:
据我们所知,
这是将3D-US与其它影像学技术进行比较的首个报道。我们的研究提示3D-US有助于早期侵蚀的检测，主要是掌指关节。
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