Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis

Wang,Ming‑Yu; Wang,Xian‑Bin; Sun,Xue‑Hui; Liu,Feng‑Li; Huang,Sheng‑Chuan

doi:10.3892/etm.2016.3695

Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis

Authors:
- Ming‑Yu Wang
- Xian‑Bin Wang
- Xue‑Hui Sun
- Feng‑Li Liu
- Sheng‑Chuan Huang
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Affiliations: Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China, Department of Rheumatology and Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China, Department of Rheumatology and Ultrasonography, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
Published online on: September 13, 2016 https://doi.org/10.3892/etm.2016.3695
Pages: 3035-3040

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Abstract

Early diagnosis and management improve the outcome of patients with rheumatoid arthritis (RA). The present study explored the application of high‑frequency ultrasound (US) and magnetic resonance imaging (MRI) in the detection of early RA. Thirty-nine patients (20 males and 19 females) diagnosed with early RA were enrolled in the study. A total of 1,248 positions, including 858 hand joints and 390 tendons, were examined by high‑frequency US and MRI to evaluate the presence of bone erosion, bone marrow edema (BME), synovial proliferation, joint effusion, tendinitis and tendon sheath edema. The imaging results of the above abnormalities, detected by US, were compared with those identified using MRI. No statistically significant overall changes were observed between high‑frequency US and MRI in detecting bone erosion [44 (5.1%) vs. 35 (4.1%), respectively; P>0.05], tendinitis [18 (4.6%) vs. 14 (1.5%), respectively; P>0.05] and tendon sheath edema [37 (9.5%) vs. 30 (7.7%), respectively; P>0.05]. Significant differences were observed between high-frequency US and MRI with regards to the detection of synovial proliferation [132 (15.4%) vs. 66 (7.7%), respectively; P<0.05] and joint effusion [89 (10.4%) vs. 52 (6.1%), respectively; P<0.05]. In addition, significant differences were identified between the detection of BME using MRI compared with high‑frequency US (5.5 vs. 0%, respectively; P<0.05). MRI and high‑frequency US of the dominant hand and wrist joints were comparably sensitive to bone erosion, tendinitis and tendon sheath edema. However, MRI was more sensitive in detecting bone marrow edema in early RA, while US was more sensitive in the evaluation of joint effusion and synovial proliferation. In conclusion, US and MRI are promising for the detection and diagnosis of inflammatory activity in patients with RA.

