title: Contrast-enhanced ultrasonography is more sensitive than grayscale and power Doppler ultrasonography compared to MRI in therapy monitoring of rheumatoid arthritis patients.
abstract: OBJECTIVE
  To evaluate wrist and finger joints in patients with rheumatoid arthritis (RA) by grayscale, power Doppler (PD) and contrast-enhanced musculoskeletal ultrasonography (US) and to compare these findings with MRI, clinical (DAS28) and laboratory (ESR; CRP) data.
  
  
  METHODS
  US was performed at baseline (t0) and after three, six and twelve (t12) months before and after a change of medical treatment. MRI was carried out at t0 and t12 and used as the reference method. Contrast-enhanced US was used to assess one clinically most affected joint region. Different semiquantitative synovitis scores were calculated by grayscale and PD US.
  
  
  RESULTS
  Contrast-enhanced US results evaluated by enhancement, slope and semi-quantitative assessment significantly correlated to each other, to grayscale US, CRP, as well as to MRI with the highest correlation coefficients for the used contrast-enhanced US modes (r = 0.56, r = 0.55, r = 0.57; each p < 0.05). Sum scores evaluated by grayscale US showed that synovial inflammation in finger joints was detected significantly more frequently in the palmar aspect than on the dorsal side (p = 0.001). Using power Doppler US, the wrists were significantly more inflamed from dorsal than on the palmar side (p = 0.0004). Significant longitudinal correlations between grayscale and power Doppler US scores were detected.
  
  
  CONCLUSIONS
  Grayscale, power Doppler and contrast-enhanced US are accurate tools for the detection and follow-up of synovitis in RA wrist and finger joints, with contrast-enhanced US being most sensitive compared to MRI. All imaging methods reflected a good response to TNFα blocking therapy.
authors: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany. sarah.ohrndorf@charite.de
authors: S
authors: S
authors: Ohrndorf
authors: A
authors: A
authors: Hensch
authors: L
authors: L
authors: Naumann
authors: K-G A
authors: KG
authors: Hermann
authors: C
authors: C
authors: Scheurig-Münkler
authors: S
authors: S
authors: Meier
authors: G R
authors: GR
authors: Burmester
authors: M
authors: M
authors: Backhaus
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D003287:Contrast Media / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000187:drug effects; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy; D018608:Ultrasonography, Doppler / Q000379:methods*; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000187:drug effects
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D003287:Contrast Media; D000068879:Adalimumab