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Dual-energy CT: a new imaging modality for bone marrow oedema in rheumatoid arthritis
  1. Lennart Jans1,
  2. Isabelle De Kock1,
  3. Nele Herregods1,
  4. Koenraad Verstraete1,
  5. Filip Van den Bosch2,3,
  6. Philippe Carron2,3,
  7. Edwin H Oei4,
  8. Dirk Elewaut2,3,
  9. Peggy Jacques2,3
  1. 1 Department of Radiology, Ghent University Hospital, Ghent, Belgium
  2. 2 Department of Rheumatology, Ghent University Hospital, Ghent, Belgiuim
  3. 3 Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, Ghent, Belgium
  4. 4 Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Prof dr Lennart Jans, Department of Radiology, Ghent University Hospital, Ghent 9000, Belgium; lennart.jans{at}ugent.be

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Active joint inflammation is a key feature in rheumatoid arthritis (RA). Treatment guidelines for RA,1 including ‘Treat-to-Target’ strategies,2 stress the importance of abrogation of inflammation. MRI clearly demonstrates bone marrow oedema lesions (BMEL) as a sign of inflammation.3 Dual-energy CT (DECT) scanners could provide a new approach to visualise BME.4–7 We investigated if DECT could visualise BME of the hand and wrist in patients with active RA, with MRI-proven BME as a gold standard.

Institutional review board approval was obtained. Twenty consecutive patients with active clinical synovitis of a metacarpophalangeal, proximal interphalangeal or wrist joint provided written informed consent and were included; 9 men and 11 women with a mean age of 60.7 (±10.3) years. Thirteen patients were ACPA positive and 8 were ACPA and RF positive; mean tender joint count and swollen joint count were both 5.9. Mean DAS28 was 4.37 (±1.4). The mean disease duration was 6.6 (±6.1) years. Seventeen patients were treated with conventional disease-modifying antirheumatic drugs, 7 were also treated with biologicals.

DECT was performed on a dual-source CT, data were post-processed with SyngioVia ‘Bone Marrow Oedema’ application (see the online supplementary text). Images were presented as colour-coded maps. …

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