The utility of MRI in predicting radiographic erosions in the metatarsophalangeal joints of the rheumatoid foot: A prospective longitudinal cohort study
Matthew L Mundwiler et al. – Study reports that the positive predictive value (PPV) of MRI erosions and of bone marrow edema to predict subsequent radiographic erosions was low. Alternatively, the negative predictive value (NPV) of the absence of an MRI erosion or bone marrow edema predicts that a later radiographic erosion or MRI erosion will likely not develop. Anti-TNF therapies may have resulted in the lower than anticipated positive predictive values, suggesting that more sensitive imaging modalities than radiographs are necessary to monitor disease in the biologic era. Methods- The purpose of this study was to:
- Determine the sensitivity, specificity, PPV and NPV of a metatarsophalangeal (MTP) erosion on MRI to predict a subsequent radiographic erosion in the same joint
- Perform similar analysis for bone marrow edema predicting a subsequent MRI erosion
- Report the descriptive results of other lesions
- 50 pts with RA of <5 yrs duration who were RF positive and/or anti-CCP positive were recruited
- Patients on anti-TNF therapy were excluded
- Anti-TNF therapy could begin after enrollment
- MRI and radiographs of the 3rd, 4th, and 5th MTP joints bilaterally were taken at baseline, 6, 12, and 24 mo
- Clinical data was collected
Results- 46/50 patients had suitable data
- Results for MRI erosions predicting subsequent radiographic erosions for 6, 12, and 24 mo, respectively, were as follows:
- Sensitivity 0.75, 0.60, 0.75
- Specificity 0.93, 0.94, 0.94
- PPV 0.086, 0.10, 0.17
- NPV 0.998, 0.995, 0.995
- Results for MRI bone marrow edema predicting MRI erosions at 6 and 12 mo, respectively, revealed:
- Sensitivity 0.50, 0.67
- Specificity 0.97, 0.97
- PPV 0.25, 0.50
- NPV 0.99, 0.99
- Synovitis was the most common finding and, when present in isolation, resolved on 67.3% of subsequent studies
- MRI erosions persisted on subsequent studies with one exception
- 46% of the cohort was on anti-TNF therapy after study inception
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