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Published on: October 6, 2023
Distinguishing erosions from non-inflammatory lesions in hand MRI: A quantitative morphological approach
Carina Obermüller1, Elizabet Nikolova1, Alexander Tom Hoppe1
1Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Objective:
To assess differential MRI characteristics of cortical lesions in patients with and without inflammatory arthritis, distinguishing erosions from non-inflammatory lesions.
Methods:
Lesions were classified into those associated with inflammatory arthritis (IA) (n = 177) and without (n = 148). Two radiologists measured lesion diameter and cortical defect width. Linear mixed models were used for continuous outcome variables and generalized estimating equations for binary outcomes and all predictive modeling to estimate odds ratios and predicted probabilities.
Results:
This retrospective study included hand MRI exams of 161 patients (83 female, median age (IQR) 54 (39-69)), with 325 cortical lesions. Mean (±standard deviation) cortical defect width (2.74 ± 1.69 mm vs. 1.81 ± 1.20 mm; p < 0.001) and ratio of cortical defect width to lesion diameter (0.61 ± 0.36 vs. 0.37 ± 0.21; p < 0.001) was significantly greater in IA. Blurred delineation (42% vs. 18%; OR = 3.42, p < 0.001), bone marrow edema (BME) (31% vs. 11%; OR = 3.45, p < 0.001) and signal heterogeneity (51% vs. 36%, OR = 1.80, p < 0.001) were significantly more common in IA. Using the ratio and BME to predict IA yielded a cross-validated AUC of 0.721 (95% CI: 0.535-0.788), with a sensitivity of 58% and a specificity of 85% at an optimal threshold.
Conclusion:
These results suggest that using a quantitative morphological approach can aid differentiation of erosions from non-inflammatory lesions in hand MRI.
Insights
Hand MRI can differentiate inflammatory arthritis (IA) erosions from non-inflammatory lesions using quantitative morphology. Key MRI features like defect width and bone marrow edema help distinguish these conditions.
Area of Science:
- Radiology
- Rheumatology
- Orthopedics
Background:
- Distinguishing erosions from non-inflammatory lesions in hand MRI is crucial for accurate diagnosis and treatment of arthritis.
- Inflammatory arthritis (IA) and non-inflammatory conditions can present with similar cortical lesions, complicating interpretation.
Purpose of the Study:
- To assess differential MRI characteristics of cortical lesions in patients with and without inflammatory arthritis (IA).
- To distinguish erosions (IA-associated) from non-inflammatory lesions using MRI features.
Main Methods:
- Retrospective analysis of hand MRI exams from 161 patients (325 cortical lesions).
- Lesions classified as IA (n=177) or non-IA (n=148).
- Radiologists measured lesion diameter and cortical defect width; statistical models analyzed differences and predictive values.
Main Results:
- Cortical defect width and its ratio to lesion diameter were significantly greater in IA.
- Blurred delineation, bone marrow edema (BME), and signal heterogeneity were more common in IA lesions.
- A model using the ratio and BME achieved an AUC of 0.721 for predicting IA, with 58% sensitivity and 85% specificity.
Conclusions:
- Quantitative morphological assessment aids in differentiating erosions from non-inflammatory lesions on hand MRI.
- Specific MRI features, including defect width and BME, are valuable indicators of inflammatory arthritis.