title: Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group.
abstract: The purpose of this study way to assess the value of contrast enhanced gray-scale ultrasound (CEUS) in detection of vascularity in joints of patients with rheumatoid arthritis (RA) in a multicenter study of the International Arthritis Contrast Ultrasound (IACUS) study group. We assessed 113 joints in 113 patients (44 men, 69 women; mean age 51+/-14 years) with clinical diagnosis of RA. Gray-scale ultrasound (US), power Doppler US (PDUS) and CEUS, using a low mechanical index US technique, was performed. CEUS was done by bolus administration of the contrast agent SonoVue (Bracco, Milan, Italy) with a dosage of 4.8-ml SonoVue flushed with 10 ml saline. Detection of joint vascularity was performed for differentiation of active synovitis from inactive intra-articular thickening (synovitis/effusion). With the use of US and PDUS, active synovitis could be differentiated from inactive intra-articular thickening in 68/113 joints (60.1%), whereas CEUS enabled differentiation in 110/113 (97.3%) joints (p<0.0001). Thickness measurement of active synovitis was significantly improved after contrast administration (p=0.008). In conclusion, CEUS improves the differentiation of active synovitis from inactive intra-articular thickening. Since CEUS has shown an ability to improve assessment of vascularized synovial proliferation in RA affected joints, this technique may have further potential in monitoring therapy.
authors.affiliation: Department of Radiology II and Internal Medicine, Medical University Innsbruck, Innsbruck, 6020, Austria. andrea.klauser@uibk.ac.at
authors.forename: Andrea
authors.initials: A
authors.lastname: Klauser
authors.forename: Johannes
authors.initials: J
authors.lastname: Demharter
authors.forename: Armanda
authors.initials: A
authors.lastname: De Marchi
authors.forename: Delia
authors.initials: D
authors.lastname: Sureda
authors.forename: Antonio
authors.initials: A
authors.lastname: Barile
authors.forename: Carlo
authors.initials: C
authors.lastname: Masciocchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Faletti
authors.forename: Michael
authors.initials: M
authors.lastname: Schirmer
authors.forename: Timm
authors.initials: T
authors.lastname: Kleffel
authors.forename: Klaus
authors.initials: K
authors.lastname: Bohndorf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005060:Europe; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007391:International Cooperation; D007596:Joints / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014652:Vascular Diseases / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride