human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the role of ultrasound and magnetic resonance imaging ( MRI ) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis ( RA ) of the shoulder joint . METHODS Forty-three consecutive patients with known RA prospect ively underwent clinical examination , radiography , ultrasound , and MRI of the shoulder joints . Each patient was assigned a clinical /laboratory score consisting of 7 parameters , including measurements of shoulder mobility , the erythrocyte sedimentation rate , and C-reactive protein level .  Conventional radiography was st and ardized and performed in 2 planes . Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer . MRI at 1.5 T comprised transverse and oblique coronal T1- and T2 * -weighted fast spin-echo , gradient-echo ( GRE ) , and inversion-recovery sequences with a matrix size of up to 512 pixels . A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium . Erosions were assessed using all 3 imaging techniques on a 4-point scale . Soft-tissue involvement was evaluated according to the presence of synovitis , tenosynovitis , and bursitis on ultrasound and MRI . The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain . RESULTS In the study group , erosions of the humeroscapular joint were detected by conventional radiography in 26 patients , by ultrasound in 30 patients , and by MRI in 39 patients ; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI ( P < 0.0001 ) . Conventional radiography detected 12 erosions of the scapula and MRI detected 15 . Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI ( P = 0.0003 ) . Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI ( P = 0.0064 ) . Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI . The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI ( P < 0.05 ) . CONCLUSION Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint . Although conventional radiography can be used as the sole method of following up known joint destruction in RA , ultrasound and , preferably , MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results OBJECTIVES To evaluate the role of magnetic resonance imaging ( MRI ) of the wrist in detecting early joint damage in patients with rheumatoid arthritis ( RA ) . METHODS  MRI was performed on 42 patients with early RA ( median symptom duration of four months ) . Scans were scored separately by two musculoskeletal radiologists using a newly devised scoring system , which was vali date d. MRI findings were compared with plain radiography , clinical measures , and HLA-DRB*01/04 genotyping . RESULTS Interobserver reliability for the overall MRI score was high ( r = 0.81 ) as was intraobserver reliability ( r = 0.94 for observer 1 and 0.81 for observer 2 ) . There was more variation in scoring synovitis ( interobserver reliability : r = 0.74 ) . Erosions were detected in 45 % of scans ( 19 of 42 ) , compared with 15 % of plain radiographs . The most common site for erosions was the capitate ( 39 % ) , for synovitis the ulnar aspect of the radiocarpal joint , and for tendonitis , the extensor carpi ulnaris tendon . The total MRI score and MRI synovitis score correlated most significantly with C reactive protein ( r = 0.40 and 0.42 respectively , p<0.01 ) . The MRI erosion score was highly correlated with MRI bone marrow oedema ( r = 0.83 ) as well as the Ritchie score and disease activity score ( r = 0.32 , p<0.05 ) . HLA-DRB1 * 04 or * 01 ( shared epitope + ve ) was found in 76 % of patients ; 84 % of those with MRI erosions and 69 % of those without ( NS , p = 0.3 ) . CONCLUSIONS A high proportion of RA patients develop MRI erosions very early in their disease , when plain radiography is frequently normal . MRI of the dominant wrist may identify those requiring early aggressive treatment Objective . To evaluate the sensitivity and specificity of magnetic resonance imaging ( MRI ) in detecting erosions , bone edema , and synovitis in the metacarpophalangeal and wrist joints for rheumatoid arthritis ( RA ) . Methods . MRI scans of bilateral h and s and wrists of 40 healthy subjects and 40 RA patients were performed using 0.2 T extremity-MRI and read blindly using a modified RA MRI ( RAMRIS ) system ( no contrast injection , imaging in 1 plane only ) . To determine interreader reliability , images of 10 r and omly selected subjects were read independently by a musculoskeletal radiologist . Results . A total of 3360 bones were evaluated . Patients with RA had significantly more erosions as well as higher scores for bone edema and synovitis than healthy subjects . Age had a significant effect on the number of erosions in both groups . However , when disease duration was factored in , age became insignificant in RA patients . Erosion number correlated with positive rheumatoid factor and higher C-reactive protein values . The intraclass