Comparison of Ultrasound and Magnetic Resonance Imaging in the Evaluation of Hand and Wrist Joint Involvement in Rheumatoid Arthritis

  Objective  To compare the values of ultrasound and magnetic resonance imaging (MRI) in the diagnosis of hand and wrist joint involvement in rheumatoid arthritis(RA) patients and summarize the distribution pattern of these lesions.

  Methods  A total of 11 RA cases were included. The detection rates of synovitis, bone erosion, and tenosynovitis of different joints were calculated based on ultrasound and MRI findings. The diagnostic efficiency of ultrasound was evaluated by using the MRI as golden standard.

  Results  Totally 103 joints and 112 tendon areas were evaluated. The detection rates of synovitis, bone erosion, and tenosynovitis of wrist and hand joints were 59.2%, 11.7%, and 18.8% by ultrasound and 62.1%, 14.6%, and 32.1% by MRI. The detection rate of wrist joint was higher than metacarpophalangeal (MCP) or proximal interphalangeal(PIP) joints. The detection rate of extensor lesions was higher than that of flexor lesions at the wrist level; at the MCP level, however, the detection rate of flexor lesions was higher than that of extensor lesions. Compared with MRI, for the diagnosis of synovitis, bone erosion, and tenosynovitis, the ultrasound had a sensitivity of 92.2%, 73.3%, and 59.5%, a specificity of 94.9%, 97.7%, and 98.6%, a positive predictive value of 96.7%, 84.6%, and 96.2%, and a negative predictive value of 88.1%, 95.6%, and 80.2%.

  Conclusions  Wrist joint involvement is more common than MCP and PIP joints involvement in RA patients. The tendon involvement is more common in extensor at the wrist level, while in flexor at the MCP level. Compared with MRI, the diagnostic efficiency of ultrasound is higher for wrist lesions than for hand joints lesions. However, ultrasound is less sensitive in the diagnosis of extensor lesions at the MCP level.