title: Contrast-enhanced ultrasound in coxitis.
abstract: OBJECTIVE
  Hip involvement is common in rheumatological diseases but can be difficult to diagnose, especially in absence of MRI. B-mode ultrasound (US) detects joint capsule distention while distinguishing effusion from proliferative synovial tissue is strenuous since both appear hypoechoic. Power Doppler ultrasound (PDUS) often fails to detect vascularisation in the hip. We therefore evaluated contrast-enhanced ultrasound (CEUS) in the hip joint.
  
  
  METHODS
  We investigated 36 hip joints of patients with known rheumatological joint diseases presenting with hip pain and 5 hips of healthy controls using B-mode US, PDUS and CEUS. We assessed CEUS hypervascularisation semiquantitatively comparing to the periarticular tissue. In B-mode, we measured the distance between femoral neck and joint capsule (DNC) and compared the results to the avascular intraarticular margin (AIM) in CEUS using t-tests and crosstables.
  
  
  RESULTS
  PDUS signals were received in only 2/36 cases (5.6%). B-mode US established the diagnosis of coxitis in 64% of all symptomatic hip joints. In 4 cases (11%), the diagnosis was revised after the use of CEUS. In patients with definite coxitis, 14 hips (73.7%) showed CEUS hypervascularisation°2, five°1 (26.3%) and none°0 (χ2=3.277, P<0.001). The difference DNC/AIM was highly significant in patients with hip pain (P<0.001, 95% CI: 2.054-4.684) and those with definite coxitis (P<0.001, 95% CI: 3.268-7.258).
  
  
  CONCLUSIONS
  In most cases, clinical parameters together with B-mode US findings are sufficient to diagnose coxitis. However, CEUS is capable of visualizing and quantifying the degree of hypervascularisation and enables the discrimination between effusion and proliferative synovial tissue.
authors.affiliation: Department of rheumatology, nephrology, oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany; Department of nephrology, hypertensiology, rheumatology, University of Heidelberg, University hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Electronic address: christianloeffler@gmx.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Löffler
authors.affiliation: Department of rheumatology, nephrology, oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sattler
authors.affiliation: Department of rheumatology, nephrology, oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uppenkamp
authors.affiliation: Department of rheumatology, nephrology, oncology, Klinikum Ludwigshafen, Bremserstr. 79, 67065 Ludwigshafen, Germany; Department of nephrology, hypertensiology, rheumatology, University of Heidelberg, University hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Raoul
authors.initials: R
authors.lastname: Bergner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015331:Cohort Studies; D003287:Contrast Media; D016208:Databases, Factual; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasound; Coxitis; Doppler; Hip