correlation coefficient between the 2 readers was 0.76 for individual joints and 0.88 for total scores . When having a single erosion was used as a positive test for RA , the sensitivity of this test was 90 % , but the specificity was only 35 % . Presence of bone edema provided 65 % sensitivity and 82.5 % specificity . Eliminating the lunate from scoring for bone edema increased the specificity to 87.5 % while decreasing the sensitivity to 62.5 % . Conclusion . While MRI is a highly sensitive tool for identifying and tracking the progression of erosions , erosions detected by MRI with measures commonly used in a rheumatologist ’s office ( no contrast , imaging in 1 plane ) provide low specificity for RA . Bone marrow edema is the most specific MRI lesion for RA in this setting Objectives To determine the accuracy of ultrasonography ( US ) for bone erosion detection in different areas of rheumatoid arthritis ( RA ) metacarpophalangeal ( MCP ) joints with multislice CT as the reference method . Second , to establish the necessary bone volume loss on CT for US to reliably detect it as an erosion , and finally to compare two semiquantitative US-erosion scoring methods . Methods The 2nd–5th MCP joints of 49 patients with RA were examined by CT and US  , and evaluated for the presence of bone erosion in each MCP joint quadrant . On CT , erosion volume was scored according to the OMERACT-RAMRIS score ( bone volume loss in 10 % increments of original bone volume ) . US erosions were scored 0–3 according to the Szkudlarek and Scoring by UltraSound Structural erosion ( ScUSSe ) systems , respectively . Results Seven hundred and eighty-four MCP joint quadrants were examined . Erosions were detected by CT in 259 quadrants and by US in 142 quadrants . Sensitivity/specificity/accuracy of US was overall 44%/95%/78 % compared with 71%/95%/90 % in areas with good US accessibility ( radial 2nd MCP , ulnar 5th MCP and all dorsal/palmar aspects ) . US detected 95 % of erosions with bone volume loss > 20 % . In US accessible areas , 63 % of erosions with 1–10 % bone volume loss and 94 % of erosions with > 10 % bone loss were detected . The two US scoring systems agreed well on large erosions , whereas the smallest erosions ( Szkudlarek grade 1 , of which 86 % were confirmed by CT ) were not scored by ScUSSe . Conclusion In accessible areas , US was highly accurate for detection and semiquantitative assessment of RA bone erosion . Even the smallest erosions , only detected in one plane , were generally confirmed by CT OBJECTIVE Magnetic resonance imaging ( MRI ) is capable of revealing synovitis and tendinitis in early rheumatoid arthritis ( RA ) , as well as bone edema and erosion . These features are visible before radiographic joint damage occurs . We sought to examine whether MRI of one body region ( the wrist ) can be used to predict whole-body radiography scores reflecting joint damage at 6 years . METHODS We conducted a 6-year prospect i ve study of a cohort of patients who fulfilled the criteria for RA at presentation , using clinical parameters , radiographs , and MRI scans of the dominant wrist . Of the 42 patients enrolled at baseline , full MRI , radiographic , and clinical data were available for 31 at 6-year followup .  MRI scans were scored by 2 radiologists , using a vali date d scoring system . Radiographs of the h and s and feet were grade d using the modified Sharp scoring method . MRI and radiography scores obtained at baseline and 6 years were compared , and baseline MRI scores were examined for their ability to predict radiographic outcome at 6 years . RESULTS At 6 years , the total Sharp score correlated significantly with the total MRI score and the MRI erosion score ( r = 0.81 , P < 0.0001 and r = 0.79 , P < 0.0001 , respectively ) . The 6-year Sharp score also correlated with the baseline total MRI and MRI erosion scores ( r = 0.56 , P < 0.0001 and r = 0.33 , P = 0.03 , respectively ) . MRI synovitis and bone edema scores remained constant for the group as a whole over 6 years , but bone erosion scores progressed ( P = 0.0001 ) , consistent with radiographic deterioration . Erosions on 6-year MRI scans were frequently preceded by MRI bone edema at baseline ( odds ratio 6.5 , 95 % confidence interval 2.78 - 18.1 ) . Regression models indicated that the baseline MRI bone edema score was predictive of the 6-year total Sharp score ( P = 0.01 ) , as was the C-reactive protein ( CRP ) level ( P = 0.0002 ) . Neither shared epitope status nor swollen or tender joint counts predicted radiographic outcome in this cohort . A model incorporating baseline MRI scores for erosion , bone edema , synovitis , and tendinitis plus the CRP level and the erythrocyte sedimentation rate explained 59 % of the variance in the 6-year total Sharp score ( R(2 ) = 0.59 , adjusted R(2 ) = 0.44 ) . CONCLUSION MRI