Becce, Fabio

Federau, Christian

Grandjean, Albane

Letovanec, Igor

Rüdiger, Hannes A.

So, Alexander K.

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23 ter Borg EJ, Horst G, Hummel EJ, Limburg PC,Kallenberg CG. Measurement of increases in anti-double-stranded DNA antibody levels as a predictor of diseaseexacerbation in systemic lupus erythematosus. A long-term, prospective study. Arthritis Rheum 1990;33:63443.24 Biesen R, Dahnrich C, Rosemann A et al. Anti-dsDNA-NcX ELISA:dsDNA-loaded nucleosomes improvediagnosis and monitoring of disease activity in sys-temic lupus erythematosus. Arthritis Res Ther 2011;13:R26.Clinical vignetteRheumatology 2015;54:457doi:10.1093/rheumatology/keu473Advance Access publication 11 December 2014Dual-energy computed tomography molecularimaging of pigmented villonodular synovitisA 35-year-old woman presented with a 1 year history of non-traumatic gradual swelling of the first ray of the left foot, whichhad been painful for several weeks. Physical examination re-vealed a firm, slightly tender mass in the medial plantar softtissues. Laboratory investigations, including levels of uric acidand CRP, were normal. Radiographs showed a soft tissuemass without’ calcification or involvement of bones andjoints. The patient underwent dual-energy CT (DECT) for furtherevaluation. Spectral analysis with two-material decompositiondemonstrated an X-ray attenuation characteristic of iron withinthe distal synovial sheath of the flexor hallucis longus tendon(Fig. 1A and B), consistent with localized pigmented nodulartenosynovitis. The diagnosis was subsequently confirmed bypercutaneous core needle biopsy (Fig. 1C).Pigmented villonodular synovitis (PVNS) encompasses afamily of rare, usually benign, neoplastic processes arisingfrom the synovium of joints, bursae and tendon sheaths, withpigmented nodular tenosynovitis occurring most commonly inthe digits. While DECT has been proved effective for the de-tection, characterization and quantification of uric acid depositsin patients with gout [1], additional musculoskeletal applicationshave been suggested, including the detection of iron depositionin PVNS [2]. To our knowledge, this is the first description ofnon-invasive molecular imaging of PVNS using DECT.Disclosure statement: A.G. is an employee of General ElectricMedical Systems Europe (activity not directly related to thepresent work). All other authors have declared no conflicts ofinterest.Fabio Becce1, Christian Federau1, Igor Letovanec2,Albane Grandjean3, Alexander K. So4 andHannes A. R €udiger5,*1Department of Diagnostic and Interventional Radiology,2University Institute of Pathology, Lausanne UniversityHospital, Lausanne, Switzerland, 3General Electric MedicalSystems Europe, Buc, France, 4Department of Rheumatologyand 5Department of Orthopaedics and Traumatology,Lausanne University Hospital, Lausanne, Switzerland.*Present address: Department of Orthopaedics, SchulthessClinic, Z€urich, Switzerland.Correspondence to: Fabio Becce, Department of Diagnosticand Interventional Radiology, Lausanne University Hospital,Rue du Bugnon 46, 1011 Lausanne, Switzerland.E-mail: fabio.becce@chuv.chReferences1 Bongartz T, Glazebrook KN, Kavros SJ et al. Dual-energyCT for the diagnosis of gout: an accuracy and diagnosticyield study. Ann Rheum Dis 2014, March 25. doi: 10.1136/annrheumdis-2013-205095 [Epub ahead of print].2 Nicolaou S, Liang T, Murphy DT et al. Dual-energy CT: apromising new technique for assessment of the muscu-loskeletal system. AJR Am J Roentgenol 2012;199(5Suppl):S7886.! The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.comFIG. 1 Dual-energy CT and histopathology images of localized pigmented nodular tenosynovitis(A) Axial and (B) three-dimensional volume-rendered dual-energy CT images of the left foot illustrate the presence ofiron material (colour coded in blue) within the distal synovial sheath of the flexor hallucis longus tendon, consistentwith localized pigmented nodular tenosynovitis, also referred to as giant cell tumour of the tendon sheath.(C) Photomicrograph of the core needle biopsy specimen revealed intra- and extracellular haemosiderin, bland mono-nuclear cells and scattered multinucleated giant cells (Prussian blue stain; original magnification 100).www.rheumatology.oxfordjournals.org 457Anti-nucleosome antibodies and disease activity in SLE

Dual-energy computed tomography molecular imaging of pigmented villonodular synovitis

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Dual-energy computed tomography molecular imaging of pigmented villonodular synovitis

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