Clinical Rheumatology

, Volume 34, Issue 7, pp 1181–1186 | Cite as

Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography

  • G. Peluso
  • S. L. Bosello
  • E. Gremese
  • L. Mirone
  • F. Di Gregorio
  • V. Di Molfetta
  • T. Pirronti
  • G. FerraccioliEmail author
Original Article


Three-dimensional (3D) volumetric ultrasonography (US) is an interesting tool that could improve the traditional approach to musculoskeletal US in rheumatology, due to its virtual operator independence and reduced examination time. The aim of this study was to investigate the performance of 3DUS in the detection of bone erosions in hand and wrist joints of early rheumatoid arthritis (ERA) patients, with computed tomography (CT) as the reference method. Twenty ERA patients without erosions on standard radiography of hands and wrists underwent 3DUS and CT evaluation of eleven joints: radiocarpal, intercarpal, ulnocarpal, second to fifth metacarpo-phalangeal (MCP), and second to fifth proximal interphalangeal (PIP) joints of dominant hand. Eleven (55.0 %) patients were erosive with CT and ten of them were erosive also at 3DUS evaluation. In five patients, 3DUS identified cortical breaks that were not erosions at CT evaluation. Considering CT as the gold standard to identify erosive patients, the 3DUS sensitivity, specificity, PPV, and NPV were 0.9, 0.55, 0.71, and 0.83, respectively. A total of 32 erosions were detected with CT, 15 of them were also observed at the same sites with 3DUS, whereas 17 were not seen on 3DUS evaluation. The majority of these 3DUS false-negative erosions were in the wrist joints. Furthermore, 18 erosions recorded by 3DUS were false positive. The majority of these 3DUS false-positive erosions were located at PIP joints. This study underlines the limits of 3DUS in detecting individual bone erosion, mostly at the wrist, despite the good sensitivity in identifying erosive patients.


3D ultrasound Computed tomography Erosions Rheumatoid arthritis 



The study was supported by ASRALES foundation.

Conflict of interest


Ethical standards

The study was approved by the local Ethics Committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

All enrolled patients gave their written informed consent prior to inclusion into the study.


  1. 1.
    Demoruelle MK, Deane KD (2012) Treatment strategies in early rheumatoid arthritis and prevention of rheumatoid arthritis. Curr Rheumatol Rep 14:472–480PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Jimenez-Bo E, Nobauer-Huhmann I, Hanslik-Schnabel B, Dorotka R, Wanivenhaus AH, Kainberger F et al (2007) Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 56:1118–1124CrossRefGoogle Scholar
  3. 3.
    Peterfy CG, Olech E, Dicarlo JC, Merrill JT, Countryman PJ, Gaylis NB (2013) Monitoring cartilage loss in the hands and wrists in rheumatoid arthritis with magnetic resonance imaging in a multi-center clinical trial: IMPRESS (NCT00425932). Arthritis Res Ther 20:R44CrossRefGoogle Scholar
  4. 4.
    Døhn UM, Ejbjerg B, Boonen A, Hetland ML, Hansen MS, Knudsen LS et al (2011) No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Ann Rheum Dis 70:252–258PubMedCrossRefGoogle Scholar
  5. 5.
    Baillet A, Gaujoux VC, Mouterde G, Pham T, Tebib J, Saraux A et al (2011) Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 50:1137–1147CrossRefGoogle Scholar
  6. 6.
    Døhn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M et al (2006) Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 8:R110PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Rowbotham EL, Grainger AJ (2011) Rheumatoid arthritis: ultrasound versus MRI. AJR Am J Roentgenol 197:541–546PubMedCrossRefGoogle Scholar
  8. 8.
    Filippucci E, Meenagh G, Epis O, Iagnocco A, Riente L, Delle Sedie A et al (2008) Ultrasound imaging for the rheumatologist XIII. New trends three-dimensional ultrasonography. Clin Exp Rheumatol 26:1–4PubMedGoogle Scholar
  9. 9.
    Filippucci E, Meenagh G, Delle Sedie A, Salaffi F, Riente L, Iagnocco A et al (2009) 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 27:197–200PubMedGoogle Scholar
  10. 10.
    Naredo E, Acebes C, Brito E, de Agustin JJ, de Miguel E, Mayordomo L et al (2013) Ultrasound School of the Spanish Society of Rheumatology. Three-dimensional volumetric ultrasound: a valid method for blinded assessment of response to therapy in rheumatoid arthritis. J Rheumatol 40:253–260PubMedCrossRefGoogle Scholar
  11. 11.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper N et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  12. 12.
    Aletaha D, Neogi T, Silman A, Funovits J, Felson DT, Bingham CO 3rd et al (2010) rheumatoid arthritis classification criteria: an America College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588PubMedCrossRefGoogle Scholar
  13. 13.
    Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino M et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487PubMedGoogle Scholar
  14. 14.
    Combe B, Dougados M, Goupille P, Cantagrel A, Eliaou JF, Sibilia J et al (2001) Prognostic factors for radiographic damage in early rheumatoid arthritis: a multiparameter prospective study. Arthritis Rheum 44:1736–1743PubMedCrossRefGoogle Scholar
  15. 15.
    Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS (2004) Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 43:906–914CrossRefGoogle Scholar
  16. 16.
    American College of Rheumatology Subcommittee in Rheumatoid Arthritis (2002) Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum 46:328–346CrossRefGoogle Scholar
  17. 17.
    McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL et al (1998) Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis 57:350–356PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Backhaus M, Kamradt T, Sandrock D, Loreck D, Fritz J, Wolf KJ et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245PubMedCrossRefGoogle Scholar
  19. 19.
    Klarlund M, Østergaard M, Jensen KE, Madsen JL, Skjødt H, Lorenzen I (2000) Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group. Ann Rheum Dis 59:521–528PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Lindegaard H, Vallø J, Hørslev-Petersen K, Junker P, Østergaard M (2001) Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset. Ann Rheum Dis 60:770–776PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Conaghan PG, O’Connor P, Mc Gonagle D, Astin P, Wakefield RJ, Gibbon WW et al (2003) Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 48:64–71PubMedCrossRefGoogle Scholar
  22. 22.
    Døhn UM, Ejbjerg BJ, Hasselquist M, Narvestad E, Møller J, Thomsen HS et al (2008) Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthritis Res Ther 10:R25PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E et al (2006) Presence of significant synovytis in rheumatoid arthritis patients with disease-modifying anti-rheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54:3761–3773PubMedCrossRefGoogle Scholar
  24. 24.
    Finzel S, Ohrndorf S, Englbrecht M, Stach C, Messerschmidt J, Schetet G et al (2011) A detailed comparative study of high-resolution ultrasound and micro–computed tomography for detection of arthritic bone erosions. Arthritis Rheum 63:1231–1236PubMedCrossRefGoogle Scholar
  25. 25.
    Hoving JL, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S et al (2004) A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol 31:663–675PubMedGoogle Scholar
  26. 26.
    Moller Døhn U, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A et al (2013) Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis 72(4):530–534CrossRefGoogle Scholar
  27. 27.
    Ellegaard K, Bliddal H, Møller Døhn U, Henriksen M, Boesen M, Bouert R et al (2014) Validity and reliability of 3D US for the detection of erosions in patients with rheumatoid arthritis using MRI as the gold standard. Ultraschall Med 35(2):137–141PubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2015

Authors and Affiliations

  • G. Peluso
    • 1
  • S. L. Bosello
    • 1
  • E. Gremese
    • 1
  • L. Mirone
    • 1
  • F. Di Gregorio
    • 2
  • V. Di Molfetta
    • 2
  • T. Pirronti
    • 2
  • G. Ferraccioli
    • 1
    • 3
    Email author
  1. 1.Institute of Rheumatology and Affine SciencesCatholic University - Complesso Integrato ColumbusRomeItaly
  2. 2.Department of Bioimaging and Radiological SciencesCatholic University - Complesso Integrato ColumbusRomeItaly
  3. 3.Division of Rheumatology, Institute of Rheumatology and Affine SciencesCatholic University - Complesso Integrato ColumbusRomeItaly

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