Skeletal Radiology

, Volume 43, Issue 10, pp 1377–1385 | Cite as

Carpal pseudoerosions: a plain X-ray interpretation pitfall

  • Richard WawerEmail author
  • Jean François Budzik
  • Xavier Demondion
  • Gerard Forzy
  • Anne Cotten
Scientific Article



To examine in detail images of pseudoerosion of the wrist and hand on plain radiographs.

Material and methods

The study was conducted with 28 cadaver wrists. During a single imaging session three techniques—plain radiography, tomosynthesis, and computed tomography—were used to visualize the wrist and hand specimens. For each technique, 20 radio-ulno-carpo-metacarpal sites known to present bone erosions in rheumatoid arthritis were analyzed by two radiologists using a standard system to score the cortical bone: normal, pseudoerosion, true erosion, or other pathology. Cohen’s concordance analysis was performed to determine inter-observer and intra-observer (for the senior radiologist) agreement by site and by technique. Serial sections of two cadaver specimens were examined to determine the anatomical correlation of the pseudoerosions.


On the plain radiographs, the radiologists scored many images as pseudoerosion (7.3 %), particularly in the distal ulnar portion of the capitate, the distal radial portion of the hamate, the proximal ulnar portion of the base of the third metacarpal, the proximal radial portion of the base of the fourth metacarpal, the distal ulnar portion of the hamate, and the proximal portion of the base of the fifth metacarpal. The computed tomography scan revealed that none of these doubtful images corresponded to true erosions. The anatomical correlation study showed that these images could probably be attributed to ligament insertions, thinner lamina, and enhanced cortical bone transparency.


Knowledge of the anatomical carpal localizations where pseudoerosions commonly occur is a necessary prerequisite for analysis of plain radiographs performed to diagnose or monitor rheumatoid arthritis.


Erosion Pseudoerosion Wrist Rheumatoid arthritis Radiography Tomosynthesis 



Maurice Demeulaere (Anatomy Laboratory, CHU Lille, 59000 Lille, France). The radiographers’ team from the Musculoskeletal Imaging Department, CHRU Lille, France.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© ISS 2014

Authors and Affiliations

  • Richard Wawer
    • 1
    Email author
  • Jean François Budzik
    • 1
    • 4
  • Xavier Demondion
    • 2
    • 5
  • Gerard Forzy
    • 3
  • Anne Cotten
    • 2
    • 4
  1. 1.Groupement des Hôpitaux de l’Institut Catholique de Lille, Service d’imagerie médicaleHôpital St Vincent de Paul, Faculté Libre de Médecine, Université Catholique de LilleLilleFrance
  2. 2.Service d’imagerie musculosquelettique, Centre de consultation et d’imagerie de l’appareil locomoteurHôpital Roger Salengro, 2, Bld du Pr Laine, CHRU Lille, Université Lille2LilleFrance
  3. 3.Groupement des hôpitaux de l’Institut Catholique de Lille, Laboratoire de biologie, Département de biostatistiquesHôpital St Philibert, Faculté Libre de Médecine, Université Catholique de LilleLommeFrance
  4. 4.Unité de recherche EA 4490, Physiopathologie des maladies osseuses inflammatoiresUniversité Nord de France, Quai Masset, Bassin NapoléonBoulogne sur MerFrance
  5. 5.Laboratoire d’Anatomie, faculté de Médecine de LillePôle RechercheLilleFrance

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