Wrist Ultrasound Research Articles

The frequency of synovitis and calcium pyrophosphate deposition with ultrasound is increased in transfusion-dependent beta-thalassaemia patients: effect of iron accumulation?

To determine the frequency of synovitis and calcium pyrophosphate deposition (CPDD) with ultrasound (US) in the wrists of transfusion dependant (TD) beta-thalassaemia patients and to investigate the associated factors with these pathologies. Eighty-seven beta-thalassaemia patients (46 thalassaemia major and 41 thalassaemia minor patients) were grouped into two as TD and transfusion non-dependent (TND)-thalassaemia patients. Under bilateral wrist US the presence of synovial hypertrophy (SH), power Doppler signal (PD) combined synovitis (SH+PD), tenosynovitis, and triangular fibrocartilage complex (TFC)-cartilage calcification (CC) were examined. SH, PD, and combined synovitis in the US were classified as Grade-0 (no), Grade-1 (minimal), Grade-2 (moderate), and Grade-3 (severe). The incidence of moderate/severe SH, PD, and combined synovitis with US was 34.8%, 17.4%, and 34.8% in TD-thalassaemia patients, respectively, but none in TND patients (p<0.001, p=0.006, p<0.001). The frequency of TFC-CC with US was 32.6% in TD and 2.4% in TND-thalassaemia patients (p<0.001). Ferritin level was positively correlated with SH (r=0.414, p<0.001), PD (r=0.279, p=0.009) and combined synovitis scores (r=0.402, p<0.001). Ferritin level (OR:1.001, CI:1.000-1.002) and the presence of TFC-CC (OR:25.048, CI:5.187-120.951) were determined as to be associated with moderate/severe combined synovitis. The presence of synovitis and TFC-CC with the US is common in patients with beta-thalassaemia who have had recurrent blood transfusions. Iron overload in beta-thalassaemia patients may cause CPDD and synovial inflammation.

Comparison of Role of Hand and Wrist Ultrasound in Diagnosis of Subclinical Synovitis in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Retrospective, Single-Center Study

BackgroundThis retrospective study aimed to compare the roles of hand and wrist ultrasound in diagnosing subclinical synovitis in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) at a single center in Sichuan, China.Material/MethodsForty-one patients with SLE and 20 patients with RA were included. SLE was diagnosed using the American rheumatology Society (ACR) classification standard. Severity of SLE was evaluated using the SLE disease activity index (SLEDAI). General and clinical manifestations and laboratory indicators were measured. Spearman correlation analysis was used for analyzing correlations between musculoskeletal ultrasound results and indexes.ResultsAmong 41 patients with SLE, 26 (63.4%) had joint pain, and 39 (95.1%) had at least 1 joint abnormality. Thirteen patients with SLE (31.7%) had wrist joint involvement, 7 (17.1%) had metacarpal phalangeal-1 (MCP1) involvement, 8 (19.5%) had MCP2 involvement, 17 (41.5%) had MCP3 involvement, 14 (34.1%) had MCP4 involvement, and 5 (12.2%) had MCP5 involvement. Meanwhile, 2 (4.8%) had proximal interphalangeal-1 (PIP1) involvement, 10 (24.4%) had PIP2 involvement, 17 (41.5%) had PIP3 involvement, 12 (29.3%) had PIP4 involvement, and 3 (7.3%) had PIP4 involvement. Twelve patients demonstrated knee joint involvement. MCP joints had the highest involvement frequency (P=0.003). The most frequently detected disease was synovitis, followed by tenosynovitis, joint effusion, and bone erosion. ESR (P=0.002), CRP (P=0.020), and SLEDAI (P=0.011) of patients with SLE with arthralgia were significantly higher compared to patients without arthralgia. In patients with RA, musculoskeletal ultrasound scores were correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease activity score-28 (DAS28), and interleukin-6 (IL-6). In patients with SLE, musculoskeletal ultrasound scores were correlated with double-stranded DNA (dsDNA), ribonucleoprotein (RNP), DAS28, and IL-6.ConclusionsMusculoskeletal ultrasound is highly sensitive in evaluating subclinical synovitis in patients with SLE, and its score is positively correlated with dsDNA, RNP IL-6, and DAS28 in patients with SLE.

Wrist ultrasound - the model method for grey-scale and power Doppler scoring

The use of ultrasound (US) has been at the forefront of aiding diagnosis of inflammatory arthritis since its introduction. More recently, US imaging in patients with clinical remission appears to...

