• Users Online: 29
  • Print this page
  • Email this page

 
Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 27  |  Issue : 1  |  Page : 3-12

Reliability of ultrasound for the detection of rheumatoid arthritis


Faculty of Allied Heath Sciences Department, University Institution of Radiological Sciences and Medical Imaging Technology, The University of Lahore, Lahore, Pakistan

Date of Submission15-Jan-2018
Date of Acceptance12-Nov-2018
Date of Web Publication26-Feb-2019

Correspondence Address:
Dr. Rabia Hassan
Ibrahim street Awan Town Multan Road Lahore, The University of Lahore, Lahore
Pakistan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JMU.JMU_112_18

Get Permissions

  Abstract 


The aim of this review article was to investigate the pooled sensitivity and specificity of musculoskeletal ultrasound (MSUS) for the detection of synovitis and early bone erosion in the small joint in rheumatoid arthritis (RA). In addition, investigate the pooled sensitivity and specificity of Power Doppler ultrasonography (PDUS) for the detection of synovial hypervascularity in small joints in RA. A systematic literature search of PubMed, Wiley online library, Google Scholar, Research gate, E-book, BioMed Central, the Journal of Rheumatology and Springer Link were investigated from 2001 to 2017. Original researches related to the article written in English including RA, synovitis, bone erosion, grayscale, and PDUS were included in this study. The sample size, study design, sensitivity, and specificity were analyzed. The review summarizes the value of MSUS for the detection of RA as it is the first choice of modality. Results show the acceptable reliability of US for the diagnosis of early bone erosions, synovitis, and synovial hypervascularity.

Keywords: Bone erosion, rheumatoid arthritis, sensitivity, synovitis


How to cite this article:
Hassan R, Hussain S, Bacha R, Gillani SA, Malik SS. Reliability of ultrasound for the detection of rheumatoid arthritis. J Med Ultrasound 2019;27:3-12

How to cite this URL:
Hassan R, Hussain S, Bacha R, Gillani SA, Malik SS. Reliability of ultrasound for the detection of rheumatoid arthritis. J Med Ultrasound [serial online] 2019 [cited 2020 Nov 24];27:3-12. Available from: http://www.jmuonline.org/text.asp?2019/27/1/3/252983


  Introduction Top


Rheumatoid arthritis (RA) is a long-term autoimmune disease and inflammatory disorder. It affects the synovial membrane resulting in synovitis that is a primary abnormality and leads to structural destruction such as bone erosions, cartilage damage.[1],[2],[3] Small joints are frequently involved in RA such as metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints and metatarsophalangeal (MTP) joints.[4] Early and accurate diagnosis of structural damage is necessary for early treatment.

Musculoskeletal ultrasound (MSUS) is, nowadays, widely used worldwide for the diagnosis of RA.[5],[6] Magnetic resonance imaging (MRI) is considered a sensitive imaging modality for the detection of synovitis, joint effusion, and early bone erosions.[7] However, MRI has some limitations and disadvantages as it is expensive and not easily accessible.[8] In contrast, US is readily available, relatively cheap, easy to tolerate by the patient, free of bioeffects and portable. It is, therefore, the modality of choice due to its numerous benefits.[9] Several studies have reported that US is more sensitive and specific technique for the detection of RA as compared to clinical assessment and laboratory examination.[10],[11],[12],[13]

On gray-scale US (GSUS), the inflammatory and destructive activity of small joints in RA can be visualized with the help of high-frequency linear array transducer.[10],[12] Power Doppler ultrasonography (PDUS) is a good tool for the evaluation of inflammatory activity of joints in RA. Blood flow to the Synovial membrane can be detected by PDUS.[14],[15],[16]

Bone erosion is another sign of RA; however, it also is seen in other rheumatoid diseases.[17] Early bone erosions changes in RA cannot be detected by conventional radiography (CR); however, the US and other imaging modalities can detect the earliest bone erosive changes.[18] Hence, the review is aimed to justify the “use of US in the diagnosis of RA by evaluating its reliability.


  Methodology Top


Articles were collected related to our topic from 2001 to 2017. Thirty-six articles were studded in which twenty-nine articles were included and summarized. Seven articles were excluded in which two articles reported large joints such as shoulder and knee.[19],[20] The remaining five articles were not provided sufficient information regarding RA as they mention the keywords of RA[21],[22],[23],[24],[25] These articles were provided by the university library and online source of PubMed, Google Scholar, AJR, and Wiley online library, BMJ Journal, Researchgate, E-book, BioMed Central, The Journal of Rheumatology and Springer Link. Seventeen articles reported the sensitivity and specificity of US for the detection of synovitis, synovial hypervascularity and bone erosion in which 934 patients were examined that have RA.[7],[10],[11],[13],[14],[17],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35] Different types of studies such as cohort study, case–control study, and case study were included in this study.


  Synovitis Top


MSUS (including GS and PDUS imaging) is a reliable and useful tool for the detection of synovitis. GSUS often detects the signs of synovitis such as synovial hypertrophy and synovial fluid or effusion.[16] Previous five studies discussed the sensitivity and specificity of US for the detection of synovitis by comparing with different modalities such as MRI, CR, laboratory, and clinical assessments that are summarized in [Table 1].[10],[13],[18],[27],[33] PDUS has increased the sensitivity of US and able to detect the synovial hypervascularity in small joints. Previous four studies have discussed the sensitivity and specificity of PDUS for the detection of hypervascularity in RA and compare with different modalities such as MRI, CR, laboratory, and clinical examination that is summarized in [Table 2].[14],[27],[28],[29]
Table 1: Sensitivity and specificity of grayscale ultrasonography for the diagnosis of small joints synovitis

Click here to view
Table 2: Sensitivity and specificity of power Doppler ultrasonography for the detection of synovial hypervascularity of small joints

Click here to view


Previous five studies reported the sensitivity and specificity of GSUS for the detection of synovitis.[10],[13],[18],[27],[33] The sensitivity of GSUS for the detection of synovitis ranged from 47.4% to 92% as shown in [Table 1]. However, we have excluded the 47.4% sensitivity as it decreased the mean sensitivity.[27] The specificity of GSUS ranged from 74% to 90.9% as shown in [Table 1]. However, we were excluded Freeston et al., study as this study reported low sensitivity.[27] A study conducted by authors; Szkudlarek et al., in 2004 with the objective to compare the US with MRI, CR and clinical examination in the evaluation of bone destruction and signs of inflammation in the MTP joints of patients with RA. They have assessed one hundred MTP joints of twenty healthy control and two hundred MTP joints of forty patients with RA. They were assessed synovitis in 36 patients, 31 patients, and 21 patients with the help of US, MRI, and clinical examination, respectively. They were considered the MRI as a reference method and reported the US sensitivity 87% and specificity 74% for MTP joints, while for clinical examination, the corresponding values 43% and 89%. They evaluated that by comparing with MRI, US was found to be more sensitive and accurate than CR and clinical examination.[18] Another study conducted by authors; Scheel et al., in 2005 with the objective to evaluate the synovitis with help of US of finger joints in patients with active RA. They were performed MRI in 10 patients and compared the results with the US and found a good correlation between MRI and US for the detection of synovitis. They were reported US sensitivity 94% and specificity 89% for MCP and sensitivity 90% and specificity 88% for PIP joints for the detection of synovitis. Hence, the sensitivity and specificity for MTP joints were high.[13] Another study conducted by authors; Szkudlarek et al., in 2006 with the objective of to investigate whether US can provide information synovitis that is not available with CR and clinical examination and also compare with MRI. T1-weighted MRI sequences as the reference method, they were reported the US sensitivity 70% and specificity 78% for MCP and PIP joints with synovitis and reported 40% sensitivity and 85% specificity for the clinical examination. Their results indicated that with MRI as a reference method the US had higher sensitivity and accuracy.[10] Another study conducted by authors; Wakefield et al., in 2008 with the objective of compare clinical examination and the US with high-field MRI as the reference method for the detection of synovitis in RA. They have compared MRI as the gold standard with clinical examination and with the US reported the sensitivity 76% and specificity 70% for hind foot. They were reported clinical examination sensitivity 69% and specificity 34.5% for the detection of synovitis. They evaluated that US is more sensitive and specific than clinical examination when compared with MRI as Gold standard.[33] According to four studies, the pooled sensitivity and specificity of GSUS for the detection of synovitis of small joints is 83.5% and 79.8%, respectively, as shown in [Table 3] and [Graph 1]. All these above studies agreed with pooled sensitivity and specificity of US for the detection of synovitis.
Table 3: Pooled sensitivity and specificity of musculoskeletal ultrasound

