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European Radiology
Published in: European Radiology 9/2022

Open Access 01-04-2022 | Magnetic Resonance Imaging | Computed Tomography

Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study

Authors: Sevtap Tugce Ulas, Katharina Ziegeler, Sophia-Theresa Richter, Sarah Ohrndorf, Robert Biesen, Fabian Proft, Denis Poddubnyy, Torsten Diekhoff

Published in: European Radiology | Issue 9/2022

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Abstract

Objectives

To investigate the performance of dual-energy CT (DECT)-generated iodine maps (iMap) and CT subtraction (CT-S) in the detection of synovitis, tenosynovitis, and peritendonitis/paratenonitis compared to magnetic resonance imaging (MRI) using musculoskeletal ultrasound (MSUS) as standard of reference.

Methods

This IRB-approved prospective study consecutively investigated patients with undifferentiated arthritis. All patients underwent MSUS, MRI and contrast-enhanced DECT of the hand; from the latter conventional CT-S, image-based iMap (iMap-I) and raw data-based iMap (iMap-RD) were reconstructed. CT and MRI datasets were scored for synovitis and tenosynovitis/paratenonitis applying the modified Rheumatoid Arthritis MRI Score (RAMRIS). Sensitivity, specificity, and diagnostic accuracy were calculated. Non-inferiority was tested using the one-tailed McNemar test. Correlation of sum scores was assessed using Pearson’s test. Interreader reliability was assessed using Cohen’s kappa.

Results

Overall, 33 patients were included. MSUS was positive for synovitis and tenosynovitis/paratenonitis in 28 patients with a sum score of 6.91. Excellent correlation with MSUS was shown for CT-S (sum score 6.38; r = 0.91), iMap-RD (sum score 9.74; r = 0.82), MRI (sum score 12.70; r = 0.85), and iMap-I (sum score 6.94; r = 0.50). CT-S had the highest diagnostic accuracy of 83%, followed by iMap-I (78%), MRI (75%), and iMap-RD (74%). All modalities showed non-inferiority. Reader agreement was good for CT-S and MRI (κ = 0.62; 0.64) and fair for iMap-RD and iMap-I (κ = 0.31; 0.37).

Conclusion

CT-S and iMap allow highly standardized arthritis imaging and are suitable for clinical practice. MSUS still has the highest availability for arthritis imaging and served as gold standard for this study.

Key Points

• CT subtraction, iodine map with dual-energy CT, and MRI showed non-inferiority to musculoskeletal ultrasound.
• MRI was the most sensitive but least specific imaging technique compared with CT subtraction and dual-energy CT.
• CT subtraction showed the best correlation with musculoskeletal ultrasound.
Appendix
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Metadata
Title
Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
Authors
Sevtap Tugce Ulas
Katharina Ziegeler
Sophia-Theresa Richter
Sarah Ohrndorf
Robert Biesen
Fabian Proft
Denis Poddubnyy
Torsten Diekhoff
Publication date
01-04-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-08744-0

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