Changes in Medicare Reimbursement for Advanced Upper Extremity Imaging

Advanced noninvasive imaging of the upper extremity joints, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) , has numerous applications in the evaluation of musculoskeletal pathology. Choice of modality is influenced by clinical and cost concerns, with US and CT traditionally considered less expensive than MRI. We analyzed the changes in Medicare reimbursement for these imaging modalities with the hypothesis that recent reimbursement decreases in MRI have made this modality more cost-competitive than other commonly used imaging modalities. Using the Medicare Fee Schedule Database, we reviewed the Medicare reimbursements fee schedule for CT, US, and MRI from 2000 to 2015 at the national, regional, and state levels. Charges were identified and queried by Common Procedural Terminology (CPT) codes for each modality. Changes in reimbursement were calculated for each of the modalities. Total (technical and professional) reimbursement for MRI decreased from $516.93 to $237.16 between 2007 and 2015. Adjusted for inflation, this represents a 60% decrease in reimbursement. During the same time period, total (technical and professional) reimbursement for CT decreased from $256.95 to $180.03, a 39% decrease adjusted for inflation. Total (technical and professional) reimbursement for US increased over the same time period, from $98.91 to $118.22 in 2015, in conjunction with changes in the CPT coding for US. Total (technical and professional) MRI reimbursement decreased from 5.23 times the reimbursement of US in 2007 to 2.01 times in2015. In concordance with our hypothesis, these findings demonstrate that upper extremity MRI and CT reimbursements as scheduled by Medicare have declined significantly in recent years and that these modalities are approaching financial parity with wrist US. In spite of these decreases, MRI remains the most costly advanced imaging modality. Depending on each clinical scenario, the added cost may be justified by the value added by the type of information that can be garnered from each study. Cost-analysis studies evaluating the clinical application of MRI performed prior to the reimbursement decline should be evaluated with caution, and cost-benefit analyses based on these data are at risk of being out-of-date. Economic Analysis IV.

High-resolution ultrasonography of cross-sectional area of median nerve compared with electro-diagnostic study in carpal-tunnel syndrome

Carpal tunnel syndrome is a common chronic entrapment neuropathy. The present study evaluated the diagnostic ability of ultrasound (US) in measuring the cross-sectional area of the median nerve in the entrance of the carpal tunnel area in comparison with electrodiagnostic testing for diagnosing carpal tunnel syndrome. In this cross-sectional study, 253 patients with carpal tunnel syndrome based on American Academy of Neurology clinical symptoms were selected for participation. After screening, 200 patients were enrolled in the study. Wrist US and electrodiagnostic findings for patients were compared. Data were analyzed by SPSS. There was a good agreement between sonographic and electrodiagnostic findings [right hand (kappa= 0.71), left hand (kappa= 0.78)]. For the right and left hands, respectively, ultrasound sensitivity (89% vs 90%), specificity (90% vs 89.2%), positive predictive value (84.7% vs 94.7%), and negative predictive value (75.7% vs 81.6%) were calculated. High-resolution ultrasound of the median nerve cross-sectional area is an accurate test for diagnosing carpal tunnel with an acceptable level of diagnostic ability. In comparison with the electrodiagnostic test, ultrasonography can provide more practical information about anatomical changes in the tunnel, which can be considered in selecting treatment options.

Invited Commentary

Invited Commentary

MR Imaging Findings in the Hands

HomeRadiologyVol. 241, No. 1 PreviousNext CommunicationsLetters to the EditorMR Imaging Findings in the HandsPhilip G. Conaghan*, Philip O'Connor†, and Paul Emery‡Philip G. Conaghan*, Philip O'Connor†, and Paul Emery‡Author Affiliations*Department of Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, Yorkshire LS7 4SA, United Kingdom e-mail: [email protected]†Department of Musculoskeletal Radiology, Leeds Teaching Hospital Trust, Leeds, United Kingdom‡Department of Rheumatology, University of Leeds, Leeds, United KingdomPhilip G. Conaghan*Philip O'Connor†and Paul Emery‡Published Online:Oct 1 2006https://doi.org/10.1148/radiol.2411051682MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Boutry N, Hachulla E, Flipo RM, Cortet B, Cotten A. MR imaging findings in hands in early rheumatoid arthritis: comparison with those in systemic lupus erythematosus and primary Sjögren syndrome. Radiology 2005;236(2):593–600. Link, Google Scholar2 Conaghan PG, O'Connor P, McGonagle D, et al. Elucidation of the relationship between synovitis and bone damage: a randomised MRI study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 2003;48:64–71. Crossref, Medline, Google ScholarArticle HistoryPublished in print: 2006 FiguresReferencesRelatedDetailsCited ByArthritis & Rheumatism, Vol. 56, No. 4Recommended Articles Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging CharacteristicsRadioGraphics2020Volume: 40Issue: 5pp. 1339-1354Case 229: Burn-related Global Ankylosis of Interphalangeal Joints with Associated AcroosteolysisRadiology2016Volume: 279Issue: 2pp. 645-649Rheumatoid Arthritis and Tenosynovitis at the Metatarsophalangeal Joints: An Anatomic and MRI Study of the Forefoot Tendon SheathsRadiology2020Volume: 295Issue: 1pp. 146-154Adult Inflammatory Arthritides: What the Radiologist Should KnowRadioGraphics2016Volume: 36Issue: 6pp. 1849-1870MR Imaging and US of the Wrist TendonsRadioGraphics2016Volume: 36Issue: 6pp. 1688-1700See More RSNA Education Exhibits The Expanding Role of Wrist Ultrasound in Rheumatoid Arthritis and Its MimicsDigital Posters2018Differentiation of Hand Small Joints Arthropathy in Patients with Rheumatoid Arthritis and Psoriatic Arthritis: Multimodality Imaging Characteristics  Digital Posters2019Imaging Features of Peripheral Arthritis: A Systematic Imaging ApproachDigital Posters2018 RSNA Case Collection SclerodermaRSNA Case Collection2022Gout of the hand and elbowRSNA Case Collection2021High Pressure Injection InjuryRSNA Case Collection2021 Vol. 241, No. 1 Metrics Altmetric Score PDF download