RPS 1410a - Spine and inflammatory disorders

Purpose:

To validate the relationship of the RA MRI scoring system (RAMRIS) and the Sharp/Van der Heijde score on radiography with 28-joint count disease activity score (DAS28) in therapy-naive patients with RA.

Methods and materials:

We analysed radiograph and MRI data of unilateral wrist and metacarpophalangeal (MCP) joints in 408 patients with newly diagnosed rheumatoid arthritis. Two readers scored synovitis, bone marrow oedema, bone erosion, joint space narrowing, and tenosynovitis according to RAMRIS. Radiographs were scored according to the SvH method. Correlations between RAMRIS, SvH scores, and DAS28 were determined. Low to moderate (≤5.1) and high (>5.1) disease activity were divided. The differences of RAMRIS and SvH scores in the 2 groups were compared.

Results:

Synovitis, tenosynovitis, and MCP (2-5) scores were positively associated with DAS28 (all p<0.05). The tenosynovitis and MCP (2-5) scores of the low to moderate disease activity groups (7.93 ± 3.97, 11.21 ± 5.3, respectively) were significantly lower than those of the high disease activity group (10.11± 4.47, 13.97 ± 5.25, respectively) (P=0.021 and P=0.025, respectively). The total scores of RAMRIS in the high disease activity group (39.19 ± 18.24) were significantly different from those of the low to moderate disease activity groups (32.48 ± 20.52, P=0.025)

Conclusion:

Synovitis, tenosynovitis, and MCP scores can be used to assess the activity of RA. The tenosynovitis, MCP, and total scores of RAMRIS may be helpful for differentiating high, moderate, and low disease activity.

Limitations:

The study only included inpatients and may not be entirely generalisable to other populations. This study was also limited in the evaluation of DAS-28.

Ethics committee approval

Our study was approved by the ethics committee of our hospital and informed consent was obtained.

Funding:

No funding was received for this work.

Purpose:

To create an efficient tool for the semi-automated detection of bone marrow oedema lesions in patients with axial spondyloarthritis (axSpA).

Methods and materials:

MRI examinations of 22 sacroiliac joints of patients with confirmed axSpA-related sacroiliitis (mean SPARCC score: 24.3±26.1) were included in the study. The design of our algorithm is based on Maksymowych et al. evaluation method and consists of the following steps: manual segmentation of bones (T1W sequence), automated detection of reference signal region, sacroiliac joint central lines and ROIs, a division of ROIs into quadrants, and automated detection of inflammatory changes (STIR sequence). As a gold standard, two sets of manual lesion delineations were created. Two approaches to the performance assessment of lesion detection were considered: pixel-wise (detections compared pixel by pixel) and quadrant-wise (quadrant to quadrant). Statistical analysis was performed using Spearman's correlation coefficient.

Results:

The correlation coefficient obtained for pixel-wise comparison of semi-automated and manual detections was 0.87 (p=0.001, 95% CI 0.83-0.92), while for quadrant-wise analysis was 0.83 (p=0.001, 95% CI 0.75-0.89). The correlation between two sets of manual detections was 0.91 for pixel-wise comparison (p=0.001, 95% CI 0.86-0.94) and 0.88 (p=0.001, 95% CI 0.82-0.92) for the quadrant-wise approach. Spearman's correlation between two manual assessments was not statistically different from the correlation between semi-automated and manual evaluations, both for pixel- (p=0.14) and quadrant-wise (p=0.17) analysis. The average single-slice processing time was 0.64±0.30 seconds.

Conclusion:

Our method allows for highly objective detection of bone marrow oedema lesions in patients with axSpA. The quantification of both affected pixels and quadrants using our semi-automated algorithm have comparable reliability to manual assessment.

Limitations:

Time-consuming manual segmentation of bones.

Ethics committee approval

Jagiellonian University Bioethics Comittee approval No.1072.6120.16.2019.

Funding:

No funding was received for this work.

Purpose:

To calculate values of an effective radiation dose given by tin-filtrated ultra-low dose computed tomography (TFULDCT) in a cohort of patients referred with suspected sacroiliitis. For comparison, the effective radiation doses given by x-ray in the same group were calculated. We evaluated the accuracy of TFULDCT and x-ray for detecting bone changes in sacroiliac joints (SI).

Methods and materials:

Effective radiation dose was calculated by an experienced radiation physicist using ImpactDose 2.3, patient model-real patient data (CT Imaging GmbH, Germany), and PCXMC 2.0 (x-ray, STUK Finland). Datasets of 30 consecutive patients examined by TFULDCT and x-ray were evaluated independently by 3 radiologists. Every investigator blindly evaluated the CT and x-ray studies and decided whether the finding was positive, negative, or uncertain for sacroiliitis. The results were statistically evaluated.

