Synovitis maps for the assessment of inflammatory disorders of the hand

Transcription

1 Synovitis maps for the assessment of inflammatory disorders of the hand Poster No.: B-754 Congress: ECR 2010 Type: Scientific Paper Topic: Musculoskeletal Authors: C. A. Karlo 1, M. Zanetti 1, P. Stolzmann 1, I. Steurer-Dober 2, F. Keywords: DOI: Brunner 1, J. Hodler 1, C. W. A. Pfirrmann 1 ; 1 Zurich/CH, 2 Luzern/CH synovitis maps, flash, mri /ecr2010/B-754 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Purpose To evaluate the diagnostic accuracy of synovitis maps derived from a 3D-fast low angle shot (FLASH) sequence, usually used for MR angiography, to assess articular synovitis and tenosynovitis of the hand. Methods and Materials 80 hands in 40 patients (mean age, 48 years; range,15-72 years; 14 male) were assessed on conventional MR images (transverse T1w, coronal intermediate weighted, transverse and coronal T1w with fat saturation after i.v. gadobutrol) and synovitis maps derived from a FLASH sequence for the presence or absence of synovitis by two readers independently. Reader1 (R1) was a fellowship trained musculoskeletal radiologist, reader2 (R2) a staff rheumatologist. Reporting times and diagnostic confidence (scale: 1=least, 5=most confident) for all assessments were measured. Results from an assessment of a panel of senior staff musculoskeletal radiologists using all imaging and clinical data served as the standard of reference for data analysis. Results Sensitivity and specificity for the detection of articular synovitis was 0.91/1.00 (R1) and 1.00/0.67 (R2) on conventional MRI (cmri) and 0.87/0.75 (R1) and 0.91/0.45 (R2) on synovitis maps (SM). Sensitivity and specificity for the detection of tenosynovitis was 0.95/0.63 (R1) and 0.67/0.79 (R2) on cmri and 0.67/0.89 (R1) and 0.38/1.00 (R2) on SM. Mean review times (cmri / SM, sec) were 142/37(R1) and 167/25(R2). Mean diagnostic confidence (cmri / SM) was 3.7/3.4 (R1) and 3.2/3.5 (R2) for articular synovitis and 4.0/4.0 (R1), 3.3/3.7 (R2) for tenosynovitis. Conclusion Synovitis maps provide a fast overview of all locations with synovitis and tenosynovitis of the hand. Images for this section: Page 2 of 8

3 Fig. 1: 52-year-old male patient suffering from rheumatoid arthritis. Contrast enhanced coronal and transverse T1-weighted images after fat saturation depicting hyperintense signal alterations at the flexor tendon sheaths II-V on the right and hyperintense signal at the metacarpo-phalangeal joints II-IV. The synovitis map shows the enhancement pattern of tenosynovitis as the typical "tram line" sign and provides an overview of additional articular synovitis locations. Page 3 of 8

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7 37. Hoving JL, Buchbinder R, Hall S, et al. A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol 2004; 31: Klarlund M, Ostergaard M, Jensen KE, Madsen JL, Skjodt H, Lorenzen I. 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: Peterfy CG. MRI of the wrist in early rheumatoid arthritis. Ann Rheum Dis 2004; 63: Tehranzadeh J, Ashikyan O, Anavim A, Tramma S. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skeletal Radiol 2006; 35: Eshed I, Feist E, Althoff CE, et al. Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology (Oxford) Lard LR, Visser H, Speyer I, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001; 111: Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2004; 43: Personal Information Karlo C, MD 1,2, Zanetti M, MD 1, Stolzmann P, MD 2, Steurer-Dober I, MD 1,3, Brunner F, MD 4, Hodler J, MD, MBA 1, Pfirrmann CWA, MD 1 1 Department of Radiology, University Hospital Balgrist, Zurich / CH 2 Institute for Diagnostic Radiology, University Hospital Zurich / CH 3 Department of Radiology, Kantonsspital Luzern / CH 4 Department of Rheumatology, University Hospital Balgrist, Zurich / CH Corresponding Author: Page 7 of 8

8 Christoph Karlo, MD Institute for Diagnostic Radiology University Hospital Zurich Rämistrasse Zurich / Switzerland Tel.: mailto: christoph.karlo@usz.ch Page 8 of 8