Skip to main content

Advertisement

SpringerLink
Log in

Comparison of low-field dedicated extremity magnetic resonance imaging with articular ultrasonography in patients with rheumatoid arthritis

  • Original Article
  • Published:
Modern Rheumatology

Abstract

To compare magnetic resonance imaging (MRI) and ultrasonography (US) in the detection of joint inflammation of rheumatoid arthritis (RA), 6 patients with RA were examined by US and low-field 0.3-T nonenhanced dedicated extremity MRI (compacTscan). All patients were females, with mean age of 50.2 years, mean disease duration of 13.5 years, and mean disease activity score (DAS)28-CRP of 1.78. Each patient was treated with either infliximab, etanercept, adalimumab, or tocilizumab. Intercarpal joints, radioulnar joints, second through fifth proximal interphalangeal (PIP) joints, and first through fifth metacarpophalangeal (MCP) joints (a total of 132 joints, 22 joints in each patient) were assessed by MRI for presence of joint inflammation. A total of 156 joints (24 first interphalangeal and radiocarpal joints plus the above 132 joints), were assessed by grayscale US (GS-US) and power Doppler US (PD-US) for presence of joint inflammation by two trained ultrasonographers. We assessed correlations between joint inflammations on MRI and GS-US/PD-US, and also interobserver correlation between the two ultrasonographers by calculating intraclass correlation coefficients (ICC). Synovial hypertrophy and/or synovial fluid was detected in 74/156 joints on GS-US, and synovitis was detected in 10/156 joints on PD-US and in 38/132 joints on MRI. Using PD-US as a reference, sensitivity of MRI in detection of synovitis was 80%. Using MRI as a reference, sensitivity of PD-US was 21%. Specificity of PD-US was higher than that of MRI. Overall agreement between GS-US and MRI and between PD-US and MRI was 0.56 and 0.76, respectively, suggesting that results of PD-US are close to those of MRI. ICC was 0.545 for GS-US and 0.807 for PD-US, suggesting specificity of PD-US in detecting joint inflammation. Our results show that findings of PD-US correlated with those of MRI. Low-field MRI and PD-US are useful tools for assessment of patients with RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Emery P, Salmon M. Early rheumatoid arthritis: time to aim for remission? Ann Rheum Dis. 1995;54:944–7.

    Article  CAS  PubMed  Google Scholar 

  2. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762–84.

    Article  CAS  PubMed  Google Scholar 

  3. Takeuchi T, Yamanaka H, Inoue E, et al. Retrospective clinical study on the notable efficacy and related factors of infliximab therapy in a rheumatoid arthritis management group in Japan: one-year outcome of joint destruction (RECONFIRM-2J). Mod Rheumatol. 2008;18:447–54.

    Article  CAS  PubMed  Google Scholar 

  4. Hammer HB, Haavardsholm EA, Bøyesen P, et al. Bone erosions at the distal ulna detected by ultrasonography are associated with structural damage assessed by conventional radiography and MRI: a study of patients with recent onset rheumatoid arthritis. Rheumatology. 2009;48:1530–2.

    Article  PubMed  Google Scholar 

  5. Szkudlarek M, Klarlund M, Narvestad E, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther. 2006;8:R52.

    Article  PubMed  Google Scholar 

  6. Szkudlarek M, Court-Payen M, Stranberg C, et al. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum. 2001;44:2018–23.

    Article  CAS  PubMed  Google Scholar 

  7. Magarelli N, Guglielmi G, DiMatteo L, et al. Diagnostic utility of an echo-contrast agent in patients with synovitis using power Doppler ultrasound: a preliminary study with comparison to contrast-enhanced MRI. Eur Radiol. 2001;11:1039–46.

    Article  CAS  PubMed  Google Scholar 

  8. Szkudlarek M, Narvestad E, Klarlund M, et al. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis. Arthritis Rheum. 2004;50:2103–12.

    Article  PubMed  Google Scholar 

  9. Conaghan PG, Wakefield RJ, O’Connor P, et al. MCPJ assessment in early RA: a comparison between X-ray, MRI, high-resolution ultrasound and clinical examination. Arthritis Rheum. 1998;41:S246.

    Article  Google Scholar 

  10. Gaylis NB, Needell SD. In-office magnetic resonance imaging to monitor responses to therapy in rheumatoid arthritis. Rheumatol Int. 2009. doi:10.1007/s00296-009-0927-2.

  11. Gaylis NB, Needell SD, Rudensky D. Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis. Mod Rheumatol. 2007;17:273–8.

    Article  CAS  PubMed  Google Scholar 

  12. Yocum DE, Conaghan PG, Olech E, et al. Office-based low-field extremity magnetic resonance imaging: is the glass half empty of half full? Arthritis Rheum. 2006;54:1048–50.

