Three-dimensional US for Quantification of Volumetric Blood Flow: Multisite Multisystem Results from within the Quantitative Imaging Biomarkers Alliance (original) (raw)
Related papers
Clinical Rheumatology, 2012
This study aimed to compare the intraobserver and interobserver reliability of three-dimensional (3D) and two-dimensional (2D) power Doppler ultrasonography (PDUS) and to assess the relationship between 3D PDUS and clinical parameters in patients with rheumatoid arthritis (RA). Bilateral second/third metacarpophalangeal joints and second/third proximal interphalangeal joints in 33 patients were examined by both 2D and 3D PDUS. Each joint was given a separate 2D PDUS subjective score (range, 0-3) in a standard manner. The 2D PDUS index is the sum of the scores of all eight joints assessed. 3D PDUS voxel signals were quantitatively analyzed by using computerized voxel counts. Intraobserver reliability was high for both examinations (2D PDUS: ICC=0.957, 95% confidence interval= 0.818-0.999; 3D PDUS: ICC=0.998, 95% confidence interval=0.998-1.000). Interobserver reliability was also high (2D PDUS: ICC=0.993, 95% confidence interval= 0.806-0.988; 3D PDUS: ICC=0.999, 95% confidence interval=0.999-1.000). A significant correlation was found between the 2D PDUS index and 3D PDUS voxel count (r=0.795; p<0.001). The 3D PDUS voxel count showed significant correlation with 28 joints Disease Activity Score (DAS28)-erythrocyte sedimentation rate (r=0.448, p<0.01) and DAS28-C-reactive protein (r=0.383, p<0.05). Our study indicates that the measurement of 3D PDUS may be a valuable tool for predicting disease activity.
Vascular Function and Handgrip Strength in Rheumatoid Arthritis Patients
The Scientific World Journal, 2012
Objective. To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients. Methods. Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA = 42 and controls (CT) = 36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated. Results. The patients' RBF (P = 0.02) and RHBF (P = 0.0001) were less, whereas RVR (P = 0.002) and RHVR (P = 0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P = 0.0001). Finally, handgrip strength was directly associated with RBF (r = 0.43; P = 0.0001), and RHBF (r = 0.5; P = 0.0001), and inversely related to RVR (r = −0.3; P = 0.009) and RHVR (r = −0.3; P = 0.007). Conclusion. The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals.
Rheumatology International, 2012
In 90% of patients with rheumatoid arthritis (RA), the joints of the hand are aVected. Studies of grip strength training have not indicated a negative eVect on disease activity after training. Introduction of ultrasound Doppler (USD) to measure increased blood Xow induced by inXammation has made it possible to investigate the direct eVect on blood supply in the synovium after training. In this case-control study, 24 patients with RA with USD activity in the wrist joint participated. The USD activity was measured by the color fraction (CF) (CF = colored pixels/total number of pixels in ROI). Twenty-four patients were assigned to an 8-week grip strength training program. At baseline and after 8 weeks of training, an USD examination of the wrist joint was performed. In the training group, we measured grip strength and pain in the wrist joint. Six patients withdrew from the training because of pain or change in medication. Eighteen patients served as control group. There was a modest, not signiWcant, decrease in the CF in response to training (1.86%; P = 0.08). Grip strength increased 8.8% after training (P = 0.055). Pain in motion deceased after training (P = 0.04). No diVerence in the CF was seen between the training and control groups, neither at baseline nor at follow-up (P = 0.82 and P = 0.48). Patients withdrawing from training had a signiWcantly higher CF than the other patients (P > 0.001). The results in this study might indicate that the Xow in the synovium assessed by USD is not aVected by grip strength training.
