title: The usefulness of power Doppler ultrasonography in differentiating primary and secondary Raynaud's phenomenon.
abstract: The objectives of this study were to assess a usefulness of power Doppler ultrasonography (PDU) and compare the diagnostic value of PDU to nailfold capillaroscopy (NFC) in the patients with clinically diagnosed Raynaud's phenomenon (RP) and healthy controls. Forty-one patients with primary (n=19), secondary RP (n=22), and ten healthy controls underwent PDU and NFC examinations on the same day. Microvascularity was evaluated using PDU before and after cold challenges, and the PDU signals were qualitatively graded on a scale of 1-4. According to the change of microvascularity before and after cold challenges, the findings of PDU were classified into three groups: (1) 'pattern I' (normal microvascularity over grade 3 both before and after cold challenges), (2) 'pattern II' (decreased microvascularity to grade 1 or 2 only after cold challenge), and (3) 'pattern III' (decreased microvascularity of grade 1 or 2 both before and after cold challenges). PDU confirmed the presence of RP in all patients with clinically diagnosed RP and yielded a correct classification in 88.9% of the all persons analyzed (normal=100%, primary RP=89.5%, secondary RP=77.3%). The analysis was performed to assess the degree of agreement between the final diagnoses obtained by PDU and NFC. A good correlation rate was observed between PDU and NFC examinations in differentiating primary from secondary RP (Kappa=0.658, p<0.01). In conclusion, PDU examination with a cold challenge is a useful and reliable method to diagnose RP and discriminate between primary and secondary RP.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School, and Research Institute of Clinical Medicine, San 2-20, Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-180, Republic of Korea. goldgu@chonbuk.ac.kr
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Lee
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Lee
authors.forename: Wan Hee
authors.initials: WH
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications*; D003080:Cold Temperature; D003240:Connective Tissue Diseases / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009262:Nails / Q000098:blood supply / Q000473:pathology; D011928:Raynaud Disease / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D018608:Ultrasonography, Doppler