Abstract
IntroductionWe sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS).MethodsTwenty-six tendons of 24 patients (nine men, 15 women; mean age ± SD, 54.4 ± 11.8 years) with a clinical diagnosis of tenosynovitis were examined with B-mode ultrasonography, PDUS, and CEUS by using a second-generation contrast agent, SonoVue (Bracco Diagnostics, Milan, Italy) and a low-mechanical-index ultrasound technique. Thickness of synovitis, extent of vascularized pannus, intensity of peritendinous vascularisation, and detection of intratendinous vessels was incorporated in a 3-score grading system (grade 0 to 2). Interobserver variability was calculated.ResultsWith CEUS, a significantly greater extent of vascularity could be detected than by using PDUS (P < 0.001). In terms of peri- and intratendinous vessels, CEUS was significantly more sensitive in the detection of vascularization compared with PDUS (P < 0.001). No significant correlation between synovial thickening and extent of vascularity could be found (P = 0.089 to 0.097). Interobserver reliability was calculated to be excellent when evaluating the grading score (κ = 0.811 to 1.00).ConclusionsCEUS is a promising tool to detect tendon vascularity with higher sensitivity than PDUS by improved detection of intra- and peritendinous vascularity.
Highlights
We sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS)
Differences between the CEUS and the PDUS groups regarding the severity scores were tested for significance by using the Wilcoxon test
Tenosynovial thickening was detected in all tendons examined (26 of 26; 100%). 40.4% (10 of 26 by observer 1, 11 of 26 by observer 2) were assessed with grade 1, and 59.6% (16 of 26 and 15 of 26) showed sizable thickening of more than 4 mm
Summary
We sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS). Besides mechanical overloading and attrition, rheumatologic diseases are widespread causes of tenosynovitis and tendinosis. These chronic systemic inflammatory diseases lead to enormous costs for hospitalizations, physician visits, employee’s illness, and invalidity pensions. They are caused by osseous destruction, and by tendinosis and consecutive tendon rupture, which are not detectable by conventional imaging such as radiographs. Rheumatoid arthritis (RA), with a prevalence of 0.5% to 1%, the most common disease of this group [1], is accompanied by tendon involvement in Angiogenesis is a hallmark of acute inflammation and exacerbation of chronic disease. Angiogenesis is a step in the inflammatory cascade that can be identified and quantified with imaging modalities [5]
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