Click here to view



Previous four studies reported the sensitivity and specificity of PDUS ranged from 71.1% to 92% and 40% to 97.9%, respectively mentioned in [Table 2]. A study conducted by authors; Szkudlarek et al., in 2001, with the objective of to diagnose the effectiveness of PDUS for the evaluation of inflammatory activity in the MCP joints of patients with RA, using T1-weighted MRI sequences as a reference method. They have assessed 54 MCP joints of 15 patients with active RA and 12 MCP joints of three healthy controls. They were detected flow signal on PDUS in 17 of 54 MCP joints in RA patients. They were reported a good sensitivity of 88.8% and specificity 97.9% for MCP joints.[14] Another study conducted by authors, Kiris et al., in 2006 with the objective of to evaluate synovial vascularity and flow pattern in MCP joints and ulnar styloid regions of hand and wrist of patients with RA. They have examined 240 MCP joints and 48 ulnar styloid regions in 24 patients with RA. They were reported good sensitivity 92% but not good specificity 40% MCP and USLT regions. Hence, we have not included Kiris et al., study as it too much decreased the overall mean specificity.[29] Another study conducted by Freeston et al., in 2010 with the objective of assesses the value of PDUS in patients with early RA. They have examined 50 patients with or without a sign of early RA with the help of clinical, laboratory, and imaging assessments. They were reported sensitivity 71.1% and specificity 81.1% for hand and wrist joints.[27] Another study conducted by authors; Harman et al., in 2015 with the objective to evaluate the efficacy of PDUS for the detection of RA and compare the PDUS findings with contrast-enhanced MRI. They were examined the wrist and hand joint including MCP and PIP joints using MRI and US. They have enrolled 31 patients with early RA and included 279 joints in the study reported the sensitivity of 73% and specificity 76% for finger joints.[28] According to three studies, the pooled sensitivity and specificity of PDUS for the detection of synovial hypervascularity of small joints is 77.633% and 85.233% as shown in [Table 3] and [Graph 2]. All these above studies agreed with pooled sensitivity and specificity of US for the detection of synovial hypervascularity.




  Bony Erosion Top


US is increasingly being used for the detection of early destructive changes in RA.[36] Previous eleven studies have described the sensitivity and specificity of US for the diagnosis of early bone erosions and these studies also discussed the US comparison with MRI, CR, CT, and clinical assessment.[7],[10],[11],[17],[18],[26],[30],[31],[32],[34],[35] A number of articles have shown the sensitivity and specificity of US for the detection of RA that is mentioned in [Table 4].
Table 4: Sensitivity and specificity of ultrasonography for the detection of bone erosion in rheumatoid arthritis in small joints

Click here to view


These studies described the sensitivity and specificity ranged from 32.9%–100% to 85.19%–98% respectively as shown in [Table 4]. Some studies described the US sensitivity and specificity for the detection of bone erosions with MRI as a reference method.[7],[18],[26],[31],[32],[35] Moreover, some studies described the US sensitivity and specificity for the detection of bone erosions with CT as the reference method. These studies described the lower sensitivity of US for bone erosion.[17],[26],[30],[32] According to Rashad et al., in 2014, reported (100%) sensitive and 85.19% specificity for foot joints bone erosions and 58.33% sensitivity and 91.67% specificity for hand joints bone erosions.[31] Remaining nine studies reported sensitivity ranged from 32.9% to 83% and specificity ranged from 85.19% to 98% for the small joint as summarized in [Table 4].[7],[10],[11],[17],[18],[26],[32],[34],[35] In 2015 Peluso et al., reported very low sensitivity only 9% that was not included as it decreased the mean.[30]

