Ultra-low-dose CT detects synovitis in patients with suspected rheumatoid arthritis. Issue 1 (29th September 2018)

• Record Type: Journal Article
• Authors: Diekhoff, Torsten; Ulas, Sevtap Tugce; Poddubnyy, Denis; Schneider, Udo; Hermann, Sandra; Biesen, Robert; Burmester, Gerd R; Hamm, Bernd; Hermann, Kay Geert
• Is Part Of: Annals of the rheumatic diseases. Volume 78:Issue 1(2019)
• Page Start: 31
• Page End: 35
• Publication Date: 2018-09-29
• Subjects: computed tomography -- synovitis -- rheumatoid arthritis; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-213904
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Purpose: To prove the feasibility and measure the diagnostic accuracy of contrast-enhanced ultra-low-dose CT (ULD-CT) for the depiction of inflammatory soft-tissue changes (synovitis, tenosynovitis and peritendonitis) in patients with arthritis of the hand. Materials and methods: In this institutional review board–approved study, 36 consecutive patients over the age of 50 with suspected rheumatoid arthritis underwent ULD-CT (estimated radiation exposure <0.01 mSv) and MRI of the hand with weight-adapted intravenous contrast administration. ULD-CT subtraction and MR images were assessed for synovitis, tenosynovitis and peritendonitis by three readers using a modified Rheumatoid Arthritis MRI Score (RAMRIS). Patients were asked which modality they would prefer for future examinations. Sensitivity and specificity of ULD-CT for detection of inflammatory changes were calculated using MRI as standard of reference. The sum scores were correlated using Pearson's r. Results: All 36 patients showed synovitis in MRI. ULD-CT had 69% sensitivity on the patient level and 65% on the joint level with 87% specificity. Sensitivity was higher in patients with more severe inflammation (80% for MRI RAMRIS >1). There was almost perfect correlation between the modified RAMRIS sum scores of ULD-CT and MRI (Pearson's r=0.94). Regarding preferences for future examinations, 85% preferred ULD-CT over MRI. ULD-CT detected more differential diagnoses than MRI (8 vs 2/12). Conclusion: Contrast-enhanced ULD-CT of the hand allows for depiction of soft-tissue inflammation at the hand and can be achieved using very low radiation exposure (<0.01 mSv). ULD-CT may evolve to a fast and comfortable alternative to MRI, although it is not as sensitive as MRI for detecting mild disease.