title: Grading of ultrasound Doppler signals in synovitis: does it need an update?
abstract: OBJECTIVE
  To compare subjective estimation with computerized quantification of synovial perfusion in active RA, develop new quantitative scores, establish quantitative limit values for the respective grades in order to achieve even distribution and compare the new scores with the established semi-quantitative score.
  
  
  METHODS
  Patients fulfilling the 2010 RA classification criteria in whom US showed power Doppler signals in one or more wrist or MCP joints were included. Right and left wrists and MCP joints 1-5 were examined with dorsal and volar scans. The proportion of the synovium covered by Doppler signals was estimated and quantified electronically in the area with the greatest fraction of colour signals.
  
  
  RESULTS
  Forty-one RA patients [29 females, mean age 62 years (s.d. 14), disease duration 11 years (s.d. 13), 28-joint DAS 5.5 (s.d. 1.3)] were examined. Colour signals were found in 192 of 984 joint regions. Forty-two, 139 and 11 regions were allocated to the semi-quantitative grades 1, 2 and 3, respectively, with electronically calculated colour fractions of 3.9%, 12.6% and 29.7%. The mean estimated colour fractions were lower than the mean measured fractions. An even distribution of the scores was found for estimated colour fractions of >0-10% for grade 1, >10-25% for grade 2 and >25% for grade 3 and for measured colour fractions of >0-6% for grade 1, >6-12% for grade 2 and >12% for grade 3.
  
  
  CONCLUSIONS
  This study suggests replacing the semi-quantitative grading system for synovial Doppler US with more evenly distributed quantitative scores that might better reflect treatment response.
authors.affiliation: Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, w.schmidt@immanuel.de.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Schmidt
authors.affiliation: Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen and.
authors.forename: Verena
authors.initials: V
authors.lastname: Schönau
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Britta E
authors.initials: BE
authors.lastname: Reiche
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Philipp D
authors.initials: PD
authors.lastname: Oberdorfer
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ohrndorf
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000145:classification* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012984:Software; D013583:Synovial Membrane / Q000000981:diagnostic imaging; D013585:Synovitis / Q000145:classification* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000592:standards*; D014955:Wrist Joint / Q000000981:diagnostic imaging
keywords: Doppler ultrasound; disease activity; grading system; hand; outcome measure; rheumatoid arthritis; synovitis; ultrasound