A comparative study of ultrasound, X-ray and magnetic resonance imaging for the detection of wrist joints in rheumatoid arthritis patients

ZHOU Bo; ZHU Jian; ZHANG Hong; LUO Gui; ZHANG Jiang-lin; HUANG Feng

doi:10.3969/j.issn.2095-252X.2013.07.002

Abstract： Objective To investigate the soft tissue involvement and the shape and position of bone erosions in the wrist joints of rheumatoid arthritis ( RA ) patients using ultrasonography, and to e valuate the advantages of ultrasonography when further compared with the X-ray and MRI. Methods RA patients from both the clinic and wards of our hospital were enrolled, and all of them underwent ultrasonography, X-ray and MRI respectively in the wrist joints to record the involvement. At the same time, the clinical and laboratory data of the patients were collected. The differences among these examination methods were further compared, and the correlation between the changes of ultrasound and clinical indexes was analyzed. Results 36 RA patients ( 72 wrist joints ) were enrolled in this study. The ultrasound-related soft tissue lesions were found in 66 wrist joints, and the positive rate was 91.7%. Articular cavity effusion occurred in 63 joints ( 87.5%), and tenosynovitis of the flexor tendon in the dorsal wrist occurred in 57 joints ( 79.2%). Synovitis changes were found in 61 joints ( 84.7%). The X-ray-related soft tissue swelling was found in 1 wrist joint, and the positive rate was 1.4%. Ultrasound was superior to X-ray in detecting soft tissue lesions ( P=0.00 ). Ultrasound detected bone erosions in the radius ( 21 ), lunate ( 41 ) andcapitate bone ( 40 ), and the X-ray detected bone erosions in the radius ( 13 ), lunate ( 10 ) and capitate bone ( 12 ). Ultrasound was superior to X-ray in detecting bone erosion lesions ( P=0.00 ), especially for patients with early RA ( 54.5%:9.1%). Abnormal changes were confirmed by MRI, which were detected as positive by ultrasonography and negative by X-ray. Conclusions Ultrasonography of the wrist joints is inexpensive, easy and convenient, which can early detect bone erosion changes and lesions of periarticular soft tissues. Therefore, ultrasonography is the optimal tool for RA patients.