TY - JOUR T1 - Ultra-low-dose CT detects synovitis in patients with suspected rheumatoid arthritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 31 LP - 35 DO - 10.1136/annrheumdis-2018-213904 VL - 78 IS - 1 AU - Torsten Diekhoff AU - Sevtap Tugce Ulas AU - Denis Poddubnyy AU - Udo Schneider AU - Sandra Hermann AU - Robert Biesen AU - Gerd R Burmester AU - Bernd Hamm AU - Kay Geert Hermann Y1 - 2019/01/01 UR - http://ard.bmj.com/content/78/1/31.abstract N2 - Purpose To prove the feasibility and measure the diagnostic accuracy of contrast-enhanced ultra-low-dose CT (ULD-CT) for the depiction of inflammatory soft-tissue changes (synovitis, tenosynovitis and peritendonitis) in patients with arthritis of the hand.Materials and methods In this institutional review board–approved study, 36 consecutive patients over the age of 50 with suspected rheumatoid arthritis underwent ULD-CT (estimated radiation exposure <0.01  mSv) and MRI of the hand with weight-adapted intravenous contrast administration. ULD-CT subtraction and MR images were assessed for synovitis, tenosynovitis and peritendonitis by three readers using a modified Rheumatoid Arthritis MRI Score (RAMRIS). Patients were asked which modality they would prefer for future examinations. Sensitivity and specificity of ULD-CT for detection of inflammatory changes were calculated using MRI as standard of reference. The sum scores were correlated using Pearson’s r.Results All 36 patients showed synovitis in MRI. ULD-CT had 69% sensitivity on the patient level and 65% on the joint level with 87% specificity. Sensitivity was higher in patients with more severe inflammation (80% for MRI RAMRIS >1). There was almost perfect correlation between the modified RAMRIS sum scores of ULD-CT and MRI (Pearson’s r=0.94). Regarding preferences for future examinations, 85% preferred ULD-CT over MRI. ULD-CT detected more differential diagnoses than MRI (8 vs 2/12).Conclusion  Contrast-enhanced ULD-CT of the hand allows for depiction of soft-tissue inflammation at the hand and can be achieved using very low radiation exposure (<0.01 mSv). ULD-CT may evolve to a fast and comfortable alternative to MRI, although it is not as sensitive as MRI for detecting mild disease. ER -