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1	Gibofsky A: Overview of epidemiology, pathophysiology and diagnosis of rheumatoid arthritis. Am J Manag Care. 18(Suppl 13): S295–S302. 2012.PubMed/NCBI
2	Apfelberg D, Maser R, Lash H, Kaye R, Britton M and Bobrove A: Rheumatoid hand deformities: Pathophysiology and treatment. West J Med. 129:267–272. 1978.PubMed/NCBI
3	Machold KP, Stamm TA, Nell VP, Pflugbeil S, Aletaha D, Steiner G, Uffmann M and Smolen JS: Very recent onset rheumatoid arthritis: Clinical and serological patient characteristics associated with radiographic progression over the first years of disease. Rheumatology (Oxford). 46:342–349. 2007. View Article : Google Scholar : PubMed/NCBI
4	Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L and Taunton JE: Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med. 37:149–153. 2003. View Article : Google Scholar : PubMed/NCBI
5	Østergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B, Shnier R, O'Connor P, Klarlund M, Emery P, et al: OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions and the OMERACT RA-MRI scoring system. J Rheumatol. 30:1385–1386. 2003.PubMed/NCBI
6	Ostendorf B, Scherer A, Mödder U and Schneider M: Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalangeal joints of the hands remain normal. Arthritis Rheum. 50:2094–2102. 2004. View Article : Google Scholar : PubMed/NCBI
7	Suter L, Fraenkel L and Braithwaite R: The role of magnetic resonance imaging in the diagnosis and prognosis of rheumatoid arthritis. Arthritis Care Res (Hoboken). 63:675–688. 2011. View Article : Google Scholar : PubMed/NCBI
8	Døhn UM, Ejbjerg BJ, Hasselquist M, Narvestad E, Court-Payen M, Szkudlarek M, Møller J, Thomsen HS and Ostergaard M: Rheumatoid arthritis bone erosion volumes on CT and MRI: Reliability and correlations with erosion scores on CT, MRI and radiography. Ann Rheum Dis. 66:1388–1392. 2007. View Article : Google Scholar : PubMed/NCBI
9	Narváez J, Sirvent E, Narváez JA, Bas J, Gómez-Vaquero C, Reina D, Nolla JM and Valverde J: Usefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosion. Semin Arthritis Rheum. 38:101–109. 2008. View Article : Google Scholar : PubMed/NCBI
10	Backhaus M, Burmester G, Sandrock D, Loreck D, Hess D, Scholz A, Blind S, Hamm B and Bollow M: Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis. 61:895–904. 2002. View Article : Google Scholar : PubMed/NCBI
11	Zheng G, Wang L, Jia X, Li F, Yan Y, Yu Z, Li L, Wei Q and Zhang F: Application of high frequency color doppler ultrasound in the monitoring of rheumatoid arthritis treatment. Exp Ther Med. 8:1807–1812. 2014.PubMed/NCBI
12	McQueen FM: Imaging in early rheumatoid arthritis. Best Pract Res Clin Rheumatol. 27:499–522. 2013. View Article : Google Scholar : PubMed/NCBI
13	Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH and Luthra HS: The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 31:315–324. 1988. View Article : Google Scholar : PubMed/NCBI
14	Schmidt W, Schmidt H, Schicke B and Gromnica-Ihle E: Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 63:988–994. 2004. View Article : Google Scholar : PubMed/NCBI
15	Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA, et al: Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 32:2485–2487. 2005.PubMed/NCBI
16	Gabriel SE: The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am. 27:269–281. 2001. View Article : Google Scholar : PubMed/NCBI
17	Cooles FA and Isaacs JD: Pathophysiology of rheumatoid arthritis. Curr Opin Rheumatol. 23:233–240. 2011. View Article : Google Scholar : PubMed/NCBI
18	Scott IC, Steer S, Lewis CM and Cope AP: Precipitating and perpetuating factors of rheumatoid arthritis immunopathology: Linking the triad of genetic predisposition, environmental risk factors and autoimmunity to disease pathogenesis. Best Pract Res Clin Rheumatol. 25:447–468. 2011. View Article : Google Scholar : PubMed/NCBI
19	Hutchinson D, Shepstone L, Moots R, Lear J and Lynch M: Heavy cigarette smoking is strongly associated with rheumatoid arthritis (RA), particularly in patients without a family history of RA. Ann Rheum Dis. 60:223–227. 2001. View Article : Google Scholar : PubMed/NCBI
20	Cutolo M and Straub RH: Stress as a risk factor in the pathogenesis of rheumatoid arthritis. Neuroimmunomodulation. 13:277–282. 2006. View Article : Google Scholar : PubMed/NCBI
21	Kahlenberg J and Fox D: Advances in the medical treatment of rheumatoid arthritis. Hand Clin. 27:11–20. 2011. View Article : Google Scholar : PubMed/NCBI
22	Nell V, Machold K, Eberl G, Stamm T, Uffmann M and Smolen J: Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 43:906–914. 2004. View Article : Google Scholar : PubMed/NCBI
