Three-dimensional Doppler sonographic vascular imaging in regions with increased MR enhancement in inflamed wrists of patients with rheumatoid arthritis.
OBJECTIVE
To compare three-dimensional (3D) power Doppler ultrasonography (PDUS) with contrast enhanced magnetic resonance imaging (MRI) in their capability to visualize synovial vascularity in inflamed wrists of patients with rheumatoid arthritis (RA).


METHODS
Nine patients with RA showing clinically active arthritis of the wrist as determined by tenderness and swelling were examined by contrast enhanced MRI and 3D PDUS. Vascularity close to and inside the joint capsule was visualized by conventional power Doppler mode. In a region with high Doppler signal intensity (=region of interest/ROI) a 3D blood vessel tree was obtained by a free-hand sweep. 3D images were evaluated with regard to the number of blood vessels in the intra- and peri-articular region. MRI examinations were performed using a 1.5 T Scanner. In MRI, time resolved coronal contrast enhanced T1-weighted sequences with fat suppression were acquired during an 8 min period to assess tissue enhancement. Relative enhancement was calculated and compared to 3D PDUS findings.


RESULTS
A 3D vascular tree consisting of peri- and intra-articular blood vessels could be demonstrated in the same anatomical ROI in which an increased gadolinium enhancement was measured by MRI in all examined RA patients. The number of penetrating vessels into the joint capsule, the number of intra-articular vessels and a semiquantitative estimation of the strength of blood flow were used to generate a 3D score for the intensity of synovial vascularity.


CONCLUSIONS
When compared with clinical symptoms and the gold standard dynamic MRI, 3D PDUS is a reliable imaging technique for assessing synovial vascularity in inflamed wrists of RA patients.
Strunk
Johannes
J
Department of Rheumatology and Clinical Immunology, Kerckhoff-Clinic, University of Giessen, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. j.strunk@kerckhoff-klinik.de
Klingenberger
Pascal
P
Strube
Katinka
K
Bachmann
Georg
G
Müller-Ladner
Ulf
U
Kluge
Alexander
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D013583:Synovial Membrane / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D018608:Ultrasonography, Doppler / Q000379:methods*; D014955:Wrist Joint / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology