title: Three-dimensional volumetric ultrasound: a valid method for blinded assessment of response to therapy in rheumatoid arthritis.
abstract: OBJECTIVE
  To assess the responsiveness and repeatability of volumetric power Doppler ultrasound (PDUS) evaluation of synovitis and bone erosions in rheumatoid arthritis (RA).
  
  
  METHODS
  Twenty-three patients with RA (19 women, mean age 52.7 ± 12.6 yrs, mean disease duration 10.1 ± 8.6 yrs) were prospectively enrolled. All patients were beginning therapy with rituximab because of disease activity despite therapy with synthetic disease-modifying antirheumatic drugs and tumor necrosis factor-blocking agents. Patients underwent clinical, laboratory, and volumetric PDUS examination at baseline, 6 months, and 12 months. Ten centers participated in the study. Four centers recruited the patients and performed the volumetric acquisitions of PDUS images, while the remaining 6 centers assessed the PDUS volumes, blinded to the identity of patients and date of the visits. The most symptomatic hand and foot were scored for B-mode synovitis, synovial PD signal, and bone erosions. The repeatability of the volumetric PDUS assessment was investigated.
  
  
  RESULTS
  An overall improvement in clinical and PDUS measurements was found at the followup assessments. The mean indexes for synovial PD signal and bone erosions and the number of sites with abnormalities decreased significantly throughout the followup (p < 0.05). The intraacquisition, intrareader reliability was excellent for all PDUS measurements (intraclass correlation coefficients > 0.9).
  
  
  CONCLUSIONS
  The results of our pilot study suggest that volumetric PDUS can be responsive and repeatable in multicenter cohort studies of RA. This technique may minimize assessment biases and reduce acquisition variability in open-label and observational studies.
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain. enaredo@ser.es
authors: Esperanza
authors: E
authors: Naredo
authors: Carlos
authors: C
authors: Acebes
authors: Elia
authors: E
authors: Brito
authors: Juan José
authors: JJ
authors: de Agustín
authors: Eugenio
authors: E
authors: de Miguel
authors: Lucía
authors: L
authors: Mayordomo
authors: Ingrid
authors: I
authors: Möller
authors: Carmen
authors: C
authors: Moragues
authors: Eduardo
authors: E
authors: Rejón
authors: Ana
authors: A
authors: Rodriguez
authors: Jacqueline
authors: J
authors: Uson
authors: Jesús
authors: J
authors: Garrido
authors: David
authors: D
authors: Martínez-Hernández
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D000069283:Rituximab; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab