Aims and objectives
We present the new use of Cone Beam Computed Tomography scanning to image the wrist in patients with Rheumatoid Arthritis as an alternative to Magnetic Resonance Imaging and plain film radiography.
Rheumatoid Arthritis (RA) is a chronic,
systemic,
inflammatory disorder of unknown aetiology that primarily affects the joints.
Left untreated,
the natural history of this arthritis involves progressive destruction of cartilage with bone erosions leading to significant deformity and physical disability.
Early diagnosis and aggressive treatment to achieve disease remission is imperative to prevent this...
Methods and materials
A single centre retrospective study was performed.
Twenty two patients with a diagnosis of RA were imaged with MRI and CBCT and assessed for evidence of erosions of the carpal bones,
the metacarpal bases,
the distal radius and the distal ulna.
No more than three months between the two imaging modalities was allowed.
The first metacarpal base of one patient was excluded as it was unfortunately not included in the in the CBCT field of view.
Validated-Outcome Measures in Rheumatology Clinical Trials/Rheumatoid Arthritis Magnetic Resonance...
Results
Overall,
more erosions wereseen on CBCT than MRI with statisticallysignificant results in several bones.
The mean number of bone erosions detected using CBCT compared to MRI is shown in Table 1.
Reader 1 detected a total of 470 erosions on MRI and 662 erosions on CBCT. Reader 2 detected a total of 728 erosions on MRI and 429 on CBCT.
Reader 1 detected a statisticallysignificant higher mean number of erosions using CBCT compared to MRI in 7 of the 15 bones assessed.
Reader 2 detected...
Conclusion
Cone Beam Computed tomography (CBCT) of the wrist demonstrates more erosions in patients with a diagnosis of Rheumatoid Arthritis (RA) when compared to the current gold standard of Magnetic Resonance Imaging (MRI).
CBCT is potentially a highly valuable technique and its benefits are highlighted by the results of this retrospective audit.
In particular,
results for the pisiform and the fourth and fifth metacarpal bases demonstrate marked difference in the number of erosions detected on CBCT compared to MRI.
We propose that this marked difference may...
Personal information
Elena Trajcevska,
MBBS
Radiology Department,
Austin Health,
Melbourne,
Victoria,
Australia
Claire Owen,
MBBS FRACP
Rheumatology Department,
Austin Health,
Melbourne,
Victoria,
Australia
Russel Buchanan, MBBS FRACP
Associate Clinical Professor,
University of Melbourne.
Rheumatology Department,
Austin Health,
Melbourne,
Victoria,
Australia
Richard Zwar,
MBBS RANZCR
Associate Clinical Professor,
University of Melbourne
Radiology Department,
Austin Health,
Melbourne,
Victoria,
Australia
With kind appreciation of Associate Professor Ruth Lim,
Radiologist,
Austin Health,
for assistance in statistical analysis.
References
McQueen FM.
Imaging in early rheumatoid arthritis.
Best Practice & Research in Clinical Rheumatology.
2013;27(4):499-522.
Ejbjerg BJ,
Vestergaard A,
Jacobsen S,
Thomsen H,
Ostergaard M.
Conventional radiography requires a MRI-estimated bone volume loss of 20% to 30% to allow certain detection of bone erosions in rheumatoid arthritis metacarpophalangeal joints.
Arthritis Research & Therapy.
2006;8(3):R59.
Ostergaard M,
Hansen M,
Stoltenberg M,
Jensen KE,
Szkudlarek M,
Pedersen-Zbinden B,
et al.
New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance...