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

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 o...

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Autores principales: Ulas, Sevtap Tugce, Ziegeler, Katharina, Richter, Sophia-Theresa, Ohrndorf, Sarah, Biesen, Robert, Proft, Fabian, Poddubnyy, Denis, Diekhoff, Torsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9381445/
https://www.ncbi.nlm.nih.gov/pubmed/35359165
http://dx.doi.org/10.1007/s00330-022-08744-0
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author Ulas, Sevtap Tugce
Ziegeler, Katharina
Richter, Sophia-Theresa
Ohrndorf, Sarah
Biesen, Robert
Proft, Fabian
Poddubnyy, Denis
Diekhoff, Torsten
author_facet Ulas, Sevtap Tugce
Ziegeler, Katharina
Richter, Sophia-Theresa
Ohrndorf, Sarah
Biesen, Robert
Proft, Fabian
Poddubnyy, Denis
Diekhoff, Torsten
author_sort Ulas, Sevtap Tugce
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-022-08744-0.
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spelling pubmed-93814452022-08-18 Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study Ulas, Sevtap Tugce Ziegeler, Katharina Richter, Sophia-Theresa Ohrndorf, Sarah Biesen, Robert Proft, Fabian Poddubnyy, Denis Diekhoff, Torsten Eur Radiol Computed Tomography 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-022-08744-0. Springer Berlin Heidelberg 2022-04-01 2022 /pmc/articles/PMC9381445/ /pubmed/35359165 http://dx.doi.org/10.1007/s00330-022-08744-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Computed Tomography
Ulas, Sevtap Tugce
Ziegeler, Katharina
Richter, Sophia-Theresa
Ohrndorf, Sarah
Biesen, Robert
Proft, Fabian
Poddubnyy, Denis
Diekhoff, Torsten
Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
title Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
title_full Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
title_fullStr Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
title_full_unstemmed Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
title_short Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
title_sort contrast-enhanced ct techniques and mri perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study
topic Computed Tomography
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9381445/
https://www.ncbi.nlm.nih.gov/pubmed/35359165
http://dx.doi.org/10.1007/s00330-022-08744-0
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