Tenosynovitis Evaluation Using Image Fusion and B-Flow – A Pilot Study on New Imaging Techniques in Rheumatoid Arthritis Patients

Abstract

Aim The aim of this study was to compare the assessment of tenosynovitis by ultrasound (US) and magnetic resonance imaging (MRI) using the image fusion technique and to investigate whether US B-flow imaging (BFI) is an alternative to Doppler US when assessing tenosynovitis.

Materials and Methods 15 patients with rheumatoid arthritis (RA) had US-verified tenosynovitis in the wrist/hand. An MRI was performed of the wrist/hand with subsequent repeated US and image fusion. Images were compared in three steps: 1. Visual image comparison, 2. Quantitative measurement of transverse areas of the affected tendon and tendon sheath, using two tendon measures on MRI, area 1 and area 2, excluding and including partial volume artifacts, respectively, 3. Assessment using the OMERACT semi-quantitative scoring systems for US and MRI. Furthermore, BFI was assessed as: 0: No flow, 1: Focal flow, 2: Multifocal flow, 3: Diffuse flow, in the tendon sheath.

Results The median areas on US and MRI (areas 1 and 2) were 0.16 cm² (25;75 pctl: 0.10; 0.25), 0.9 cm² (0.06; 0.18) and 0.13 cm² (0.10; 0.25), respectively, for included tendons and 0.18 cm² (0.13; 0.26), 0.27 cm² (0.20; 0.45) and 0.23 cm² (0.16; 0.40) for tendon sheaths. No statistically significant difference was found between US tendon area and MRI tendon area 2 (Wilcoxon’s test; p = 0.47). Overall, the agreement between grayscale and color Doppler (CD) US and MRI tenosynovitis visualization and scoring was good, but not between CD and BFI.

Conclusion US and MRI have high agreement using image fusion for the assessment of tenosynovitis when partial volume artifacts are taken into account. BFI is not an alternative to CD for the measurement of slow flow in tenosynovitis.

Zusammenfassung

Ziel Das Ziel dieser Studie war es, die Beurteilung der Tenosynovitis mittels Ultraschall (US) und Magnetresonanztomografie (MRT) mittels Bildfusionsverfahren zu vergleichen und zu untersuchen, ob das sonografische B-Flow-Imaging (BFI) eine Alternative zur Dopplersonografie bei der Einstufung der Tenosynovitis darstellt.

Material und Methoden 15 Patienten mit rheumatoider Arthritis (RA) hatten eine sonografisch bestätigte Sehnenscheidenentzündung des Handgelenks/der Hand. Eine MRT wurde am Handgelenk/der Hand durchgeführt gefolgt von wiederholten US-Untersuchungen und Bildfusion.

Ergebnisse Die medianen Bereiche im US und MRT (Regionen 1 und 2) betrugen für eingeschlossene Sehen 0,16 cm² (25; 75 Perz.: 0,10; 0,25), 0,9 cm² (0,06; 0,18) und 0,13 cm² (0,10; 0,25), und für Sehnenscheiden 0,18 cm² (0,13; 0,26), 0,27 cm² (0,20; 0,45) und 0,23 cm² (0,16; 0,40). Kein statistisch signifikanter Unterschied wurde zwischen dem Sehnenbereich im US und der Sehnenregion 2 in der MRT beobachtet (Wilcoxon-Test; p = 0,47).

Schlussfolgerung Insgesamt ergab sich eine gute Übereinstimmung zwischen Graustufen- und Farbdoppler (CD)-US und MRT bei der Darstellung der Tenosynovitis und das Scoring war gut. Allerdings traf dies für CD und BFI nicht zu. Schlussfolgerung: US und MRT zeigen ein hohe Übereinstimmung bei der Anwendung der Bildfusion zur Bewertung der Tenosynovitis, wenn partielle Volumenartefakte mit berücksichtigt werden. BFI ist keine Alternative zum CD bei der Bestimmung des langsamen Flusses bei Tenosynovitis.

Key words

tendons - ultrasound - arthritides - MR imaging - ultrasound Doppler

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