Use of tomosynthesis for erosion evaluation in rheumatoid arthritic hands and wrists

To compare tomosynthesis with radiography for the detection of hand and wrist bone erosions in patients with rheumatoid arthritis (RA), using multidetector computed tomography (CT) as the reference method.

The study was approved by the local ethics committee, and written consent was obtained from all patients. From December 2008 to April 2009, 30 consecutive patients with RA were included in this prospective study. They underwent radiography, tomosynthesis, and CT of the most symptomatic hand and wrist on the same day. Two radiologists and one rheumatologist independently read images from the three imaging modalities.

A total of 232 erosions were detected with CT, while 199 and 140 erosions, respectively, were detected with tomosynthesis and radiography. More erosions were revealed with CT than with tomosynthesis and radiography (P < .0001); significantly more erosions were shown with tomosynthesis than with radiography (P < .0001). With CT as the reference method for bone erosions, the overall sensitivity, specificity, and accuracy of tomosynthesis were, respectively, 77.6%, 89.9%, and 83.1%. The corresponding values for radiography were 53.9%, 92%, and 70.9%. The sensitivity of each reader increased by roughly 20% with use of tomosynthesis.

The depiction of bone erosions of the hands and wrists is significantly greater with tomosynthesis than with radiography.