Use of tomosynthesis for erosion evaluation in rheumatoid arthritic hands and wrists.
OBJECTIVE
To compare tomosynthesis with radiography for the detection of hand and wrist bone erosions in patients with rheumatoid arthritis (RA), using multidetector computed tomography (CT) as the reference method.


METHODS
The study was approved by the local ethics committee, and written consent was obtained from all patients. From December 2008 to April 2009, 30 consecutive patients with RA were included in this prospective study. They underwent radiography, tomosynthesis, and CT of the most symptomatic hand and wrist on the same day. Two radiologists and one rheumatologist independently read images from the three imaging modalities.


RESULTS
A total of 232 erosions were detected with CT, while 199 and 140 erosions, respectively, were detected with tomosynthesis and radiography. More erosions were revealed with CT than with tomosynthesis and radiography (P < .0001); significantly more erosions were shown with tomosynthesis than with radiography (P < .0001). With CT as the reference method for bone erosions, the overall sensitivity, specificity, and accuracy of tomosynthesis were, respectively, 77.6%, 89.9%, and 83.1%. The corresponding values for radiography were 53.9%, 92%, and 70.9%. The sensitivity of each reader increased by roughly 20% with use of tomosynthesis.


CONCLUSIONS
The depiction of bone erosions of the hands and wrists is significantly greater with tomosynthesis than with radiography.
Department of Musculoskeletal Radiology, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Centre Hospitalier Régional Universitaire de Lille, Rue du Professeur Emilie Laine, Lille 59000, France. clacanella@yahoo.com.br
Clarissa
C
Canella
Peggy
P
Philippe
Vittorio
V
Pansini
Julia
J
Salleron
René-Marc
RM
Flipo
Anne
A
Cotten
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014953:Wrist / Q000000981:diagnostic imaging* / Q000473:pathology; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000473:pathology