Tomosynthesis superior for bone erosion detection

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Tomosynthesis is superior to radiography and almost comparable to MRI of the wrist and hand in the detection of bone erosion in patients with rheumatoid arthritis (RA), according to a study published in the February issue of the American Journal of Roentgenology.

Thus far, tomosynthesis has been used for musculoskeletal, chest, and breast clinical applications. Lead author Takatoshi Aoki, MD, of the University of Occupational and Environmental Health School of Medicine in Kitakyushu, Japan, and colleagues compared the performance of tomosynthesis with radiography and MRI of the wrist and hand for evaluating bone erosion in patients with RA.

The retrospective study reviewed 20 patients with established RA diagnoses and included a control group of five patients with unclassified self-limited arthritis. The participants underwent radiography, tomosynthesis, and MRI of the bilateral hand and wrist within a week.

After two radiologists independently reviewed the bone erosion from the three modalities, results indicated that the detection rates for radiography, tomosynthesis and MRI were respectively 26.5 percent, 36.1 percent, and 36.7 percent. Significantly more bone erosions were revealed with tomosynthesis and MRI than with radiography.

When MRI was used as the reference standard, the sensitivity, specificity, and accuracy were 68.1 percent, 97.5 percent, and 86.7 percent, respectively, for radiography and 94.8 percent, 97.8 percent, and 96.7 percent, respectively, for tomosynthesis. The sensitivity of bone erosions increased by 26.7 percent when using tomosynthesis in comparison with radiography. Accuracy increased by ten percent when using tomosynthesis.

“Tomosynthesis may represent an alternative for the evaluation of bone erosions in the wrist and hand and would provide useful clues for therapeutic strategies in patients with RA,” concluded the study’s authors.