Magnetic Resonance Imaging, 2007
Background: Contrast-enhanced MRI is of value in assessing rheumatoid pannus in the hand, but the images are not always easy to quantitate. Objective: To develop and evaluate an improved measurement of volume of enhancing pannus (VEP) in the hand in human rheumatoid arthritis (RA). Methods: MR images of the hand and wrist were obtained for 14 patients with RA at 0, 1 and 13 weeks. Volume of enhancing pannus was measured on images created by subtracting precontrast T1-weighted images from contrast-enhanced T1-weighted images using a shuffle transformation technique. Maximum intensity projection (MIP) and 3D volume rendering of the images were used as a guide to identify the pannus and any contrast-enhanced veins. Result: Visualisation of pannus was much improved following the shuffle transform. Between 0 weeks and 1 week, the mean value of the within-subject coefficient of variation (CoV) was 0.13 and the estimated total CoV was 0.15. There was no evidence of significant increased variability within the 13-week interval for the complete sample of patients. Conclusion: Volume of enhancing pannus can be measured reproducibly in the rheumatoid hand using 3D contrast-enhanced MRI and shuffle transform. D
Journal of Magnetic Resonance Imaging, 1999
The purpose of this study was to assess the role of inflamed synovial volume (ISV) in defining a state of remission in rheumatoid arthritis (RA) with contrast-enhanced, fatsuppression, three-dimensional (3D) gradient-recalled acquisition in the steady state with radiofrequency spoiling (SPGR) magnetic resonance (MR) imaging. Sixteen patients with RA (5 remission and 11 non-remission patients) were enrolled in this study. Contrast-enhanced, fat-suppression, 3D-SPGR MR imaging was performed before (n ؍ 12) and after (n ؍ 16) a mean 17 months of disease-modifying antirheumatic drugs (DMARDs). ISV was calculated by using a segmentation method. Statistical analysis of changes in ISVs and residual ISVs between the remission and the non-remission groups was performed. Intra-and interobserver reproducibility was tested. Residual ISVs and relative changes in ISVs were 3.23 ؎ 1.84 cm 3 and 51.4% (range 47.6-55.2%) in the remission group and 6.26 ؎ 2.03 cm 3 and 31.4% (range -73.5-53.5%) in the non-remission group. Both values were significantly different between the two groups (P F 0.05 and 0.05, respectively). Volume measurement showed high reproducibility: Intra-and interobserver mean percentage errors were 5.04, 7.06, and 5.09%, respectively. Residual ISVs and relative changes in ISVs measured by MR imaging may provide objective and quantitative parameters in defining a state of remission in RA after therapy; however, the clinical utility of these measurements remains to be verified.
The Journal of Rheumatology, 2013
Objective.To assess the responsiveness and repeatability of volumetric power Doppler ultrasound (PDUS) evaluation of synovitis and bone erosions in rheumatoid arthritis (RA).Methods.Twenty-three patients with RA (19 women, mean age 52.7 ± 12.6 yrs, mean disease duration 10.1 ± 8.6 yrs) were prospectively enrolled. All patients were beginning therapy with rituximab because of disease activity despite therapy with synthetic disease-modifying antirheumatic drugs and tumor necrosis factor-blocking agents. Patients underwent clinical, laboratory, and volumetric PDUS examination at baseline, 6 months, and 12 months. Ten centers participated in the study. Four centers recruited the patients and performed the volumetric acquisitions of PDUS images, while the remaining 6 centers assessed the PDUS volumes, blinded to the identity of patients and date of the visits. The most symptomatic hand and foot were scored for B-mode synovitis, synovial PD signal, and bone erosions. The repeatability of ...
