Ultrasound Doppler Score Correlates with OMERACT RAMRIS Bone Marrow Oedema and Synovitis Score in the Wrist Joint of Patients with Rheumatoid Arthritis

Zusammenfassung

Ziel: Das MRT gilt als Goldstandard für moderne Bildgebung bei rheumatoider Arthritis (RA). Trotzdem werden in der klinischen Routine der höheren Flexibilität wegen Patienten häufig mit Ultraschall (US) bzw. Doppler zur raschen Bewertung von Arthritiden untersucht. Ziel der Studie war der Vergleich von Niedrigfeld-MRT-Scores mit US-Doppler-Messungen an Handgelenken von Patienten mit RA. Material und Methoden: Die Handgelenke von 50 Patienten mit RA (46 Frauen und 4 Männer) wurden mit Niedrigfeld-Extremitäten-MRT (E-scan®, Esaote) und einem High-End-US-Gerät (Sequioa®, Siemens) vor dem Beginn einer Therapie mit einer biologischen Substanz (Biological, n = 26) oder der intraartikulären Injektion mit Depomedrole® (n = 24) untersucht. Das mittlere Alter war 56 Jahre (21 – 83 Jahre); die mittlere Krankheitsdauer lag bei 87,2 Monaten (4 – 349 Monate), der mittlerer DAS 28 war 4,8 (2 – 7). Das MRT wurde entsprechend der OMERACT-RAMRIS-Empfehlungen ausgewertet und US-Doppler-Colour-Fractions wurden bestimmt. Ergebnisse: Anhand Spearman’s Rho ergab sich eine relativ gute bis moderate Korrelation zwischen der US-Colour-Fraction und dem MRT-basierten OMERACT-Knochenmarksödem und Synovitis-Score (r = 0,6; p < 0,001 bzw. r = 0,4; p < 0,006). Es gab einen Trend, jedoch keine signifikante Korrelation mit dem OMERACT-Score für Gelenkserosion (r = 0,3; p = 0,06). Schlussfolgerung: Die OMERACT-RAMRIS-Scores für Inflammation bei RA-Patienten (Knochenmarksödem und synoviales Enhancement) sind in Grenzen mit den mittels High-End-Gerät bestimmten US-Colour-Fractions vergleichbar. Inflammatorische Prozesse können mit beiden Bildgebungsmodalitäten detektiert werden, obschon sie unterschiedliche Aspekte des Entzündungsprozesses des Handgelenks darstellen. Die gute Korrelation von US-Colour-Fractions zum MRT bewerteten Knochenmarksödem spricht für die positive Wertigkeit des US-Dopplers zur Beurteilung entzündlicher Veränderungen bei RA.

Abstract

Purpose: MRI is considered the standard of reference for advanced imaging in rheumatoid arthritis (RA). However, in daily clinical practice ultrasound (US) imaging with Doppler information is more versatile and often used for fast and dynamic assessment of joint inflammation. The aim was to compare low-field MRI scores with the US Doppler measurements in the wrist joint of patients with RA. Material and Methods: Fifty consecutive patients with RA (46 women & 4 men) completed both low-field dedicated extremity MRI (E-scan®, Esaote) and a high-end US (Sequioa®, Siemens) imaging of the wrist before initiating either biological treatment (n = 26) or intraarticular injection of Depomedrole® (n = 24). Mean age was 56 years (range 21 – 83 years); mean disease duration 87.2 months (range 4 – 349 months), mean DAS 28 4,8 (range 2 – 7). MRI was scored according to the OMERACT RAMRIS recommendations and US Doppler colour-fractions were determined. Results: Using Spearman’s rho, we found a relatively good to moderate correlation between the US colour-fraction and the total OMERACT bone marrow oedema and synovitis scores on MRI (r = 0.6; p < 0.001 and r = 0.4; p < 0.006 respectively). There was a trend but no significant correlation with the total OMERACT erosion score (r = 0.3; p = 0.06). Conclusion: Within limits, the OMERACT RAMRIS scores of inflammation in RA patients (bone marrow oedema and synovial enhancement) are comparable to the US colour-fraction measurements using a high-end US scanner. Both imaging modalities detect inflammation although showing different aspects of the inflammatory process in the wrist joint. The higher correlation between US colour-fractions and MRI bone marrow oedema indicates a potential importance of US Doppler in monitoring inflammatory disease changes in RA.

Key words

MR-imaging - ultrasound-color doppler - rheumatoid arthritis - synovitis - bone marrow oedema

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