Talk: Comparative Study of MRI and Power Doppler Ultrasonography (US) of the Heel in Spondyloarthritis (SpA) Patients with and without Heel Pain and in Controls: The ETERS Study (2009 ACR/ARHP Annual Scientific Meeting)

Monday, October 19, 2009: 3:30 PM

113 A (Pennsylvania Convention Center)

Marie-Charlotte Lavie¹, Laure Gossec², Frédéric Lavie³, Henri Guerini¹, F. Rannou⁴, Christelle Nguyen⁴, Xavier Ayral¹, Antoine Feydy⁵ and M. Dougados⁶, ¹Cochin Hospital Paris France, Paris, France, ²French Society of Rheumatology Patient Education, Paris, France, ³Cochin Hospital, Rene Descartes University, Paris, Paris, France, ⁴Paris Descartes University, Cochin Hospital, AP-HP; INSERM, Federative Institute on Handicap Research (IFR 25), Paris, France, ⁵Paris Descartes University, Cochin Hospital, AP-HP, ⁶Hôpital Cochin, Rene Descartes University, Paris, Paris, France

Presentation Number: 1182

Purpose Enthesitis of the heel is frequent in spondyloarthritis (SpA). However symptomatic heel pain occurs only in a minority of SpA patients. Magnetic resonance imaging (MRI) and Power Doppler ultrasonography (PDUS) may visualize posterior and inferior inflammatory heel lesions but their utility is debated. To assess the diagnostic capacities of MRI and of PDUS of the heel : a) to distinguish patients with SpA versus controls; and b) to distinguish SpA patients with versus without heel pain

Method Cross-sectional, monocenter study. In all, 72 patients (144 heels) were included: definite heels SpA patients according to Amor’s criteria (n=96) were divided into 3 groups: (1) heels with no history of pain (n=57), (2) heels with history of pain (n=18), (3) heels with current pain related to enthesitis according to clinical examination and expert opinion (n=21). Patients with degenerative low back pain (48 heels) group (4)) were included as a control group. Bilateral heel MRI (coronal STIR, sagittal STIR and sagittal T1 images) and PDUS were performed by two different senior musculoskeletal radiologists blinded to other data, the same day as clinical evaluation. Imaging analysis was focused on inflammatory signs.

MRI was considered as positive if any of the following signs were observed: Intra or peri Achilles tendon or aponeurosis hypersignal, Achilles tendon thickness > 5.29 mm, retrocalcaneal bursitis, plantar fascia thickness > 4.4 mm, or calcaneus bone edema. PDUS was considered as positive if any of the following signs were observed: Achilles tendon or aponeurosis echostructure abnormality, Achilles tendon thickness > 5.29 mm, plantar fascia thickness > 4.4 mm, retrocalcaneal bursitis, or presence of abnormal Power-Doppler signal.

Results

For the whole population, mean age was 50+/- 18 yrs, and 53% were male. Among SpA patients, 82% were B27+ and 64% had sacro-iliitis (mean symptom duration, 13+/-12 yrs). Inferior bone edema was the only specific abnormality of SpA (18% of SpA heels vs 4 % of controls heels, p=0.020), but with a poor sensitivity. PDUS showed no specific abnormality of SpA, even when using the power Doppler. However, among patients with SpA, painful heels presented more inflammatory abnormalities than painless heels (81% versus 56% in MRI, p=0.045, and 58% versus 17% in PDUS, p=0.008, respectively).

Conclusion Heel MRI and PDUS show frequent abnormalities (inflammatory lesions) in SpA and more so in painful heels. However, they are also frequently abnormal in controls. Our results suggest that heel MRI and PDUS cannot be used for the diagnosis of SpA. However, PDUS and MRI may be useful for the depiction and assessment of enthesis inflammatory lesions in SpA with heel pain.

Keywords: ankylosing spondylitis (AS), magnetic resonance imaging (MRI) and ultrasound

Disclosure: M. C. Lavie, None; L. Gossec, None; F. Lavie, None; H. Guerini, None; F. Rannou, None; C. Nguyen, None; X. Ayral, None; A. Feydy, None; M. Dougados, None.

1182 - Comparative Study of MRI and Power Doppler Ultrasonography (US) of the Heel in Spondyloarthritis (SpA) Patients with and without Heel Pain and in Controls: The ETERS Study