    Article  PubMed  Google Scholar 

  13. Ejbjerg BJ, Narvestad E, Jacobsen S, et al. Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography. Ann Rheum Dis. 2005;64:1280–7.

    Article  CAS  PubMed  Google Scholar 

  14. Bachir T, Souhil Z, Charles G, et al. Rheumatoid arthritis of the hand and wrist: comparison of three imaging techniques. Am J Roentgenol. 2004;182:937–43.

    Google Scholar 

  15. Schirmer C, Scheel AK, Althoff CE, et al. Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI. Ann Rheum Dis. 2007;66:522–9.

    Article  PubMed  Google Scholar 

  16. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:3315–24.

    Google Scholar 

  17. Suzuki T, Ito S, Handa S, et al. A new low-field extremity magnetic resonance imaging and proposed compact MRI score: evaluation of anti-tumor necrosis factor biologics on rheumatoid arthritis. Mod Rheumatol. 2009;19:358–65.

    Article  PubMed  Google Scholar 

  18. Szkudlarek M, Court-Payen M, Jacobsen S, et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48:955–62.

    Article  PubMed  Google Scholar 

  19. Suzuki T, Ito S, Handa S, et al. New low-field extremity MRI, compacTscan: comparison with whole body 1.5 tesla conventional MRI. Mod Rheumatol. 2009. doi:10.1007/s10165-010-0282-x.

  20. Naredo E, Möller I, Moragues C, et al. Interobserver reliability in musculoskeletal ultrasonography: results from a “Teach the Teachers” rheumatologist course. Ann Rheum Dis. 2006;65:14–9.

    Article  CAS  PubMed  Google Scholar 

  21. Scheel AK, Schmidt WA, Hermann KG, et al. Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR “Train the trainers” course. Ann Rheum Dis. 2005;64:1043–9.

    Article  CAS  PubMed  Google Scholar 

  22. Klarlund M, Ostergaard M, Jensen KE, et al. 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. 2000;59:521–8.

    Article  CAS  PubMed  Google Scholar 

  23. McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis. 1999;58:156–63.

    Article  CAS  PubMed  Google Scholar 

  24. Wakefield RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000;43:2762–70.

    Article  CAS  PubMed  Google Scholar 

  25. Terslev L, Torp-Pedersen S, Savnik A, et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum. 2003;48:2434–41.

    Article  CAS  PubMed  Google Scholar 

  26. Karim Z, Wakefield RJ, Conaghan PG, et al. The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions. Arthritis Rheum. 2001;44:2932–3.

    Article  CAS  PubMed  Google Scholar 

  27. Wakefield RJ, Green MJ, Marzo-Ortega H, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis. 2004;63:382–5.

    Article  CAS  PubMed  Google Scholar 

  28. Palosaari K, Vuotila J, Takalo R, et al. Bone edema predicts erosive progression on wrist MRI in early RA—a 2-yr observational MRI and NC scintigraphy study. Rheumatology (Oxford). 2006;45:1542–8.

    Article  Google Scholar 

  29. Wakefield RJ, Freeston JE, Hensor EM, et al. Delay in imaging versus clinical response: a rationale for prolonged treatment with anti-tumor necrosis factor medication in early rheumatoid arthritis. Arthritis Rheum. 2007;57:1564–7.

    Article  PubMed  Google Scholar 

  30. Naredo E, Möller I, Cruz A, et al. Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2008;58:2248–56.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Doctoral Program in Clinical Sciences, Division of Clinical Immunology, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Masanobu Horikoshi, Takeshi Suzuki, Makoto Sugihara, Yuya Kondo, Hiroto Tsuboi, Isao Matsumoto, Satoshi Ito & Takayuki Sumida

  2. Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Takeaki Uehara, Maasa Hama & Yoshiaki Ishigatsubo

  3. Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan

    Kaoru Takase & Shigeru Ohno

  4. Sagawa Akira Rheumatology Clinic, Sapporo, Japan

    Yuri Yoshida & Akira Sagawa

  5. Department of Allergy and Clinical Immunology, Chiba University, Chiba, Japan

    Kei Ikeda

  6. Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

    Toshiyuki Ota

Authors
  1. Masanobu Horikoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Makoto Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuya Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroto Tsuboi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takeaki Uehara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maasa Hama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kaoru Takase
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shigeru Ohno
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshiaki Ishigatsubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yuri Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Akira Sagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kei Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Toshiyuki Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Isao Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Satoshi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Takayuki Sumida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takayuki Sumida.

About this article

Cite this article

Horikoshi, M., Suzuki, T., Sugihara, M. et al. Comparison of low-field dedicated extremity magnetic resonance imaging with articular ultrasonography in patients with rheumatoid arthritis. Mod Rheumatol 20, 556–560 (2010). https://doi.org/10.1007/s10165-010-0318-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-010-0318-2

Keywords

Search

Navigation