The Diagnosis Value Of Digital Tomosynthesis In The Hand-wrist Lesions Of The Rheumatoid Arthritis

Objective:The aim of this investigation is to compare the difference detection rate of joint space narrowing, bone erosion between digital tomosynthesis(DTS) and digital X-ray photography(DR) in rheumatoid arthritis(RA) for hand-wrist lesions, to research on the correlation between bone erosion score(Sharp score) with DTS and RA disease activity score(DAS28-3 score), ESR, RF, Anti-CCP. To study the diagnosis value of DTS in the RA patients and evaluate the RA disease severity, disease activity and feasibility of prognosis with DTS, to provide a reliable basis for early RA clinical diagnosis,classification, follow-up and evaluation of curative effect.Methods:1.30 cases of RA patients as study group, and 15 cases of non-RA patients as the control group, from December 2013 to December 2014 in the hospital of Shanxi medical university,were studied.2.We collected and recorded the information of the study group and the control group about personal health and disease.3.45 subjects(30 cases of RA patients and 15 cases of non-RA patients) respectively examined hand-wrist DR and DTS, and then three experienced radiologists observed,analyzed and recorded the imaging manifestations.4.The result of laboratory information and clinical examination of the study group,including: serum concentration of ESR, RF, Anti-CCP; the number of Swelling of the joints, tender joints were recorded.Results:1.The sensitivity and specificity hand-wrist lesions of the RA patients with DTS and DR respectively was 90.0%, 76.7% and 96.7%,96.7% detecting, the sensitivity of DTS was significantly higher than the DR.Z-test was P < 0.05,the area under the curve of two kinds of examination respectively were 0.683,0.833.2.The detection date of joint space narrowing was 46(76.67%) and the bone erosion is 30(50.00%) in 60 RA hand-wrist joints with DTS. While the detection date of joint space narrowing was 28(49.38%) and the bone erosion is 22(36.67%) in 60 RA hand-wrist joints with DR. DTS detection rate was significantly higher than that of DR, and had a significant differences.3.The hand-wrist were divided into four joint group, including radiocarpal joint, wrist joint, metacarpophalangeal joint and proximal interphalangeal joint. The DTS detection date of joint space narrowing in each joint group was 15.00%, 10.00%, 4.00%, 11.00%,and DR detection rate of corresponding joint was 7.50%, 4.44%, 3.65%, 7.00%,respectively. The detection rate for group of the radiocarpal joint, wrist joint group,proximal interphalangeal(PIP) of joint space narrowing had obvious difference(P<0.05),detection rate for metacarpophalangeal joint groups was difference between the DR and DTS(P>0.05).The DTS detection date of bone erosion in each joint group was 10.00%, 11.33%,2.67%, 11.33%,and DR detection rate of corresponding joint was 4.17%, 4.33%, 2.67%,6.67%. The detection rate for group of the radiocarpal joint, wrist joint group, proximal interphalangeal(PIP) of joint space narrowing had obvious difference(P<0.05), detection rate for metacarpophalangeal joint groups was difference between the DR and DTS(P>0.05).4.Bone erosion took place in the surface of the bone cortex which major characteristic was borderline, liking "insect damage", "the crater defects". A part of the bone erosion was in cancellous bone under the articular cartilage, showing a small bright area of cystic lesions and not clear edges. The change of joint space narrowing was showed articularsurface hardening, articular surface not smooth, narrow of joint space.5.Score of bone erosion with DAS28-3 scores, Anti-PCC and RF were positively correlated in 30 RA patients(P< 0.05), r = 0.565, 0.799, 0.432.Conclusions:1.For the bone change of the RA hand-wrist DTS can detect change of bone that DR failed to find, DTS found bone change is significantly higher sensitivity than DR. In the hand-wrist joint group, the detection ability of bone change with DTS is higher than the DR in addition to the metacarpophalangeal joint group. The area under the curve is higher than the DR in the diagnosis of efficiency. Sharp score has a significant correlation with the activity index reflecting RA disease2.DTS can be used as a means to provide reliable basis in clinical diagnosis,assessment, differential diagnosis, curative effect observation.