Døhn Uffe Møller, Ejbjerg Bo J, Court-Payen Michel, Hasselquist Maria, Narvestad Eva, Szkudlarek Marcin, Møller Jakob M, Thomsen Henrik S, Østergaard Mikkel
Department of Rheumatology, University of Copenhagen Hvidovre Hospital, Hvidovre, Denmark.
Arthritis Res Ther. 2006;8(4):R110. doi: 10.1186/ar1995.
The objective of the study was, with multidetector computed tomography (CT) as the reference method, to determine whether bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints detected with magnetic resonance imaging (MRI) and ultrasonography (US), but not with radiography, represent true erosive changes. We included 17 RA patients with at least one, previously detected, radiographically invisible MCP joint MRI erosion, and four healthy control individuals. They all underwent CT, MRI, US and radiography of the 2nd to 5th MCP joints of one hand on the same day. Each imaging modality was evaluated for the presence of bone erosions in each MCP joint quadrant. In total, 336 quadrants were examined. The sensitivity, specificity and accuracy, respectively, for detecting bone erosions (with CT as the reference method) were 19%, 100% and 81% for radiography; 68%, 96% and 89% for MRI; and 42%, 91% and 80% for US. When the 16 quadrants with radiographic erosions were excluded from the analysis, similar values for MRI (65%, 96% and 90%) and US (30%, 92% and 80%) were obtained. CT and MRI detected at least one erosion in all patients but none in control individuals. US detected at least one erosion in 15 patients, however, erosion-like changes were seen on US in all control individuals. Nine patients had no erosions on radiography. In conclusion, with CT as the reference method, MRI and US exhibited high specificities (96% and 91%, respectively) in detecting bone erosions in RA MCP joints, even in the radiographically non-erosive joints (96% and 92%). The moderate sensitivities indicate that even more erosions than are seen on MRI and, particularly, US are present. Radiography exhibited high specificity (100%) but low sensitivity (19%). The present study strongly indicates that bone erosions, detected with MRI and US in RA patients, represent a loss of calcified tissue with cortical destruction, and therefore can be considered true bone erosions.
本研究的目的是以多排螺旋计算机断层扫描（CT）作为参考方法，确定在类风湿关节炎（RA）的掌指（MCP）关节中，通过磁共振成像（MRI）和超声检查（US）检测到但X线摄影未检测到的骨侵蚀是否代表真正的侵蚀性改变。我们纳入了17例RA患者，这些患者至少有一个先前检测到的、X线摄影不可见的MCP关节MRI侵蚀，以及4名健康对照个体。他们均在同一天接受了一只手的第2至第5 MCP关节的CT、MRI、US和X线摄影检查。对每种成像方式在每个MCP关节象限中是否存在骨侵蚀进行评估。总共检查了336个象限。以CT作为参考方法，X线摄影检测骨侵蚀的敏感性、特异性和准确性分别为19%、100%和81%；MRI为68%、96%和89%；US为42%、91%和80%。当从分析中排除16个有X线侵蚀的象限时，MRI（65%、96%和90%）和US（30%、92%和80%）得到了相似的值。CT和MRI在所有患者中均检测到至少一处侵蚀，但在对照个体中未检测到。US在15例患者中检测到至少一处侵蚀，然而，在所有对照个体的US上均可见类似侵蚀的改变。9例患者X线摄影未见侵蚀。总之，以CT作为参考方法，MRI和US在检测RA MCP关节的骨侵蚀方面表现出高特异性（分别为96%和91%），即使在X线摄影无侵蚀的关节中也是如此（96%和92%）。中等的敏感性表明存在比MRI和尤其是US上所见更多的侵蚀。X线摄影表现出高特异性（100%）但低敏感性（19%）。本研究强烈表明，在RA患者中通过MRI和US检测到的骨侵蚀代表钙化组织的丢失和皮质破坏，因此可被认为是真正的骨侵蚀。
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