title: Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis.
abstract: The purpose of the study was to assess the relationship of the continuous mode contrast-enhanced harmonic ultrasound (CEUS) imaging with the histopathological and immunohistochemical (IHC) quantitative estimation of microvascular proliferation on synovial samples of patients affected by sustained psoriatic arthritis (PsA). A dedicated linear transducer was used in conjunction with a specific continuous mode contrast enhanced harmonic imaging technology with a second-generation sulfur hexafluoride-filled microbubbles C-agent. The examination was carried out within 1 week before arthroscopic biopsies in 32 active joints. Perfusional parameters were analyzed including regional blood flow (RBF); peak (PEAK) of the C-signal intensity, proportional to the regional blood volume (RBV); beta (β) perfusion frequency; slope (S), representing the inclination of the tangent in the origin; and the refilling time (RT), the reverse of beta. Arthroscopic synovial biopsies were targeted in the hypervascularity areas, as in the same knee recesses assessed by CEUS; the synovial cell infiltrate and vascularity (vessel density) was evaluated by IHC staining of CD45 (mononuclear cell) and CD31, CD105 (endothelial cell) markers, measured by computer-assisted morphometric analysis. In the CEUS area examined, the corresponding time-intensity curves demonstrated a slow rise time. Synovial histology showed slight increased layer lining thickness, perivascular lymphomonocyte cell infiltration, and microvascular remodeling, with marked vessel wall thickening with reduction of the vascular lumen. A significant correlation was found between RT and CD31+ as PEAK and CD105+ vessel density; RT was inversely correlated to RBF, PEAK, S, and β. The study demonstrated the association of the CEUS perfusion kinetics with the histopathological quantitative and morphologic estimation of synovial microvascular proliferation, suggesting that a CEUS imaging represents a reliable tool for the estimate of the synovial hypervascularity in PsA.
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy. ugo.fiocco@unipd.it.
authors: Ugo
authors: U
authors: Fiocco
authors: Section of Radiology, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Roberto
authors: R
authors: Stramare
authors: Section of Radiology, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Alessandro
authors: A
authors: Coran
authors: Department of Information Engineering, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Enrico
authors: E
authors: Grisan
authors: Section of Radiology, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Elena
authors: E
authors: Scagliori
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Francesco
authors: F
authors: Caso
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.|Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy.
authors: Luisa
authors: L
authors: Costa
authors: Surgical Pathology, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Francesca
authors: F
authors: Lunardi
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Francesca
authors: F
authors: Oliviero
authors: Respiratory Pathophysiology Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Fulvia Chieco
authors: FC
authors: Bianchi
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Anna
authors: A
authors: Scanu
authors: Haematology and Clinical Immunology Branch, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
authors: Veronica
authors: V
authors: Martini
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Daniele
authors: D
authors: Boso
authors: Section of Radiology, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Valeria
authors: V
authors: Beltrame
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Maristella
authors: M
authors: Vezzù
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Luisella
authors: L
authors: Cozzi
authors: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy.
authors: Raffaele
authors: R
authors: Scarpa
authors: Department of Clinical and Experimental Medicine, Clinica Medica 5, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
authors: David
authors: D
authors: Sacerdoti
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Leonardo
authors: L
authors: Punzi
authors: Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Andrea
authors: A
authors: Doria
authors: Surgical Pathology, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Fiorella
authors: F
authors: Calabrese
authors: Section of Radiology, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
authors: Leopoldo
authors: L
authors: Rubaltelli
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging*; D001182:Arthroscopy; D001706:Biopsy; D003287:Contrast Media; D005260:Female; D006801:Humans; D007700:Kinetics; D007719:Knee Joint / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D013459:Sulfur Hexafluoride; D013583:Synovial Membrane / Q000098:blood supply* / Q000473:pathology*; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced harmonic ultrasound (CEUS); Immunohistochemical (IHC) quantitative estimation; Psoriatic arthritis (PsA); Refilling time (RT); Synovial hypervascularity; Vascular perfusion kinetics