title: Hand and wrist involvement in systemic sclerosis: US features.
abstract: OBJECTIVE
  To characterize ultrasonographic (US) features in the hand of patients with systemic sclerosis (SSc) and to evaluate the sensitivity of US in the detection of calcinosis and acroosteolysis.
  
  
  METHODS
  The local ethics committee approved this study, and oral informed consent was obtained. A total of 44 consecutive patients with SSc (34 women; mean age, 56.1 years ± 12.1 [standard deviation]; 10 men; mean age, 45.0 years ± 14.0) and 30 healthy control subjects (20 women; mean age, 46.3 years ± 12.1; 10 men; mean age, 39.6 years ± 10.8) were included between October 2010 and December 2011. Bilateral US, including Doppler assessment of the wrists, hands, and fingers, was performed, and presence of synovitis, tenosynovitis with or without a layered appearance, calcifications, acroosteolysis, and distal vascularization was recorded. Radiography of both hands was performed to assess for acroosteolysis and calcinosis. Frequency of US features, sensitivity of US for calcinosis and acroosteolysis, and respective confidence intervals were calculated.
  
  
  RESULTS
  Synovitis was found in 17 patients (39%). Tenosynovitis was found in 12 patients (27%), and it had a layered pattern in 15 (41%) of 37 cases. Calcinosis was found in 17 patients (39%) with US, with a sensitivity of 89%. Acroosteolysis was found in nine (20%) patients with US and in 10 (23%) patients with radiography, with 90% sensitivity for US. Distal vascularization was detected in 26 patients (59%) and 30 control subjects (100%) and was in contact with the acroosteolysis bed in seven (78%) of nine patients with SSc.
  
  
  CONCLUSIONS
  US can be used to assess features of SSc, including synovitis, tenosynovitis, calcinosis, acroosteolysis, and distal vascularization and is sensitive for calcinosis and acroosteolysis detection. A layered pattern (similar to the appearance of an artichoke heart) of tenosynovitis was seen commonly. Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology, Centre Hospitalier Universitaire de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, QC, Canada H2L 4M1 (V.F.); and Departments of Radiology B (R.B., R.C., E.P., J.L.D., H.G.) and Rheumatology A (M.E., J.A., Y.A.), Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Freire
authors.forename: Ramin
authors.initials: R
authors.lastname: Bazeli
authors.forename: Muriel
authors.initials: M
authors.lastname: Elhai
authors.forename: Raphaël
authors.initials: R
authors.lastname: Campagna
authors.forename: Éric
authors.initials: É
authors.lastname: Pessis
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Drapé
authors.forename: Henri
authors.initials: H
authors.lastname: Guérini
mesh_terms: D030981:Acro-Osteolysis / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013585:Synovitis / Q000000981:diagnostic imaging; D013717:Tenosynovitis / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D014953:Wrist / Q000000981:diagnostic imaging*