Results:

The median value of an effective radiation dose received by TFULDCT of SI joints in our cohort was 0.11 mSv (0.06-0.34 mSv). The median of an effective radiation dose for x-ray in the same patient cohort was 0.22 mSv (0.09-0.58 mSv). CT provides a statistically significantly more reliable distinction between positive and negative cases than x-ray. X-ray had a greater number of unclear findings.

Conclusion:

Our results show that TFULDCT significantly reduces the effective radiation dose and in the examination of SI joints achieves lower values than an x-ray. TFULDCT can be used for monitoring patients with axial spondylartitis because it has a high accurancy in assessing the bone changes and does not burden patients with a high radiation dose.

Limitations:

n/a

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

Abdominal aortic aneurysms (AAA) affect vascular perfusion of the lumbar spine by compromising its direct vascular supply. AAA treatment with endovascular aortic aneurysm repair (EVAR) completely occludes the direct vascular supply to the lumbar spine. We hypothesised that patients with AAA and patients with EVAR show a different pattern of spinal degeneration compared to controls without AAA.

Methods and materials:

Patients who underwent EVAR with computed tomography images (CT) >6 months prior (n=52), at the time of EVAR (n=100), and >1 year after EVAR (n=100) were included and compared to an age- and gender-matched control group without AAA (n=94). Degeneration scores, levels with the most severe degeneration, and levels with the progression of degeneration were analysed in CT and compared at different time points. Statistics included Fisher’s exact test, Wilcoxon's signed-rank test and a Mann-Whitney U test.

Results:

Levels of most severe degeneration were located more commonly in the mid-lumbar area in AAA patients compared to control subjects (p=0.016) with significantly more endplate erosions (p=0.001). However, EVAR did not result in an additional accelerated degeneration.

Conclusion:

AAA is associated with atypical location of lumbar spinal degeneration at the mid-lumbar segments, but EVAR does not seem to additionally accelerate the degenerative process. This observation underlines the importance of disc and endplate vascularisation in the process of spinal degeneration.

Limitations:

The retrospective design.

Ethics committee approval

The ethical committee approved this retrospective study.

Funding:

No funding was received for this work.

Purpose:

In the course of rheumatoid arthritis (RA) there may occur irreversible inflammatory-destructive changes within joints. In later stages of RA, joint pain often results from destructive changes instead of an active inflammatory process in the synovial membrane. The aim of this study was to assess the cause of joint pain in patients with long-standing RA (LSRA) in whom low disease activity was diagnosed through a disease activity score (DAS28).

Methods and materials:

53 patients with RA were enrolled in the study, each with low disease activity (DAS28 (CRP) <3.2) and disease history of 8 years or more. Participants had their metacarpophalangeal (MCP) II-V and proximal interphalangeal (PIP) I-V joints evaluated through physical examination. Joints exhibiting pain were further subjected to power Doppler ultrasound (PDUS) and grey-scale ultrasound (GSUS) examination.

Results:

954 joints in total were evaluated through physical examination, with pain found in 218 (22%) joints in 41 (77%) patients. In 218 joints examined through PDUS, an active inflammatory process was found in 171 (78%) joints. In the remaining 47 (22%) joints, the pain was related to irreversible destructive changes, including the presence of bone erosion in radiographs and membrane hypertrophy determined via GSUS. In the group of 41 patients with joint pain determined through physical examination, in 6 (15%) it was related to the presence of irreversible destructive changes and not an active inflammatory process.

Conclusion:

US examination allows the designating of patients with LSRA in whom joint pain is connected with irreversible destructive changes in joints. In such a patient group, it may be advisable to terminate or alter the standard therapy for patients with active RA.

Limitations:

A small study group.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To investigate the significance of lumbrical muscle enhancement (LME) in patients with hand arthralgia.

Methods and materials:

Blinded to the diagnoses, dynamic contrast-enhanced bilateral hand MRIs of 100 patients (F:M=88:12) with hand arthralgia taken from 2014-2019, using 3.0T and 1.5T scanners, were retrospectively evaluated by 2 radiologists for the presence of LME. When identified, the degree of enhancement was graded as weak or strong.

Patients were stratified in 3 groups according to their final diagnoses as rheumatoid arthritis (RA)(n=41), control (fibromyalgia, osteoarthritis(OA), and rheumatological disease-ruled out cases)(n=31), and other arthritides groups (n=28)(spondyloarthropathy, Behçet’s, Sjögren’s, erosive OA, systemic lupus erythematosus, dermatomyositis, and polymyalgia rheumatica).