scans performed at the first presentation of RA can be used to help predict future radiographic damage , allowing disease-modifying therapy to be targeted to patients with aggressive disease OBJECTIVE To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis ( RA ) . METHODS Forty patients with early , untreated RA underwent gadolinium-enhanced magnetic resonance imaging ( MRI ) of the second through fifth metacarpophalangeal joints of the dominant h and at presentation , 3 months , and 12 months . In the first phase ( 0 - 3 months ) , patients were r and omized to receive either methotrexate alone ( MTX ) or MTX and intraarticular corticosteroids ( MTX + IAST ) into all joints with clinical ly active RA . The MTX-alone group received no further corticosteroids until the second phase ( 3 - 12 months ) , when both groups received st and ard therapy . RESULTS In the first phase , MTX + IAST reduced synovitis scores more than MTX alone . There were significantly fewer joints with new erosions on MRI in the former group compared with the latter . During the second phase , the synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI . In both phases , there was a close correlation between the degree of synovitis and the number of new erosions , with the area under the curve for MRI synovitis the only significant predictor of bone damage progression . In individual joints , there was a threshold effect on new bone damage related to the level of synovitis ; no erosions occurred in joints without synovitis . CONCLUSION In early RA , synovitis appears to be the primary abnormality , and bone damage occurs in proportion to the level of synovitis but not in its absence . In the treatment of patients with RA , outcome measures and therapies should focus on synovitis We prospect ively evaluated the diagnostic value of sonography and magnetic resonance imaging ( MRI ) in 24 shoulders in 23 patients with suspected rotator cuff tears using arthrography as gold st and ard . Sonography demonstrated 14 of 15 , MRI 10 of 15 rotator cuff tears , respectively . Sonography diagnosed seven of nine intact rotator cuffs correctly , MRI eight of nine . In a retrospective study we review ed the diagnostic value of sonography and MRI in other pathologies of the shoulder including intra-articular pathology , humeral head and acromioclavicular 
    Output:
    
agent
It can be classified according to their configuration , shape , content , and can be described specifically with an anatomical term . “
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the role of ultrasound and magnetic resonance imaging ( MRI ) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis ( RA ) of the shoulder joint . METHODS Forty-three consecutive patients with known RA prospect ively underwent clinical examination , radiography , ultrasound , and MRI of the shoulder joints . Each patient was assigned a clinical /laboratory score consisting of 7 parameters , including measurements of shoulder mobility , the erythrocyte sedimentation rate , and C-reactive protein level .  Conventional radiography was st and ardized and performed in 2 planes . Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer . MRI at 1.5 T comprised transverse and oblique coronal T1- and T2 * -weighted fast spin-echo , gradient-echo ( GRE ) , and inversion-recovery sequences with a matrix size of up to 512 pixels . A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium . Erosions were assessed using all 3 imaging techniques on a 4-point scale . Soft-tissue involvement was evaluated according to the presence of synovitis , tenosynovitis , and bursitis on ultrasound and MRI . The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain . RESULTS In the study group , erosions of the humeroscapular joint were detected by conventional radiography in 26 patients , by ultrasound in 30 patients , and by MRI in 39 patients ; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI ( P < 0.0001 ) . Conventional radiography detected 12 erosions of the scapula and MRI detected 15 . Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI ( P = 0.0003 ) . Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI ( P = 0.0064 ) . Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI . The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI ( P < 0.05 ) . CONCLUSION Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint . Although conventional radiography can be used as the sole method of following up known joint destruction in RA , ultrasound and , preferably , MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results OBJECTIVES To evaluate the role of magnetic resonance imaging ( MRI ) of the wrist in detecting early joint damage in patients with rheumatoid arthritis ( RA ) . METHODS  MRI was performed on 42 patients with early RA ( median symptom duration of four months ) . Scans were scored separately by two musculoskeletal radiologists using a newly devised scoring system , which was vali date d. MRI findings were compared with plain radiography , clinical measures , and HLA-DRB*01/04 genotyping . RESULTS Interobserver reliability for the overall MRI score was high ( r = 0.81 ) as was intraobserver reliability ( r = 0.94 for observer 1 and 0.81 for observer 2 ) . There was more variation in scoring synovitis ( interobserver reliability : r = 0.74 ) . Erosions were detected in 45 % of scans ( 19 of 42 ) , compared with 15 % of plain radiographs . The most common site for erosions was the capitate ( 39 % ) , for synovitis the ulnar aspect of the radiocarpal joint , and for tendonitis , the extensor carpi ulnaris tendon . The total MRI score and MRI synovitis score correlated most significantly with C reactive protein ( r = 0.40 and 0.42 respectively , p<0.01 ) . The MRI erosion score was highly correlated with MRI bone marrow oedema ( r = 0.83 ) as well as the Ritchie score and disease activity score ( r = 0.32 , p<0.05 ) . HLA-DRB1 * 04 or * 01 ( shared epitope + ve ) was found in 76 % of patients ; 84 % of those with MRI erosions and 69 % of those without ( NS , p = 0.3 ) . CONCLUSIONS A high proportion of RA patients develop MRI erosions very early in their disease , when plain radiography is frequently normal . MRI of the dominant wrist may identify those requiring early aggressive treatment Objective . To evaluate the sensitivity and specificity of magnetic resonance imaging ( MRI ) in detecting erosions , bone edema , and synovitis in the metacarpophalangeal and wrist joints for rheumatoid arthritis ( RA ) . Methods . MRI scans of bilateral h and s and wrists of 40 healthy subjects and 40 RA patients were performed using 0.2 T extremity-MRI and read blindly using a modified RA MRI ( RAMRIS ) system ( no contrast injection , imaging in 1 plane only ) . To determine interreader reliability , images of 10 r and omly selected subjects were read independently by a musculoskeletal radiologist . Results . A total of 3360 bones were evaluated . Patients with RA had significantly more erosions as well as higher scores for bone edema and synovitis than healthy subjects . Age had a significant effect on the number of erosions in both groups . However , when disease duration was factored in , age became insignificant in RA patients . Erosion number correlated with positive rheumatoid factor and higher C-reactive protein values . The intraclass correlation coefficient between the 2 readers was 0.76 for individual joints and 0.88 for total scores . When having a single erosion was used as a positive test for RA , the sensitivity of this test was 90 % , but the specificity was only 35 % . Presence of bone edema provided 65 % sensitivity and 82.5 % specificity . Eliminating the lunate from scoring for bone edema increased the specificity to 87.5 % while decreasing the sensitivity to 62.5 % . Conclusion . While MRI is a highly sensitive tool for identifying and tracking the progression of erosions , erosions detected by MRI with measures commonly used in a rheumatologist ’s office ( no contrast , imaging in 1 plane ) provide low specificity for RA . Bone marrow edema is the most specific MRI lesion for RA in this setting Objectives To determine the accuracy of ultrasonography ( US ) for bone erosion detection in different areas of rheumatoid arthritis ( RA ) metacarpophalangeal ( MCP ) joints with multislice CT as the reference method . Second , to establish the necessary bone volume loss on CT for US to reliably detect it as an erosion , and finally to compare two semiquantitative US-erosion scoring methods . Methods The 2nd–5th MCP joints of 49 patients with RA were examined by CT and US  , and evaluated for the presence of bone erosion in each MCP joint quadrant . On CT , erosion volume was scored according to the OMERACT-RAMRIS score ( bone volume loss in 10 % increments of original bone volume ) . US erosions were scored 0–3 according to the Szkudlarek and Scoring by UltraSound Structural erosion ( ScUSSe ) systems , respectively . Results Seven hundred and eighty-four MCP joint quadrants were examined . Erosions were detected by CT in 259 quadrants and by US in 142 quadrants . Sensitivity/specificity/accuracy of US was overall 44%/95%/78 % compared with 71%/95%/90 % in areas with good US accessibility ( radial 2nd MCP , ulnar 5th MCP and all dorsal/palmar aspects ) . US detected 95 % of erosions with bone volume loss > 20 % . In US accessible areas , 63 % of erosions with 1–10 % bone volume loss and 94 % of erosions with > 10 % bone loss were detected . The two US scoring systems agreed well on large erosions , whereas the smallest erosions ( Szkudlarek grade 1 , of which 86 % were confirmed by CT ) were not scored by ScUSSe . Conclusion In accessible areas , US was