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Aim: To evaluate patient satisfaction outcomes with respect to pain, discomfort, and quality of life with hematology/oncology referrals undergoing CT-guided bone marrow biopsy and compare these scores with those of patients undergoing in-office biopsy. Methods: A retrospective chart review was performed over 2 years with all patients who underwent CT-guided bone marrow biopsy at our university set-up. Age, gender, BMI, radiation dose (CTDI/DLP), number of in-office biopsies, number of CT-guided biopsies, type/amount of moderate sedation used, technical and pathologic success rates, and complication rates were recorded. All patients who underwent both in-office and CT-guided biopsy were contacted by telephone to answer a brief survey regarding pain, discomfort, quality of life, and future preference with respect to each biopsy. Results: A total of 32 patients underwent CT-guided bone marrow biopsy. Moderate sedation was utilized for all CT patients, and 19 patients underwent both in-office and CT-guided biopsies. Upon surveying the 19 patients who underwent both kinds of biopsies, on a scale of 1–10 (10 = highest discomfort and highest pain), the patients on an average reported 7.8 for in-office vs. 2.1 for CT for the discomfort level (p < 0.001) and 7.9 vs. 1.7 for the pain (p < 0.001). The patients reported an average quality-of-life score of 82 (out of a scale of 100) after CT procedures and 53 for in-office (p < 0.001). All patients reported that they would prefer CT-guided procedures with sedation versus in-office procedures in the future. Conclusion: CT-guided bone marrow biopsy is the preferred and more comfortable procedure, especially in low-pain-tolerant patients, although it involves more cost, conscious sedation, and radiation exposure.

Background: The early diagnosis and treatment of rheumatoid arthritis (RA) are essential to prevent joint damage and enhance patient outcomes. Diagnosing RA in its early stages is challenging due to the nonspecific and variable clinical signs and symptoms. Our study aimed to identify the most predictive features of hand ultrasound (US) for RA development and assess the performance of machine learning models in diagnosing preclinical RA. Methods: We conducted a prospective cohort study with 326 adults who had experienced hand joint pain for less than 12 months and no clinical arthritis. We assessed the participants clinically and via hand US at baseline and followed them for 24 months. Clinical progression to RA was defined according to the ACR/EULAR criteria. Regression modeling and machine learning approaches were used to analyze the predictive US features. Results: Of the 326 participants (45.10 ± 11.37 years/83% female), 123 (37.7%) developed clinical RA during follow-up. At baseline, 84.6% of the progressors had US synovitis, whereas 16.3% of the non-progressors did (p < 0.0001). Only 5.7% of the progressors had positive PD. Multivariate analysis revealed that the radiocarpal synovial thickness (OR = 39.8), PIP/MCP synovitis (OR = 68 and 39), and wrist effusion (OR = 12.56) on US significantly increased the odds of developing RA. ML confirmed these US features, along with the RF and anti-CCP levels, as the most important predictors of RA. Conclusions: Hand US can identify preclinical synovitis and determine the RA risk. The radiocarpal synovial thickness, PIP/MCP synovitis, wrist effusion, and RF and anti-CCP levels are associated with RA development.

Clinical presentation could be challenging in patients with arthralgia, and imaging plays an important role in the evaluation of these patients to make the diagnosis or narrow the differential diagnosis. Radiography of the hands is a commonly available imaging modality that can provide crucial information with regard to the pattern and pathology of the involved joints. It is important that radiologists and rheumatologists are familiar with the imaging findings of different rheumatic diseases to make the diagnosis in the early stages of disease to initiate treatment.