A study conducted by authors; Szkudlarek et al., in 2004 with the objective to compare the US with MRI, CR and clinical examination in the evaluation of bone destruction and signs of inflammation in the MTP joints of patients with RA. They have assessed one hundred MTP joints of twenty healthy control and two hundred MTP joints of forty patients with RA. They have diagnosed bone erosions in 26 patients with the help of US, compared with MRI and radiography as these modalities diagnosed 20 patients and 11 patients, respectively. They were reported the sensitivity of US and radiography as 79% and 32%, respectively, by compared with MRI as the standard method. They were reported the specificity of US and radiography as 97% and 98% respectively with MRI as a reference method.[18]

Another study conducted by authors; Døhn et al., in 2006 with the objective of to evaluate whether bone erosions in RA in MCP joints diagnosed with MRI and US, but not with radiography, represent with true bone erosive changes. They have examined 17 patients with RA and four healthy controls. With CT as the reference method, they have detected the sensitivity, specificity, and accuracy for bone erosions as 19%, 100%, and 81%, l respectively, for radiography; 68%, 96%, and 89%, for MRI; and 42%, 91%, and 80% for the US. Hence, they were reported MRI and US had high specificity for the detection of bone erosions.[32]

Another study conducted by authors; Szkudlarek et al., in 2006 with the objective of to investigate whether US can provide information bone destruction in RA fingers joint that are not available with CR and clinical examination and also compare with MRI. T1-weighted MRI sequences as the reference method, they were reported the sensitivity, specificity, and accuracy as 59%, 98%, and 96%, respectively, for the US; 40%, 99%, and 95% for the radiography.[10]

Another study conducted by authors; Døhn et al., in 2011 with the objective to evaluate the bone erosions in patients with RA using MRI, US, radiography, and CT. They have examined 52 patients with RA. The sensitivities and specificities for bone erosion in MCP joint were 68% and 92% for MRI; 44% and 95% for the US; and 26% and 98% for radiography, with CT as the reference method.[26]

According to eight studies, the pooled sensitivity is 58.385% and pooled specificity is 93.85% as shown in [Table 3] and [Graph 3]. All the above studies agreed with pooled sensitivity and specificity of US for the detection of bone erosions.




  Review Results Top


The pooled sensitivity and specificity of GSUS for the detection of synovitis of small joints were 83.5% and 79.8%, respectively. The pooled sensitivity and specificity of PDUS for the detection of synovial hypervascularity were 77.633% and 85.23%, respectively. The pooled sensitivity and specificity of US for the detection of early bone erosion were 58.385% and 93.859%, respectively.


  Conclusion Top


The US has good pooled sensitivity and specificity for the detection of synovitis and synovial hypervascularity. The specificity of US for the detection of bone erosions is high, but sensitivity is low so examiner should be familiar with the use of US for the evaluation of bone erosions in small joints in early RA.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care 2012;18:S295-302.  Back to cited text no. 1
    
2.
Conaghan PG, O'Connor P, McGonagle D, Astin P, Wakefield RJ, Gibbon WW, et al. Elucidation of the relationship between synovitis and bone damage: A randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 2003;48:64-71.  Back to cited text no. 2
    
3.
Boutry N, Morel M, Flipo RM, Demondion X, Cotten A. Early rheumatoid arthritis: A review of MRI and sonographic findings. AJR Am J Roentgenol 2007;189:1502-9.  Back to cited text no. 3
    
4.
Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M, et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48:955-62.  Back to cited text no. 4
    