highly accurate for detection and semiquantitative assessment of RA bone erosion . Even the smallest erosions , only detected in one plane , were generally confirmed by CT OBJECTIVE Magnetic resonance imaging ( MRI ) is capable of revealing synovitis and tendinitis in early rheumatoid arthritis ( RA ) , as well as bone edema and erosion . These features are visible before radiographic joint damage occurs . We sought to examine whether MRI of one body region ( the wrist ) can be used to predict whole-body radiography scores reflecting joint damage at 6 years . METHODS We conducted a 6-year prospect i ve study of a cohort of patients who fulfilled the criteria for RA at presentation , using clinical parameters , radiographs , and MRI scans of the dominant wrist . Of the 42 patients enrolled at baseline , full MRI , radiographic , and clinical data were available for 31 at 6-year followup .  MRI scans were scored by 2 radiologists , using a vali date d scoring system . Radiographs of the h and s and feet were grade d using the modified Sharp scoring method . MRI and radiography scores obtained at baseline and 6 years were compared , and baseline MRI scores were examined for their ability to predict radiographic outcome at 6 years . RESULTS At 6 years , the total Sharp score correlated significantly with the total MRI score and the MRI erosion score ( r = 0.81 , P < 0.0001 and r = 0.79 , P < 0.0001 , respectively ) . The 6-year Sharp score also correlated with the baseline total MRI and MRI erosion scores ( r = 0.56 , P < 0.0001 and r = 0.33 , P = 0.03 , respectively ) . MRI synovitis and bone edema scores remained constant for the group as a whole over 6 years , but bone erosion scores progressed ( P = 0.0001 ) , consistent with radiographic deterioration . Erosions on 6-year MRI scans were frequently preceded by MRI bone edema at baseline ( odds ratio 6.5 , 95 % confidence interval 2.78 - 18.1 ) . Regression models indicated that the baseline MRI bone edema score was predictive of the 6-year total Sharp score ( P = 0.01 ) , as was the C-reactive protein ( CRP ) level ( P = 0.0002 ) . Neither shared epitope status nor swollen or tender joint counts predicted radiographic outcome in this cohort . A model incorporating baseline MRI scores for erosion , bone edema , synovitis , and tendinitis plus the CRP level and the erythrocyte sedimentation rate explained 59 % of the variance in the 6-year total Sharp score ( R(2 ) = 0.59 , adjusted R(2 ) = 0.44 ) . CONCLUSION MRI scans performed at the first presentation of RA can be used to help predict future radiographic damage , allowing disease-modifying therapy to be targeted to patients with aggressive disease OBJECTIVE To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis ( RA ) . METHODS Forty patients with early , untreated RA underwent gadolinium-enhanced magnetic resonance imaging ( MRI ) of the second through fifth metacarpophalangeal joints of the dominant h and at presentation , 3 months , and 12 months . In the first phase ( 0 - 3 months ) , patients were r and omized to receive either methotrexate alone ( MTX ) or MTX and intraarticular corticosteroids ( MTX + IAST ) into all joints with clinical ly active RA . The MTX-alone group received no further corticosteroids until the second phase ( 3 - 12 months ) , when both groups received st and ard therapy . RESULTS In the first phase , MTX + IAST reduced synovitis scores more than MTX alone . There were significantly fewer joints with new erosions on MRI in the former group compared with the latter . During the second phase , the synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI . In both phases , there was a close correlation between the degree of synovitis and the number of new erosions , with the area under the curve for MRI synovitis the only significant predictor of bone damage progression . In individual joints , there was a threshold effect on new bone damage related to the level of synovitis ; no erosions occurred in joints without synovitis . CONCLUSION In early RA , synovitis appears to be the primary abnormality , and bone damage occurs in proportion to the level of synovitis but not in its absence . In the treatment of patients with RA , outcome measures and therapies should focus on synovitis We prospect ively evaluated the diagnostic value of sonography and magnetic resonance imaging ( MRI ) in 24 shoulders in 23 patients with suspected rotator cuff tears using arthrography as gold st and ard . Sonography demonstrated 14 of 15 , MRI 10 of 15 rotator cuff tears , respectively . Sonography diagnosed seven of nine intact rotator cuffs correctly , MRI eight of nine . In a retrospective study we review ed the diagnostic value of sonography and MRI in other pathologies of the shoulder including intra-articular pathology , humeral head and acromioclavicular 
    Output:
    