title: Contrast-enhanced ultrasonography for the detection of joint vascularity in arthritis--subjective grading versus computer-aided objective quantification.
abstract: OBJECTIVE
  To compare joint inflammation assessment using subjective grading of power Doppler ultrasonography (PDUS) and contrast-enhanced ultrasonography (CEUS) versus computer-aided objective CEUS quantification.
  
  
  METHODS
  37 joints of 28 patients with arthritis of different etiologies underwent B-mode ultrasonography, PDUS, and CEUS using a second-generation contrast agent. Synovial thickness, extent of vascularized pannus and intensity of vascularization were included in a 4-point PDUS and CEUS grading system. Subjective CEUS and PDUS scores were compared to computer-aided objective CEUS quantification using Qontrast® software for the calculation of the signal intensity (SI) and the ratio of SI for contrast enhancement.
  
  
  RESULTS
  The interobserver agreement for subjective scoring was good to excellent (κ = 0.8 - 1.0; P < 0.0001). Computer-aided objective CEUS quantification correlated statistically significantly with subjective CEUS (P < 0.001) and PDUS grading (P < 0.05). The Qontrast® SI ratio correlated with subjective CEUS (P < 0.02) and PDUS grading (P < 0.03). Clinical activity did not correlate with vascularity or synovial thickening (P = N. S.) and no correlation between synovial thickening and vascularity extent could be found, neither using PDUS nor CEUS (P = N. S.).
  
  
  CONCLUSIONS
  Both subjective CEUS grading and objective CEUS quantification are valuable for assessing joint vascularity in arthritis and computer-aided CEUS quantification may be a suitable objective tool for therapy follow-up in arthritis.
authors: Department of Radiology, Innsbruck Medical University, Innsbruck.
authors: A S
authors: AS
authors: Klauser
authors: M
authors: M
authors: Franz
authors: R
authors: R
authors: Bellmann Weiler
authors: J
authors: J
authors: Gruber
authors: F
authors: F
authors: Hartig
authors: E
authors: E
authors: Mur
authors: M C
authors: MC
authors: Wick
authors: W
authors: W
authors: Jaschke
mesh_terms: D000328:Adult; D000368:Aged; D001168:Arthritis / Q000000981:diagnostic imaging*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006097:Granulation Tissue / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D006984:Hypertrophy; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007596:Joints / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging; D010743:Phospholipids; D012039:Regional Blood Flow / Q000502:physiology; D012984:Software; D025241:Spondylarthritis / Q000000981:diagnostic imaging; D013459:Sulfur Hexafluoride; D013583:Synovial Membrane / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014741:Video Recording / Q000379:methods
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride