High-resolution Doppler ultrasound in systemic sclerosis: Analysis of digital arteries and nailfold microvasculature using 18-5 MHz and 33-9 MHz probes.

Abstract

Newly developed Doppler techniques enable the sampling of slow vascular flows and the extrapolation of spectral parameters in distal arterioles. The aim of this study was to investigate the role of spectral analysis performed by means of ultra-high frequency ultrasound (US) in the evaluation of the peripheral vascular bed of systemic sclerosis (SSc) patients. Both hands of 33 patients affected by diffuse cutaneous SSc and 34 volunteers were evaluated with a US machine equipped with 33-9MHz and 18-5MHz transducers. Proximal resistive index and the peak systolic velocity (pRI and pPSV, respectively), were calculated at the level of the second interdigital artery. The distal resistive index (dRI) was calculated at the level of a nailfold arteriole of the third finger. All SSc patients had been previously divided into 4 subgroups according to their nailfold videocapillaroscopic (NVC) patterns following accepted criteria. SSc patients showed a significantly slower systolic velocity at the level of the second interdigital artery (pPSV [SD]=8.38 [3]cm/s vs pPSV [SD]=11.14 [4.5]cm/s; P= .005) and a higher dRI (dRI [SD]=0.65 (0.14) vs dRI [SD]=0.57 [0.11); P= .0115). No differences were found between the pRI values measured in the SSc patients and those of the controls (pRI [SD]=0.76 [0.11] vs pRI [SD]=0.73 [0.12]; P= .359]. The subgroup analysis did not show any significant difference when pPSV, pRI and dRI were compared among NVC morphological patterns. High-resolution Doppler analysis of digital distal arterioles may disclose subtle abnormalities in the downstream microvasculature of SSc patients that could be missed when the examination is performed at a more proximal level and/or using lower Doppler frequencies.