Detection of vascularity in wrist tenosynovitis: power doppler ultrasound compared with contrast-enhanced grey-scale ultrasound.
BACKGROUND
We sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS).


METHODS
Twenty-six tendons of 24 patients (nine men, 15 women; mean age ± SD, 54.4 ± 11.8 years) with a clinical diagnosis of tenosynovitis were examined with B-mode ultrasonography, PDUS, and CEUS by using a second-generation contrast agent, SonoVue (Bracco Diagnostics, Milan, Italy) and a low-mechanical-index ultrasound technique. Thickness of synovitis, extent of vascularized pannus, intensity of peritendinous vascularisation, and detection of intratendinous vessels was incorporated in a 3-score grading system (grade 0 to 2). Interobserver variability was calculated.


RESULTS
With CEUS, a significantly greater extent of vascularity could be detected than by using PDUS (P < 0.001). In terms of peri- and intratendinous vessels, CEUS was significantly more sensitive in the detection of vascularization compared with PDUS (P < 0.001). No significant correlation between synovial thickening and extent of vascularity could be found (P = 0.089 to 0.097). Interobserver reliability was calculated to be excellent when evaluating the grading score (κ = 0.811 to 1.00).


CONCLUSIONS
CEUS is a promising tool to detect tendon vascularity with higher sensitivity than PDUS by improved detection of intra- and peritendinous vascularity.
Department of Radiology, Medical University Innsbruck, Anichstr, 35, Innsbruck, 6020, Austria. andrea.klauser@i-med.ac.at
Andrea S
AS
Klauser
Magdalena
M
Franz
Rohit
R
Arora
Gudrun M
GM
Feuchtner
Johann
J
Gruber
Michael
M
Schirmer
Werner R
WR
Jaschke
Markus F
MF
Gabl
D005260:Female; D006801:Humans; D008297:Male; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D013717:Tenosynovitis / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods; D014955:Wrist Joint / Q000098:blood supply / Q000000981:diagnostic imaging*