Stern Christoph, Feuerriegel Georg C, Germann Christoph, Sommer Stefan, Nanz Daniel, Sutter Reto
Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Eur J Radiol. 2025 Feb;183:111856. doi: 10.1016/j.ejrad.2024.111856. Epub 2024 Dec 3.
To evaluate the interest of additional pseudo-CT images to standard clinical contrast-enhanced MR images (CE-MRI) in the detection of inflammatory erosions and to differentiate them from intraosseous ganglia at the finger joints.
47 prospectively included patients with suspected or diagnosed rheumatoid arthritis received a CE-MRI of the fingers. Additionally, pseudo-CT images were derived from non-contrast MRI (pCT) and from contrast-enhanced MRI data (CE-pCT) using a high-resolution gradient-echo 3D fast low-angle shot sequence (FLASH), respectively. CE-MRI, pCT, and CE-pCT images were evaluated for erosions and intraosseous ganglia at the metacarpophalangeal and proximal interphalangeal joints by two musculoskeletal radiologists. Findings were defined on CE-MRI by an experienced independent 3rd reader which served as reference standard. Diagnostic confidence (1 = worst, 4 = best) was rated for 3 different image sets (1 = CE-MRI, 2 = CE-MRI + pCT, 3 = CE-MRI + CE-pCT) and compared.
Reference standard revealed 44 erosions and 37 intraosseous ganglia on CE-MRI. Diagnostic confidence for CE-MRI was moderate for erosions (both readers) and intraosseous ganglia (reader 2). For the combination of CE-MRI and pCT, high confidence levels were observed for erosions for both readers (median 3 (Q1-Q3: 2.5-3) and 3 (3-3); p<.001 and p<.001) and for intraosseous ganglia for reader 2 (3 (3-3); p<.001). CE-MRI combined with CE-pCT showed very high confidence levels for both readers for erosions (4 (3-4) and 4 (4-4); p<.001 and p<.001) and for intraosseous ganglia (4 (4-4) and 4 (4-4); p<.001 and p<.001).
Pseudo-CT combined with CE-MRI increases the confidence in detection of inflammatory erosions at the finger joints, with CE-pCT being superior to pCT.
评估在检测炎性侵蚀以及区分手指关节处的炎性侵蚀与骨内腱鞘囊肿方面，额外的伪CT图像相对于标准临床对比增强磁共振成像（CE-MRI）的价值。
47例前瞻性纳入的疑似或确诊类风湿关节炎患者接受了手指的CE-MRI检查。此外，分别使用高分辨率梯度回波三维快速低角度激发序列（FLASH）从非对比MRI（pCT）和对比增强MRI数据（CE-pCT）中获取伪CT图像。两名肌肉骨骼放射科医生对CE-MRI、pCT和CE-pCT图像进行掌指关节和近端指间关节处侵蚀及骨内腱鞘囊肿的评估。由一位经验丰富的独立第三方阅片者在CE-MRI上确定结果，作为参考标准。对三种不同图像集（1 = CE-MRI，2 = CE-MRI + pCT，3 = CE-MRI + CE-pCT）的诊断信心（1 = 最差，4 = 最佳）进行评分并比较。
参考标准显示CE-MRI上有44处侵蚀和37个骨内腱鞘囊肿。对于侵蚀（两位阅片者）和骨内腱鞘囊肿（阅片者2），CE-MRI的诊断信心为中等。对于CE-MRI和pCT的组合，两位阅片者对侵蚀的信心水平较高（中位数3（四分位间距：2.5 - 3）和3（3 - 3）；p <.001和p <.001），阅片者2对骨内腱鞘囊肿的信心水平较高（3（3 - 3）；p <.001）。CE-MRI与CE-pCT组合对两位阅片者的侵蚀（4（3 - 4）和4（4 - 4）；p <.001和p <.001）和骨内腱鞘囊肿（4（4 - 4）和4（4 - 4）；p <.001和p <.001）均显示出非常高的信心水平。
伪CT与CE-MRI相结合可提高对手指关节炎性侵蚀检测的信心，其中CE-pCT优于pCT。