The Journal of Rheumatology, 2014
Objective. To quantify bone structure and perfusion parameters in regions of bone marrow edema pattern (BMEP), non-edematous bone marrow (NBM), and pannus tissue areas in the wrists of patients with rheumatoid arthritis (RA) using 3-Tesla (3T) magnetic resonance imaging (MRI), and high resolution peripheral quantitative computed tomography (HR-pQCT). Methods. Sixteen subjects fulfilling American College of Rheumatology classification were imaged using a HR-pQCT system and a 3T MRI scanner with an 8-channel wrist coil. Coronal T2-weighted and dynamic contrast-enhanced (DCE-MRI) images were acquired. BMEP and pannus tissue areas were segmented semiautomatically in T2-weighted images. NBM areas were placed at a similar distance from the joint space as BMEP regions. MR and HR-pQCT images were registered, and bone variables were calculated within the BMEP and NBM regions. Perfusion parameters in BMEP, pannus tissue, and NBM regions were calculated based on the signal-time curve obtained from DCE-MRI. Results. Eighteen BMEP areas were segmented, 15 of them presented proximal to pannus-filled erosions. Significant increases in bone density and trabecular thickness and number were observed in all BMEP regions compared to NMB (p < 0.05). Significantly elevated perfusion measures were observed in both BMEP and pannus tissue regions compared to NBM (p < 0.05). Conclusion. BMEP regions showed significantly increased bone density and structures as well as perfusion measures, suggesting bone remodeling and active inflammation. Combining MRI and HR-pQCT provides a powerful multimodality approach for understanding BMEP and erosions, and for potentially identifying novel imaging markers for disease progression in
Decreased flow-mediated dilatation in patients with rheumatoid arthritis: a meta-analysis
Postgraduate Medical Journal, 2016
Premature atherosclerosis, the hallmark of cardiovascular diseases, has been found to be a significant cause of late deaths in systemic lupus erythematosus (SLE) patients. Therefore, early identification of atherosclerosis before the overt disease is curial for the management program of SLE. Flow-mediated dilatation (FMD%) is a reliable, noninvasive, easy to use, reproducible, and pathogenically relevant index for early atherosclerosis. In recent years, a number of studies have been performed to compare the mean FMD% difference between patients with SLE and healthy controls. However, these studies have shown inconclusive or even contradictory findings. In this study, to derive a more precise comparison of FMD% difference between SLE patients and healthy controls, a meta-analysis was performed. Databases were searched to identify all available studies comparing FMD% between SLE patients and healthy controls. The study eligibility criteria were cohort or case-control studies with data on both patients diagnosed with SLE and healthy controls, and use of high-resolution ultrasonography to detect FMD. Random effect meta-analysis was conducted to evaluate the overall mean FMD% difference between the two groups. Publication bias was detected by funnel plot and Egger's test. Meta-regression analysis was performed to investigate the potential influencing factors on FMD% difference. Of the 434 articles initially identified, 22 were finally included in the meta-analysis. Compared to healthy controls, SLE patients had significantly lower FMD% (standardized mean difference, −1.19; 95 % CI, −1.63, −0.74; P<0.001). There was significant heterogeneity among these studies (I 2 = 94.3 %, P<0.001), which was mainly due to variations in disease duration of SLE patients. The funnel plot showed a skewed shape, indicating a marked publication bias, which was further supported by the Egger's test De-Guang Wang, Xiao-Wu Tang, and Ye Fan contributed equally to this work and should be considered co-first authors.
Association of non-invasive hemodynamics with arterial stiffness in rheumatoid arthritis
Scandinavian Cardiovascular Journal, 2018
Objectives. Arterial stiffness has emerged as a surrogate marker of cardiovascular disease. We investigated the role of myocardial performance and hemodynamic parameters in arterial stiffness in patients with rheumatoid arthritis (RA), which is accompanied by excess cardiovascular risk. Design. Arterial stiffness was evaluated with pulse wave velocity (PWV) in RA patients and controls. Cardiac and hemodynamic characterization was based on impedance cardiography. Cardiovascular risk factors, inflammatory markers and disease-related parameters were assessed. Results. PWV (8.2 ± 2.1 vs 7.4 ± 1.4 m/s, p ¼ .016) was higher among RA patients (n ¼ 104) compared to controls (n ¼ 52). In the RA group, PWV correlated with markers of cardiac contractibility (acceleration and velocity index), myocardial blood flow (cardiac output and stroke volume), preload (thoracic fluid content) and afterload (systemic vascular resistance) (p < .05 for all). PWV tended to increase with decreasing oxygen delivery to the myocardium (r ¼ 0.055), as well as with shortening of the ejection duration of the left ventricle (p ¼ .058). However, these associations no longer remained significant after adjustment for classical cardiovascular risk factors, inflammation and corticosteroid use, which were independently associated with PWV. Conclusions. Among patients with RA, arterial stiffness appears as the composite of cardiovascular risk factors and inflammation, while corticosteroid use emerges as an additional adverse factor.