5.
Kang T, Horton L, Emery P, Wakefield RJ. Value of ultrasound in rheumatologic diseases. J Korean Med Sci 2013;28:497-507.  Back to cited text no. 5
    
6.
Marhadour T, Saraux A. Rheumatoid Arthritis Assessment with Ultrasonography. France: Sonography, InTech; 2012.  Back to cited text no. 6
    
7.
Wang MY, Wang XB, Sun XH, Liu FL, Huang SC. Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis. Exp Ther Med 2016;12:3035-40.  Back to cited text no. 7
    
8.
Weissman BN. Imaging of Arthritis and Metabolic Bone Disease. Massachusetts: Elsevier Health Sciences; 2009.  Back to cited text no. 8
    
9.
Patil P, Dasgupta B. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis 2012;4:341-55.  Back to cited text no. 9
    
10.
Szkudlarek M, Klarlund M, Narvestad E, Court-Payen M, Strandberg C, Jensen KE, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: A comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther 2006;8:R52.  Back to cited text no. 10
    
11.
Filer A, de Pablo P, Allen G, Nightingale P, Jordan A, Jobanputra P, et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2011;70:500-7.  Back to cited text no. 11
    
12.
Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A, et al. Assessment of inflammatory activity in rheumatoid arthritis: A comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005;64:375-81.  Back to cited text no. 12
    
13.
Scheel AK, Hermann KG, Kahler E, Pasewaldt D, Fritz J, Hamm B, et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum 2005;52:733-43.  Back to cited text no. 13
    
14.
Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M, et al. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: A comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001;44:2018-23.  Back to cited text no. 14
    
15.
Terslev L, von der Recke P, Torp-Pedersen S, Koenig MJ, Bliddal H. Diagnostic sensitivity and specificity of Doppler ultrasound in rheumatoid arthritis. J Rheumatol 2008;35:49-53.  Back to cited text no. 15
    
16.
Gärtner M, Mandl P, Radner H, Supp G, Machold KP, Aletaha D, et al. Sonographic joint assessment in rheumatoid arthritis: Associations with clinical joint assessment during a state of remission. Arthritis Rheum 2013;65:2005-14.  Back to cited text no. 16
    
17.
Døhn UM, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A, et al. Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: Comparison with CT. Ann Rheum Dis 2013;72:530-4.  Back to cited text no. 17
    
18.
Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M, et al. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: Comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 2004;50:2103-12.  Back to cited text no. 18
    
19.
Bruyn GA, Pineda C, Hernandez-Diaz C, Ventura-Rios L, Moya C, Garrido J, et al. Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard. Arthritis Care Res (Hoboken) 2010;62:1079-86.  Back to cited text no. 19
    
20.
Fiocco U, Ferro F, Cozzi L, Vezzù M, Sfriso P, Checchetto C, et al. Contrast medium in power Doppler ultrasound for assessment of synovial vascularity: Comparison with arthroscopy. J Rheumatol 2003;30:2170-6.  Back to cited text no. 20
    
21.
Saigal R, Goyal L, Maharia H, Sharma M, Agrawal A. Ultrasonographic evaluation of joint involvement in rheumatoid arthritis: Comparison with conventional radiography and correlation with disease activity parameters. Indian J Rheumatol 2017;12:6.  Back to cited text no. 21
  [Full text]  
22.
Naredo E, Collado P, Cruz A, Palop MJ, Cabero F, Richi P, et al. Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: Predictive value in disease activity and radiologic progression. Arthritis Rheum 2007;57:116-24.  Back to cited text no. 22
    
23.
Stramare R, Raffeiner B, Ciprian L, Scagliori E, Coran A, Perissinotto E, et al. Evaluation of finger joint synovial vascularity in patients with rheumatoid arthritis using contrast-enhanced ultrasound with water immersion and a stabilized probe. J Clin Ultrasound 2012;40:147-54.  Back to cited text no. 23
    
24.
Naredo E, Rodríguez M, Campos C, Rodríguez-Heredia JM, Medina JA, Giner E, et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008;59:515-22.  Back to cited text no. 24
    
