Diagnostic accuracy of grayscale, power Doppler and contrast-enhanced ultrasound compared with contrast-enhanced MRI in the visualization of synovitis in knee osteoarthritis

Bas A De Vries,Stephan J Breda,Duncan E Meuffels,David F Hanff,M.G Myriam Hunink,Gabriel P Krestin,Edwin H.G Oei

doi:10.1016/j.ejrad.2020.109392

Bas A De Vries, Stephan J Breda + Show 5 more

Open Access

https://doi.org/10.1016/j.ejrad.2020.109392

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Abstract

PurposeTo assess the diagnostic accuracy of grayscale (GSUS), power Doppler (PDUS) and contrast-enhanced ultrasound (CEUS) for detecting synovitis in knee osteoarthritis (OA). MethodPatients with different degrees of radiographic knee OA were included prospectively. All underwent GSUS, PDUS, CEUS, and contrast-enhanced magnetic resonance imaging (CE-MRI), on which synovitis was assessed semi-quantitatively. Correlations of synovitis severity on ultrasound based techniques with CE-MRI were determined. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance of GSUS, PDUS, and CEUS, for detecting synovitis, using CE-MRI as reference-standard. ResultsIn the 31 patients included, synovitis scoring on GSUS and CEUS was significantly correlated (ρ = 0.608, p < 0.001 and ρ = 0.391, p = 0.033) with CE-MRI. For detecting mild synovitis, the area under the curve (AUC) was 0.781 (95 %CI 0.609−0.953) for GSUS, 0.788 (0.622−0.954) for PDUS, and 0.653 (0.452−0.853) for CEUS. Sensitivity and specificity were 0.667 (0.431−0.845) and 0.700 (0.354−0.919) for GSUS, 0.905 (0.682−0.983) and 0.500 (0.201−0.799) for PDUS, and 0.550 (0.320−0.762) and 0.700 (0.354−0.919) for CEUS, respectively. The AUC of GSUS increased to 0.862 (0.735−0.989), 0.823 (0.666−0.979), and 0.885 (0.767−1.000), when combined with PDUS, CEUS, or both, respectively. For detecting moderate synovitis, the AUC of GSUS was higher (0.882 (0.750−1.000)) and no added value of PDUS and CEUS was observed. ConclusionsGSUS has limited overall accuracy for detecting synovitis in knee OA. When GSUS is combined with PDUS or CEUS, overall diagnostic performance improves for detecting mild synovitis, but not for moderate synovitis.

Highlights

Osteoarthritis (OA) is the most frequent form of arthritis and has major consequences for the individual patient and for public health
This study demonstrated that, even under optimized conditions, the combination of grayscale ultrasound (GSUS), power Doppler ultrasound (PDUS) and contrast-enhanced ultrasound (CEUS) shows only limited overall diagnostic accuracy for the assessment of synovitis compared to contrast-enhanced magnetic resonance imaging (MRI) (CE-MRI) as the gold standard
We found that GSUS showed the highest overall diagnostic performance compared to PDUS and CEUS when analyzed separately

Summary

Introduction

Osteoarthritis (OA) is the most frequent form of arthritis and has major consequences for the individual patient and for public health. Joint inflammation, characterized by swelling of the synovium and joint effusion, referred to as synovitis, is a key process in half of all OA patients [1]. Even in the early stages of OA, synovitis plays an important role in the perception of symptoms [2] and it is an important predictor of OA progression [3]. As the prominent role of synovitis in OA and the importance of identifying patients with synovitis for targeted anti-inflammatory treatment are increasingly recognized, the interest in imaging of synovitis in OA is growing. CE-MRI, incurs high costs, long scan times, and potential health issues in high-risk patients

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