value of magnetic resonance sialography and magnetic resonance imaging versus conventional sialography of the parotid gland in the diagnosis and staging of Sjogren's syndrome

The conventional sialography [CS] and minor salivary gland biopsy have been considered the cornerstones of the diagnosis of Sjogren's syndrome [SS]. However, they are invasive and with risk of complications to the patient. Magnetic resonance imaging [MRI] has been widely replacing conventional invasive examinations. They provide insufficient data for diagnosing and staging SS, because while they address the detection and diagnosis of parenchymal salivary gland disease they do not assess duct abnormalities. The introduction of magnetic resonance sialography [MRS] protocol was the first step towards non-ionizing non-invasive technique enables a more accurate assessment of the duct system. Moreover, it is postulated that the combined use of MRI and MRS is useful for the assessment of damaged salivary glands in SS. This preliminary study aimed to assess the role and efficacy of MRS and MRI in imaging the parotid gland in SS patients' and to compare their results with that of CS in the diagnosis and staging of SS. The parotid gland was examined by MRS, MRI and CS in 15 SS patients. Scoring system for overall branching pattern, ductal system staging, sialectasis for both CS and MRS was used. MRI scoring system for glandular parenchymal pattern, size and contour and lymph node was used. This revealed non-significant difference between CS and MRS findings in the diagnosis and staging of SS. Furthermore, no statistically significant correlation was found between the clinical and SS stage in both CS and MRS. On the other hand, a statistically significant positive correlation was found between the clinical findings and the MRI parenchymal stages. Moreover, MRS showed higher sensitivity and diagnostic accuracy values than CS. Combining the MRS and MRI abnormalities, 100% sensitivity diagnostic accuracy values were achieved in the diagnosis and staging of SS. The inter-observer agreement was higher in MRS than in CS and was perfect in MRI. In this preliminary study, MRS showed a higher sensitivity and accuracy in diagnosing and staging SS and may safely and securely replace CS. MRI and MRS give information on different aspects of glandular and duct pathology; therefore, both should be performed when examining the parotid glands in SS patients

MRI hand and foot in early rheumatoid arthritis with normal conventional radiography in correlation to DAS-3

The primary aim of the study was to detect the MRI changes in hand and foot in patients with early rheumatoid arthritis [RA] who had normal conventional radiography of both hands and feet. The secondary aim was to detect any correlation between the MRI changes and the disease activity score with three variables [DAS-3]. Thirty adult patients with early RA, fulfilling the 1987 revised American College of Rheumatology [ACR] criteria for the classification of RA, with disease duration between 2-6 months were recruited in the study. All patients underwent a full history taking and thorough rheumatological examination. Disease activity score with three variables [DAS-3], including the Ritchie articular index [RAI], swollen joint count [SJC] and ESR, was calculated to every patient. Routine laboratory investigations were done. Normal conventional radiography of hands and feet was an inclusion criterion. MRI to the clinically dominant hand and foot was done to every patient. 29 patients [96.7%] had MRI changes consistent with the inflammation and destruction. MRI changes were found in 66.7% of patients in hand and foot, in 20% in foot and in 10% in hand. SJC and ESR were statistically elevated in patients with MRI changes in hand and foot, in comparison with those with either hand or foot. The detected MRI changes were synovitis in 93.3%, erosions in 60%, bone marrow edema in 83.3%, tenosynovitis in 76.7% and foot bursitis in 66.7% of patients. According to the anatomical distribution, synovitis was detected in wrist joint in 76.7%, in MCP joints in 70%, in hindfoot joints in 60% and in MTP joints in 83.3% of patients. Erosions in wrist were detected in 40%, in MCP in 43.3%, in hindfoot in 36.7% and in MTP in 40% of patients. Bone marrow edema which is a unique MRI finding was detected in wrist in 66.7%, in MCP in 60%, in both hindfoot and MTP in 70% for each of patients. Tenosynovitis was detected in hand in 60% and in foot in 66.7% of patients. MRI hand and foot is an important imaging modality. It detected the pathologic manifestations at the early stages of RA especially the bone marrow edema that contains information about initial inflammatory activity and the potential for erosion development. Early disclosure of these pathological findings by MRI helps in initiating early aggressive therapy to keep the functional outcome. No correlation was found between the DAS-3 and MRI findings except the ESR which was statistically elevated in patients with erosion. This reinforced the importance of MRI in early RA. Also, MRI foot is important in early RA being involved alone in fifth of our patients

Joint involvement in asymptomatic Egyptian patients with HCV infection; ultrasonographic study

This case control diagnostic ultrasonographic study was undertaken to detect the presence of early articular and peri-articular involvement in Egyptian patients infected with hepatitis C virus [HCV] without any articular manifestation. The knee, hip and shoulder were evaluated clinically and by ultrasonography in a cohort of fifty patients with HCV without any current or previous articular manifestations in comparison with twenty healthy controls who were negative for HCV and HBV infections. Ultrasonographic alterations were detected in 96% of the HCV patients with highly significant difference in comparison to controls [p < 0.000]. Slight inflammatory changes were found in all the joints examined more than the moderate or severe changes. The knee and shoulder joints were involved in 74% of the HCV patients for each and the hip in 68%. There were higher prevalence and highly significant differences as regard the knee synovial thickening and effusion, hip effusion, trochanteric bursitis, supraspinatus tendon fluid collection and acromioclavicular joint effusion in comparison to the control group. Our study demonstrated the presence of joint changes in near all the asymptomatic patients with HCV with the prevalence of slight inflammatory alterations that can be explained by the presence of sub-clinical synovitis as well as the presence of significant changes in some of peri-articular structures. In countries like Egypt, the HCV is an endemic disease, so it is thus recommended that patients with rheumatic symptoms should be tested for the HCV infection and conversely that sign and symptoms of articular involvement should be evaluated in HCV patients