Șerban Oana, Fodor Daniela, Papp Iulia, Micu Mihaela Cosmina, Duma Dan Gabriel, Csutak Csaba, Lenghel Manuela, Bădărînză Maria, Albu Adriana
2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca Romania.
Rheumatology Division, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania.
Med Ultrason. 2019 Nov 24;21(4):405-413. doi: 10.11152/mu-2304.
To compare the ultrasonography (US) performance with magnetic resonance imaging (MRI) in identifying pathology in ankles, hindfeet and heels of rheumatoid arthritis (RA) patients and to evaluate the reasons for discordances between the two imaging methods.
RA patients were enrolled and evaluated using the Clinical Disease Activity Index (CDAI) and the Disease Activity Score 28 with C-reactive Protein (DAS28-CRP). The ankle (tibiotalar joint, tendons), hindfoot (talonavicular, subtalar joints) and heel of the most symptomatic or dominant foot (for the asymptomatic patient)were evaluated by two pairs of examiners using US and contrast-enhanced MRI.
Totally, 105 joints, 245 tendons and 35 heels in 35 patients [mean age 59.2±11.25 years old, median disease duration 36 (16.5-114), mean CDAI 19.87±12.7] were evaluated. The interobserver agreements between the two sonographers, and the two radiologists were good and very good (k=0.624-0.940). The overall agreement between US and MRI was very good for subcalcaneal panniculitis (k=0.928, p<0.001), moderate for synovitis (k=0.463, p<0.001) and tenosynovitis (k=0.514, p<0.001), fair for osteophytes (k=0.260, p=0.004), and poor for erosions (k=0.063, p=0.308) and heel's structures. MRI found more erosions, synovitis, osteophytes,tenosynovitis and retrocalcaneal bursitis, but US found more enthesophytes and plantar fasciitis. Many of the discordancesbetween the two imaging techniques have explanations related to the technique itself or definition of the pathologic findings.
US is comparable to MRI for the evaluation of ankle, hindfoot and heel in RA patients and discordances in theinterpretation of the pathological findings/normal structures must be carefully analyzed.
比较超声检查（US）与磁共振成像（MRI）在类风湿关节炎（RA）患者踝关节、后足和足跟病变识别中的表现，并评估两种成像方法结果不一致的原因。
纳入RA患者，采用临床疾病活动指数（CDAI）和含C反应蛋白的28关节疾病活动评分（DAS28-CRP）进行评估。由两组检查人员分别使用US和对比增强MRI对最有症状或病变最明显的足部（无症状患者则为优势足）的踝关节（胫距关节、肌腱）、后足（距舟关节、距下关节）和足跟进行评估。
共评估了35例患者的105个关节、245条肌腱和35个足跟[平均年龄59.2±11.25岁，疾病持续时间中位数36（16.5 - 114），平均CDAI 19.87±12.7]。两位超声检查人员之间以及两位放射科医生之间的观察者间一致性良好及非常好（k = 0.624 - 0.940）。US与MRI之间的总体一致性在跟骨下脂膜炎方面非常好（k = 0.928，p < 0.001），滑膜炎（k = 0.463，p < 0.001）和腱鞘炎（k = 0.514，p < 0.001）方面为中等，骨赘方面为一般（k = 0.260，p = 0.004），侵蚀和足跟结构方面较差（k = 0.063，p = 0.308）。MRI发现更多的侵蚀性病变、滑膜炎、骨赘、腱鞘炎和跟腱后滑囊炎，但US发现更多的附着点骨赘和足底筋膜炎。两种成像技术之间的许多不一致与技术本身或病理表现的定义有关。
在评估RA患者的踝关节、后足和足跟方面，US与MRI相当，必须仔细分析病理表现/正常结构解释中的不一致情况。
