Quantitative ultrasonography in rheumatoid arthritis: evaluation of inflammation by Doppler technique (original) (raw)
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Arthritis and Rheumatism, 2008
ObjectiveTo investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent.To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent.MethodsA total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated.A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated.ResultsA PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84–0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables.A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84–0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables.ConclusionA 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.
Diagnostic sensitivity and specificity of Doppler ultrasound in rheumatoid arthritis
The Journal of Rheumatology, 2008
To evaluate the sensitivity and specificity of Doppler ultrasound (DUS) in diagnosing arthritis in the wrist and hands, and, if possible, to define a cutoff level for our ultrasound measures for inflammation, resistive index (RI), and color fraction. Methods. Using DUS, 88 patients with active RA were selected for study and 27 healthy controls. A total of 419 joints were examined. The synovial vascularization was determined by color Doppler and spectral Doppler estimating the color fraction (the percentage of color pixels inside the synovium was the region of interest) and RI in wrist, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints. Receiver-operator characteristic (ROC) curves were made for both US measures. Cutoff levels were selected from the ROC curves as the values with the optimum sensitivity and specificity. Results. Analyses were carried out for small joints (MCP and PIP), wrists, and for all joints (pooled). Pooled joint analysis showed the area under the curve for both RI and color fraction was 0.84. The cutoff level for the color fraction was 0.01 and for RI 0.83. With these cutoff levels, the sensitivity and specificity for the color fraction were 0.92 and 0.73, respectively. For RI a sensitivity of 0.72 and specificity of 0.70 were found. Analysis of small joints and wrist gave very similar results. Conclusion. DUS may detect vascularization of the inflamed synovium with a high sensitivity and a moderate specificity with selected cutoff levels.
The role of Doppler ultrasound in rheumatic diseases
Rheumatology, 2012
The use of Doppler techniques, including power, colour and spectral Doppler, has greatly increased in rheumatology in recent years. This is due to the ability of Doppler US (DUS) to detect pathological vascularization within joints and periarticular soft tissues, thereby demonstrating the presence of active inflammation, which has been reported to be correlated with the local neo-angiogenesis. In synovitis, DUS showed a high correlation with histological and MRI findings, thus it is considered a valid tool to detect pathological synovial vascularization. Moreover, it is more sensitive than clinical examination in detecting active joint inflammation and in the evaluation of response to treatment. In addition, DUS may be considered as a reference imaging modality in the assessment of enthesitis, MRI being not sensitive and histology not feasible. Moreover, it has been demonstrated to be able to detect changes in asymptomatic enthesis. In conclusion, DUS is a useful and sensitive tool in the evaluation and monitoring of active inflammation. Its widespread use in clinical rheumatological practice is recommended. The aim of this article is to review the current literature about the role of DUS in rheumatic diseases, analysing its validity, reliability and feasibility.
Doppler ultrasound imaging techniques for assessment of synovial inflammation
Reports in Medical Imaging, 2013
Ultrasound is an evolving technique, and the rapid progress made in ultrasound technology over the past ten years has dramatically increased its range of applications in rheumatology. One of the most exciting advances is the use of Doppler ultrasound imaging in the assessment of blood flow abnormalities at the synovial tissue level in patients with chronic inflammatory arthritis. This review describes the Doppler techniques available and their main applications in patients with inflammatory arthritis, discusses the evidence supporting their use, and outlines the latest advances in hardware and software. Spectral, color, and power Doppler allow sensitive assessment of vascular abnormalities at the synovial tissue level. Use of contrast agents enhances visualization of the small synovial vessels using color or power Doppler ultrasound and allows for accurate characterization of the rheumatoid pannus. Doppler techniques represent a unique method for assessment of synovial inflammation, showing blood flow characteristics in real time. They are safe, noninvasive, cost-effective, and have high sensitivity in revealing and monitoring synovitis. However, several questions still need to be answered. In the near future, the Doppler techniques described here, together with upcoming hardware and software facilities, will be investigated further and a consensus will be reached on their feasibility and appropriate use in daily rheumatologic practice.
Acta Radiologica, 2003
To evaluate the use of spectral Doppler in the longitudinal follow-up of inflammatory joint involvement in rheumatoid arthritis (RA) by comparing resistive index (RI) findings with color fraction and pain on a visual analog scale (VAS). Material and Methods: Five patients on unchanged disease modifying antirheumatic drugs (DMARD) treatment were followed after an intra-articular corticosteroids injection and received no further injections in the observation period. They were followed clinically and by ultrasound using color Doppler pixels and the spectral Doppler RI as indicators of inflammation. At 1, 6 and 12 months the measurements were repeated on the same joint. Results: At 1-month follow-up after the corticosteroids injection, a marked decrease in the color fraction was seen in 4 out of 5 patients, while the fifth patient had a moderate decrease (Wilcoxon p < 0.05). The changes in RI showed correspondingly a marked increase in 4 out of 5 patients indicating a diminished flow to the synovium (Wilcoxon p < 0.05). The effect of the corticosteroid injection could still be seen after 1 year in 4 out of 5 patients. In RI, pixel fraction and VAS there was improvement compared with the baseline values; however, only the pixel fraction was statistically significant (Wilcoxon p < 0.05). Conclusion: RI seems to be an objective alternative to pixel estimation of the degree of inflammation and treatment response in RA.
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.
Clinical rheumatology, 2016
Ultrasonography (US) is a useful tool for the evaluation of sinovial vascularization and proliferation in rheumatoid arthritis (RA). Accordingly, resistive index (RI) on spectral Doppler (sD) US provides a quantitative analysis of vascular inflammation, but its utility in the evaluation of RA activity has not been established. Our objective was to determine the association of RI with other US parameters of synovitis and with clinical disease activity in established RA. Patients with positive power Doppler (pD) were included in a prospective cross-sectional study. Disease activity and disability were evaluated using the Disease Activity Score in 28-joints (DAS28) and Health Assessment Questionnaire (HAQ), respectively. Gray scale (GS) synovitis, pD, and sD analyses were performed by one of two examiners in wrists and the second and third metacarpophalangeal and proximal interphalangeal joints. The 10-joint GS and 10-joint pD scores and mean RI were then calculated. Weighted kappa (WK...
Gray scale and power Doppler ultrasonography in evaluation of early rheumatoid arthritis
Medical ultrasonography, 2010
Ultrasonography provides information regarding synovial membrane proliferation and its vascularization. The AIM of our study was to evaluate the role of gray scale and power Doppler ultrasonography in assessing early rheumatoid arthritis by analyzing the scores determined by the evaluation of synovial proliferation, joint effusion, erosion or soft tissue swelling. The study was prospective comprising 34 patients (31 female, 3 men), mean age 45.68 years, with clinical changes and biochemical early rheumatoid arthritis. Bilateral wrist, II-V metacarpophalangeal, and proximal interphalangeal joints were evaluated by dorsal and palmar scans. The mean duration from the onset of symptoms was 3.46 months. Based on the clinical, biochemical and US scores the patients from our study presented early stages of RA. Also, statistically significant correlations were observed between the time elapsed from the onset, the changes highlighted by ultrasound and the stage of the disease (stage 0 or 1)....