title: Value of contrast-enhanced ultrasonography for the detection and quantification of enthesitis vascularization in patients with spondyloarthritis.
abstract: OBJECTIVE
  To evaluate if contrast-enhanced ultrasound (CEUS) can improve the detection and quantification of the vascularization of mild enthesitis in spondyloarthritis (SpA) and to evaluate the influence of nonsteroidal antiinflammatory drugs (NSAIDs) on such detection.
  
  
  METHODS
  Fourteen patients with mildly active SpA were evaluated at 3 consecutive visits: at baseline while undergoing NSAID treatment (V1), after 1 week of stopping NSAIDs (V2), and after 1 week of resuming NSAIDs (V3). At each visit, enthesitis was evaluated clinically and by power Doppler US (PDUS). A selected enthesis with a doubtful PDUS vascularization signal was studied by CEUS in 2 steps: (1) using a dedicated technology that preserves microbubbles (Contrast Tuned Imaging technology [CEUS-CnTI]) and (2) using high PD (CEUS-PD) to destroy microbubbles. A linear mixed model statistical analysis, taking visits and contrast agent as fixed factors and the patient as a random factor, was used.
  
  
  RESULTS
  Disease activity and PDUS findings increased between V1 and V2 and then decreased between V2 and V3. As compared with PDUS alone, CEUS-PD and CEUS-CnTI each detected 1 supplementary vascularized enthesis at V1, CEUS-PD detected 1 vascularized enthesis and CEUS-CnTI detected 3 vascularized entheses at V2, and CEUS-PD and CEUS-CnTI each detected 2 vascularized entheses at V3. The mean inflammation score was increased by the use of CEUS (P = 0.04). This score increased between V1 and V2 (P = 0.03 by CEUS-PD and P = 0.01 by CEUS-CnTI) and decreased between V2 and V3.
  
  
  CONCLUSIONS
  CEUS improved the detection of enthesitis in SpA patients by confirming all doubtful enthesitis signals and confirming the absence of enthesis vascularization. The use of NSAIDs influenced the detection of vascularization.
authors.affiliation: AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
authors.forename: Gaël
authors.initials: G
authors.lastname: Mouterde
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Correas
authors.forename: Maxime
authors.initials: M
authors.lastname: Breban
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: D'Agostino
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D012680:Sensitivity and Specificity; D025241:Spondylarthritis / Q000150:complications*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*; D014657:Vasculitis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal