Ultrasound versus contrast-enhanced magnetic resonance imaging for subclinical synovitis and tenosynovitis: a diagnostic performance study

OBJECTIVES: Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS: The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS: The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0-0.83 and ultrasound had a likelihood of 0-0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION: Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis.

Tenosynovitis and rheumatoid nodules in tendons of hands and feet using high frequency ultrasonography and ower doppler sonography

Evaluation of disease activity and therapeutic response in patients with rheumatoid arthritis [RA] was based largely on the clinical findings. Conventional sonography provides accurate method for identification of the tendons changes with RA. The study included 69 patients with RA. Sonographic examination of the tendons in both hands and feet was performed by using B-mode real-time machines [ACUSON SEQUOIA 512, probe 7.5 MHZ]. Rheumatoid nodu1es were detected in 15 patients [21.7%]. The flexor tendons were affected mainly by tenosynovitis and nodules. The ultrasonography identified the RA tendon nodules that can not be detected by clinical examination. Ultrasonography shou1d be considered the screening procedure of choice for the diagnosis of rheumatoid inpalpable nodules in the tendons of hands and feet. It gives good information about the inflammatory synovitis and general idea about the tendon texture, that provides an objective assessment of the treatment efficacy