J. H. Gerth · A. Hansch · G. Teichmann · A. Reske · T. Wiech · H. H. Sigusch 1 Klinik für Innere Medizin II, Heinrich-Braun-Klinikum, Standort Zwickau, Zwickau, Deutschland 2 Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Heinrich-BraunKlinikum, Standort Zwickau, Zwickau, Deutschland 3 Klinik für Frauenheilkunde und Geburtshilfe, Heinrich-Braun-Klinikum, Standort Zwickau, Zwickau, Deutschland 4 Klinik für Anästhesiologie, Intensivmedizin, Notfallund Schmerzmedizin, Heinrich-Braun-Klinikum, Standort Zwickau, Zwickau, Deutschland 5 Institut für Nephropathologie, UniversitätsklinikumHamburg-Eppendorf, Hamburg, Deutschland 6 Klinik für Innere Medizin I, Kardiologie, Heinrich-Braun-Klinikum, Standort Zwickau, Zwickau, Deutschland

Neben anderen Ursachen kann auch eine plötzliche Tumorblutung zu einem akuten Exophthalmus führen [1], [2].

The established scoring techniques based on radiographs present limitations in the evaluation of structural integrity due to high effectiveness of innovative therapeutic strategies. The aim of this study was to evaluate the periarticular mineralisation as detected by Digital X-ray Radiogrammetry (DXR) as surrogate marker for structural integrity during the course of rheumatoid arthritis (RA).

OBJECTIVE:The aim of this study was to visualize soft tissue inflammation using FOI on patients with Systemic Sclerosis (SSc) characterized by SSc-related Raynaud's phenomenon and to detect the therapeutic response to treatment with iloprost or alprostadil.METHODS:Twenty-one patients with SSc and Raynaud's phenomenon and twenty-six healthy controls were prospectively included. The SSc patients were intravenously treated with iloprost or alprostadil over seven days. FOI was performed at baseline and after seven days using an intravenous application of indocyanine green (ICG). The hands were divided into nineteen segments per hand. All segments were quantitatively evaluated to determine changes in ICG.RESULTS:The sensitivity and specificity of FOI in the detection of ICG enhancement in patients with SSc were 95% versus 96%. At baseline, 31.5% hand segments showed ICG enhancement. After seven days of either iloprost or alprostadil therapy a significant reduction in the ICG was observed which ranged from 40.9% to 24.7%.CONCLUSION:The study demonstrates that the FOI technique is able to visualize soft-tissue inflammation with both high sensitivity and specificity. The anti-inflammatory therapeutic effects of iloprost were slightly stronger than alprostadil. FOI offers promising benefits in the diagnosis and therapy of patients with SSc-associated Raynaud's phenomenon.

Digital X-ray radiogrammetry (DXR) is a computer-assisted technique used to quantify cortical bone density of the metacarpals. The influence of metacarpal bone rotation and type of cast material on bone mineral density (BMD) measurements using the DXR technique was tested.

Rheumatoid arthritis (RA) as a chronic inflammatory disease is typically characterised by the periarticular demineralisation. Advanced disease activity with involvement of various peripheral articulations is associated with decreased periarticular bone mass. The periarticular demineralisation functions as surrogate marker of structural destruction of the inflamed joints and is a predictor for the occurrence of erosions. Digital X-ray radiogrammetry (DXR), dual energy X-ray absorptiometry (DXA) and high-resolution quantitative computed tomography (HR-pQCT) were used for the quantification of periarticular demineralisation. Because of the low discriminative power with limited differentiation between early periarticular bone loss and prolonged systemic secondary osteoporosis, DXA measurements were not favourable for the measurement of hand bone loss. Otherwise, DXR and HR-pQCT present high reproducibility in the quantification of bone mineral density at the metacarpal bones and adjacent to metacarpophalangeal joints. The excellent reproducibility of the DXR and HR-pQCT techniques is the basis for a precise quantification of periarticular demineralisation and also the detection of therapeutic effects during RA therapy.

