Remitting seronegative symmetrical synovitis with pitting edema of the hands: ultrasound, color doppler ultrasound, and magnetic resonance imaging findings.
OBJECTIVE
To assess the value of gray-scale ultrasound (US), color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging (MRI) in the diagnostic evaluation of the hands in patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE).


METHODS
Eight patients (5 men, 3 women; mean +/- SD age 69.3 +/- 7.2 years) with clinical diagnosis of RS3PE syndrome underwent US, CDUS, contrast-enhanced CDUS, and MRI. US was performed with a linear array transducer operating at 12 MHz. The US contrast agent (SHU 508; Levovist, Schering, Germany) was intravenously infused in a concentration of 300 mg/ml at a rate of 1 ml/minute.


RESULTS
All patients showed symmetric subcutaneous edema and synovitis of tendons and finger joints on both US and MRI. Vascularity was detected subcutaneously in tendon sheaths and in the joint synovia on CDUS and MRI. Detection of increased vascularity was improved after contrast administration compared with unenhanced CDUS (P < 0.01).


CONCLUSIONS
Ultrasound, CDUS, contrast-enhanced CDUS, and MRI are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE. Contrast-enhanced CDUS is superior to CDUS in assessment of inflammatory edema, effusion, and synovitis.
Klauser
Andrea
A
University Hospital Innsbruck, Austria. andrea.klauser@uibk.ac.at
Frauscher
Ferdinand
F
Halpern
Ethan J
EJ
Mur
Erich
E
Springer
Peter
P
Judmaier
Werner
W
Schirmer
Michael
M
D000368:Aged; D001808:Blood Vessels; D003287:Contrast Media / Q000494:pharmacology; D004487:Edema / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D005260:Female; D005384:Finger Joint / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D006225:Hand / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012075:Remission, Spontaneous; D012698:Serologic Tests; D013583:Synovial Membrane / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D013717:Tenosynovitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
D003287:Contrast Media