25.
Jain M, Samuels J. Musculoskeletal ultrasound in the diagnosis of rheumatic disease. Bull NYU Hosp Jt Dis 2010;68:183-90.  Back to cited text no. 25
    
26.
Døhn UM, Ejbjerg B, Boonen A, Hetland ML, Hansen MS, Knudsen LS, et al. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: Results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Ann Rheum Dis 2011;70:252-8.  Back to cited text no. 26
    
27.
Freeston JE, Wakefield RJ, Conaghan PG, Hensor EM, Stewart SP, Emery P, et al. A diagnostic algorithm for persistence of very early inflammatory arthritis: The utility of power Doppler ultrasound when added to conventional assessment tools. Ann Rheum Dis 2010;69:417-9.  Back to cited text no. 27
    
28.
Harman H, Tekeoǧlu İ, Saǧ MS, Harman S. Diagnostic value of musculoskeletal ultrasound in newly diagnosed rheumatoid arthritis patients. Turk J Phys Med Rehabil 2015;61:326-32.  Back to cited text no. 28
    
29.
Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O. Power Doppler assessment of overall disease activity in patients with rheumatoid arthritis. J Clin Ultrasound 2006;34:5-11.  Back to cited text no. 29
    
30.
Peluso G, Bosello SL, Gremese E, Mirone L, Di Gregorio F, Di Molfetta V, et al. Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography. Clin Rheumatol 2015;34:1181-6.  Back to cited text no. 30
    
31.
Rashad SM, Alkady EA, Abda EA, Abdel-Aziz A. The diagnosis of early rheumatoid arthritis using musculoskeletal ultrasonography. AAMJ 2014;12:119-40.  Back to cited text no. 31
    
32.
Døhn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 2006;8:R110.  Back to cited text no. 32
    
33.
Wakefield RJ, Freeston JE, O'Connor P, Reay N, Budgen A, Hensor EM, et al. The optimal assessment of the rheumatoid arthritis hindfoot: A comparative study of clinical examination, ultrasound and high field MRI. Ann Rheum Dis 2008;67:1678-82.  Back to cited text no. 33
    
34.
Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EM, Freeston JE, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 2015;74:897-903.  Back to cited text no. 34
    
35.
Rahmani M, Chegini H, Najafizadeh SR, Azimi M, Habibollahi P, Shakiba M, et al. Detection of bone erosion in early rheumatoid arthritis: Ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging. Clin Rheumatol 2010;29:883-91.  Back to cited text no. 35
    
36.
Sudoł-Szopińska I, Jans L, Teh J. Rheumatoid arthritis: What do MRI and ultrasound show. J Ultrason 2017;17:5-16.  Back to cited text no. 36
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Ultrasound Versus Contrast-Enhanced Magnetic Resonance Imaging for Subclinical Synovitis and Tenosynovitis: A Diagnostic Performance Study
Zhongtao Bao,Yanchun Zhao,Shuqiang Chen,Xiaoyu Chen,Xiang Xu,Linglin Wei,Meilian Xiong
Clinics. 2020; 75
[Pubmed] | [DOI]
2 Clinical Significance of Twinkling Artifact in the Diagnosis of Urinary Stones
Raham Bacha,Iqra Manzoor,Syed Amir Gilani,Amjad Iqbal Khan
Ultrasound in Medicine & Biology. 2019;
[Pubmed] | [DOI]
3 Diagnostic test accuracy of magnetic resonance imaging and ultrasound for detecting bone erosion in patients with rheumatoid arthritis
Haozheng Tang,Xinhua Qu,Bing Yue
Clinical Rheumatology. 2019;
[Pubmed] | [DOI]



 

Top
 
  Search
 
    Similar in PUBMED
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Methodology
Synovitis
Bony Erosion
Review Results
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed3032    
    Printed113    
    Emailed0    
    PDF Downloaded345    
    Comments [Add]    
    Cited by others 3    

Recommend this journal