Categorical variables were compared by using Chi-Square/Fisher’s exact tests. The difference among groups for continuous variables was evaluated by one-way ANOVA/Kruskal Wallis ANOVA. A multiple comparison test was used to know which groups differed from others where applicable. The agreement between raters was assessed by Cohen’s Kappa(κ) statistic. P values <0.05 were considered significant.

Results:

The mean patient age was 47.2±11.2. Age and gender were not significantly different among groups (p=0.17, p= 0.84, respectively). The RA group showed significantly more (p<0.001) and a stronger degree of enhancement (p=0.001) with substantial inter-rater-correlations for right and left hands (κ=0.739, κ=0.671, respectively, p<0.001). Right hands of RA and control patients showed significantly more LME (p=0.001, p=0.033, respectively).

Conclusion:

In comparison to controls and other arthritides cases, RA patients demonstrated a significantly higher rate and degree of LME on MRIs with substantial inter-rater-correlations. This could indicate a subtle but important radiological clue for the diagnosis and differential diagnosis of RA.

Limitations:

Due to the difficulty in recruiting patients with definitely established diagnoses, patient numbers were low in the arthritides group for individual disease analyses.

Ethics committee approval

Hospital Ethics Review Board approval was obtained.

Funding:

No funding was received for this work.

Purpose:

To determine whether T2-mapping of the sacroiliac joints (SIJs) might help to identify patients with spondyloarthritis.

Methods and materials:

This pilot study included 21 biologic-naive patients with axial spondyloarthritis (10 males; mean age=43±12years; range=19-57) and 21 controls (14 males; mean age=34±10; range=28-71) who prospectively underwent SIJs MRI at 1.5T, including a multislice multi-echo spin-echo sequence. Standard MRIs were reviewed to assess the SIJs according to the assessment of spondyloarthritis international society (ASAS) criteria and spondyloarthritis research consortium of Canada (SPARCC) MRI index. T2 maps were used to draw regions of interests in the cartilaginous part of the SIJs. Disease activity was assessed using a BASDAI questionnaire. The Bland-Altman method, ROC curve analysis, Chi-square, Mann-Whitney U, Pearson’s and Spearman's correlation coefficient were used for data analysis.

Results:

MRI was positive for sacroiliitis in 6/21 patients (29%). Interobserver reproducibility of T2 values was 88% (coefficient of repeatability=5.9, bias=0.96, p<0.001). Mean T2 values of patients (59.2±2.9ms, range: 54.3-66.3ms) were significantly higher (p<0.001) than those of controls (39.6±3.4ms, range: 33.6-46.6ms). A T2 value of 50.5ms yielded 100% sensitivity and 100% specificity to differentiate patients from controls. Mean T2 values on the iliac side of the SIJs of patients (62.8±9.8 ms) were significantly higher than on the sacral side (56.4±11.3 ms; p<0.001). No significant association/correlation was found between T2 values and BASDAI, disease duration, SPARCC, ASAS criteria, HLA-B27-positivity, age, and gender (p≥0.197).

Conclusion:

T2 values of the SIJs were significantly higher in patients than in healthy controls, making this tool potentially helpful for early identification of patients with spondyloarthritis.

Limitations:

A small sample size and a lack of follow-up.

Ethics committee approval

IRB approval was obtained. All patients provided their written informed consent.

Funding:

No funding was received for this work.

Purpose:

To evaluate the reduction of metal artefacts in patients with titanium peduncular screws at spine level using standard acquisitions, monoenergetic images (mono-E), and monoenergetic image + MARS (mono-E+MARS) acquired with dual-energy computed tomography (CT).

Methods and materials:

25 patients (15 women, 10 men) who had undergone vertebral stabilisation with titanium peduncular screws were studied using dual-energy CT (GE, Discovery 750 HD) with standard acquisitions (QC), 100 to 140 keV monoenergetic reconstructions and 140keV+MARS reconstruction.

A quantitative evaluation was performed using ROI to measure attenuation (Hounsfield Unit (HU)) at the most hyperdense and most hypodense artefacts caused by titanium peduncular screws.

A qualitative analysis was also performed based on subjective evaluation by two radiologists in terms of image quality and the reduction of artefacts.

Results:

A comparison of the mean attenuation values showed a significant (p<0.0001) reduction of artefacts in 140keV+MARS images compared to monoenergetic and conventional images at the level of the most hyperdense and hypodense artefacts.

Monoenergetic reconstructions showed a significant (p<0.0001) reduction of artefact compared to conventional images.

Monoenergetic images were qualitatively richer in diagnostic information.

Conclusion:

Mono-E+MARS showed a quantitatively greater reduction of artefacts from titanium peduncular screws at spine level, although monoenergetic images were better from a diagnostic point of view.

Limitations:

The retrospective nature of the study.

Ethics committee approval

We obtained ethics committee approval.

Funding:

No funding was received for this work.