23	Guillemin F, Billot L, Boini S, Gerard N, Ødegaard S and Kvien TK: Reproducibility and sensitivity to change of 5 methods for scoring hand radiographic damage in patients with rheumatoid arthritis. J Rheumatol. 32:778–786. 2005.PubMed/NCBI
24	Hodgson RJ, O'Connor P and Moots R: MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology. 47:13–21. 2008. View Article : Google Scholar : PubMed/NCBI
25	Patil P and Dasgupta B: Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis. 4:341–355. 2012. View Article : Google Scholar : PubMed/NCBI
26	Foltz V, Gandjbakhch F, Etchepare F, Rosenberg C, Tanguy ML, Rozenberg S, Bourgeois P and Fautrel B: Power doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum. 64:67–76. 2012. View Article : Google Scholar : PubMed/NCBI
27	Amin MF, Ismail FM and El Shereef RR: The role of ultrasonography in early detection and monitoring of shoulder erosion and disease activity in rheumatoid arthritis patients; comparison with MRI examination. Acad Radiol. 19:693–700. 2012. View Article : Google Scholar : PubMed/NCBI
28	Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T and Østergaard M: 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. 44:2018–2023. 2001. View Article : Google Scholar : PubMed/NCBI
29	Rahmani M, Chegini H, Najafizadeh SR, Azimi M, Habibollahi P and Shakiba M: Detection of bone erosion in early rheumatoid arthritis: Ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging. Clin Rheumatol. 29:883–891. 2010. View Article : Google Scholar : PubMed/NCBI
30	Orr JD, Sabesan V, Major N and Nunley J: Painful bone marrow edema syndrome of the foot and ankle. Foot Ankle Int. 31:949–953. 2010. View Article : Google Scholar : PubMed/NCBI
31	McQueen FM and Ostendorf B: What is MRI bone oedema in rheumatoid arthritis and why does it matter? Arthritis Res Ther. 8:2222006. View Article : Google Scholar : PubMed/NCBI
32	Szopińska I, Kontny E, Maśliński W, Sobieszek M, Warczyńska A and Kwiatkowska B: Significance of bone marrow edema in pathogenesis of rheumatoid arthritis. Pol J Radiol. 78:57–63. 2013. View Article : Google Scholar
33	Schett G and Gravallese E: Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment. Nat Rev Rheumatol. 8:656–664. 2012. View Article : Google Scholar : PubMed/NCBI
34	Jimenez-Boj E, Nöbauer-Huhmann I, Hanslik-Schnabel B, Dorotka R, Wanivenhaus AH, Kainberger F, Trattnig S, Axmann R, Tsuji W, Hermann S, et al: Bone erosion and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum. 56:1118–1124. 2007. View Article : Google Scholar : PubMed/NCBI
35	Magnani M, Salizzoni E, Mulè R, Fusconi M, Meliconi R and Galletti S: Ultrasonography detection of early bone erosion in the metacarpophalangeal joints of patients with rheumatoid arthritis. Clin Exp Rheumatol. 22:743–748. 2004.PubMed/NCBI
36	Hoving JL, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S, Bird P and Connell D: A comparison of magnetic resonance imaging, sonography and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol. 31:663–675. 2004.PubMed/NCBI
37	Alvarez-Nemegyei J and Canoso JJ: Evidence-based soft tissue rheumatology: III: Trochanteric bursitis. J Clin Rheumatol. 10:123–124. 2004. View Article : Google Scholar : PubMed/NCBI
38	Harcke HT, Grissom LE and Finkelstein MS: Evaluation of the musculoskeletal system with sonography. AJR Am J Roentgenol. 150:1253–1261. 1988. View Article : Google Scholar : PubMed/NCBI
39	Kannegieter NJ: Chronic proliferative synovitis of the equine metacarpophalangeal joint. Vet Rec. 127:8–10. 1990.PubMed/NCBI
40	Barile A, Sabatini M, Iannessi F, Di Cesare E, Splendiani A, Calvisi V and Masciocchi C: Pigmented villonodular synovitis (PVNS) of the knee joint: magnetic resonance imaging (MRI) using standard and dynamic paramagnetic contrast media. Report of 52 cases surgically and histologically controlled. Radiol Med. 107:356–366. 2004.PubMed/NCBI
41	Kasukawa R, Takeda I, Iwadate H and Kanno T: Ultrasonographic evaluation of synovial effusion and synovial proliferation pattern in the knee joints of patients with rheumatoid arthritis. Mod Rheumatol. 12:64–68. 2002. View Article : Google Scholar : PubMed/NCBI
42	Ong CK, Lirk P, Tan CH and Seymour RA: An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res. 5:19–34. 2007. View Article : Google Scholar : PubMed/NCBI
43	Gaffo A, Saag KG and Curtis JR: Treatment of rheumatoid arthritis. Am J Health Syst Pharm. 63:2451–2465. 2006. View Article : Google Scholar : PubMed/NCBI
44	Gorter SL, Bijlsma JW, Cutolo M, Gomez-Reino J, Kouloumas M, Smolen JS and Landewé R: Current evidence for the management of rheumatoid arthritis with glucocorticoids: A systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 69:1010–1014. 2010. View Article : Google Scholar : PubMed/NCBI
45	Vlieland TP and Van den Ende CH: Nonpharmacological treatment of rheumatoid arthritis. Curr Opin Rheumatol. 23:259–264. 2011. View Article : Google Scholar : PubMed/NCBI