Die rheumatoide Arthritis (RA) ist als chronisch entzündliche Erkrankung mit einer periartikulären Demineralisation als krankheitsspezifisches Stigma gekennzeichnet. Hierbei ist eine hohe Krankheitsaktivität und eine entzündliche Manifestation an den peripheren Gelenkpartitionen mit einem periartikulären Knochenmasseverlust assoziiert. Die periartikuläre Demineralisation ist demzufolge mit der strukturellen Destruktion der RA-spezifisch involvierten Gelenke verbunden und ein Prädiktor für das Auftreten von Erosionen. Eine Bestimmung der periartikulären Demineralisation ist insbesondere durch die Digitale Radiogrammetrie (DXR), die Dual Energie X-ray Absorptiometry (DXA) und die hochauflösende periphere quantitative Computertomografie (HR-pQCT) quantifizierbar. Aufgrund einer verminderten Differenzierbarkeit zwischen der krankheitsspezifischen frühzeitigen periartikulären Demineralisation und einer systemischen sekundären Osteoporose als Spätfolge der RA kann anhand der aktuellen Daten eine Knochenmineraldichtemessung mittels DXA nicht favorisiert werden. Mittels DXR und HR-pQCT gelingt hingegen eine Bestimmung der Knochenmineraldichte an den Metakarpalknochen und im Bereich der Metakarpophalangealgelenke mit einer hohen Reproduzierbarkeit. Die exzellente Reproduzierbarkeit der DXR und der HR-pQCT ist die Vorraussetzung für eine präzise Quantifizierung der periartikulären Knochenmineraldichte mit der Möglichkeit einer Detektion von Therapieeffekten während der Behandlung einer RA.

Objective To compare the diagnostic efficacy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) vs. multidetector computed tomography (MDCT) for the detection and classification of focal liver lesions, differentiated also for lesion entity and size; a separate analysis of pre- and postcontrast images as well as T2-weighted MRI sequences of focal and exclusively solid lesions was integrated. Methods Twenty-nine patients with 130 focal liver lesions underwent MDCT (64-detector-row; contrast medium iopromide; native, arterial, portalvenous, venous phase) and MRI (1.5-T; dynamic and tissue-specific phase 20 min after application of Gd-EOB-DTPA). Hepatic lesions were verified against a standard of reference (SOR). CT and MR images were independently analysed by four blinded radiologists on an ordinal 6-point-scale, determining lesion classification and diagnostic confidence. Results Among 130 lesions, 68 were classified as malignant and 62 as benign by SOR. The detection of malignant and benign lesions differed significantly between combined and postcontrast MRI vs. MDCT; overall detection rate was 91.5% for combined MRI and 80.4% for combined MDCT (p < 0.05). Considering all four readers together, combined MDCT achieved sensitivity of 66.2%, specificity of 79.0%, and diagnostic accuracy of 72.3%; combined MRI reached superior diagnostic efficacy: sensitivity 86.8%, specificity 94.4%, accuracy 90.4% (p < 0.05). Differentiated for lesion size, in particular lesions <20 mm revealed diagnostic benefit by MRI. Postcontrast MRI also achieved higher overall sensitivity, specificity, and accuracy compared to postcontrast MDCT for focal and exclusively solid liver lesions (p < 0.05). Conclusion Combined and postcontrast Gd-EOB-DTPA-enhanced MRI provided significantly higher overall detection rate and diagnostic accuracy, including low inter-observer variability, compared to MDCT in a single centre study.

INTRODUCTION:The aim of this study was to assess a novel approach for the quantification of finger joint space narrowing and joint destruction in patients with rheumatoid arthritis (RA) focusing on the peripheral hand articulations.METHODS:A total of 280 patients with verified RA underwent computerized semi-automated measurements of joint space distance at the finger articulations based on radiographs. The Z-Score, which can differentiate between joint space alterations caused by RA versus age/gender-related changes, was calculated as a comparative parameter. The severity of joint space narrowing was also quantified by the Sharp Score. Sensitivity and specificity of the Z-Score (based on joint space widths differentiated for each peripheral finger joint) were evaluated to reveal the potential for the occurrence of erosions. Additionally, the potential of the Z-Score regarding the differentiation of therapeutic effects on joint space widths in patients under a therapy of methotrexate versus leflunomide was performed.RESULTS:The Z-Scores of finger articulations in patients with RA were generally decreased. Metacarpal-phalangeal (MCP) joint articulations showed a continuous significant decline of -1.65±0.30 standard deviations dependent on the Sharp Score. The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96±0.31 standard deviations). The sensitivity and specificity of MCP joint space distance for the detection of erosions were 85.4% versus 55.2%. The Sharp Score for joint space narrowing was not able to detect different treatments, whereas an accentuated stabilization of joint space narrowing could be identified for the Z-Score of the MCP joints in patients treated with leflunomide and methotrexate.CONCLUSION:The Z-Scoring method based on computer-aided analysis of joint space widths was able to reliably quantify severity-dependent joint space narrowing in RA patients. In the future, calculation of a Z-Score based on gender-specific and age-specific reference data shows the potential for a surrogate marker of RA progression that comprehends the early identification of patients with RA, and in particular those with erosive course of the disease, enabling a timely therapeutic strategy for cartilage protection.