OP0169 VESSEL WALL INFLAMMATION DETECTED WITH SUPERB MICROVASCULAR IMAGING IN BEHÇET SYNDROME

Abstract

BackgroundSuperb microvascular imaging (SMI) is a novel technique that provides a more sensitive assessment of small vessels compared to color Doppler US (CDUS), by distinction of low-speed flow signals from motion artifacts. Superficial thrombophlebitis (STM) is a common manifestation in patients with Behçet syndrome (BS) and is thought to be associated with inflammation of the vessel wall rather than a procoagulant state.ObjectivesWe aimed to assess STM lesions of patients with BS, together with controls, using SMI.MethodsWe studied 51 BS (16F/35M, mean age:40.6±12.8) patients and 26 non-BS (19F/7M mean age:44.9±11.7) patients with nodular lesions on physical examination. B-mode US, CDUS, PDUS and SMI were performed and recorded by the same radiologist and images were then evaluated by 2 radiologists. Both radiologists were blinded to the diagnoses and to each other’s assessments. First, presence/absence of vessel was assessed with CDUS to differentiate STM from erythema nodosum (EN). Then STM lesions were evaluated for the presence/absence of thrombus, vessel wall color-coded signal intensity, and thickness using the imaging modalities defined above. Vessel wall signal intensity was graded into 4 groups according to the percentages of the effected vessel wall area (Grade 0= no signal, Grade 1= < 25%, Grade 2= 25-50%, Grade 3= 50-75%, Grade 4= >75%). CDUS was the gold standard in the final diagnosis of STM. Interobserver reliability was assessed by kappa statistic.ResultsThe nodular lesions of 26 BS and 15 non-BS patients were diagnosed as STM (Table 1). The diagnosis was EN in the remaining 25 BS and 11 non-BS patients. SMI showed increased color-coded signal intensity in the vessel wall in patients with STM. We did not observe increased signal intensity in any of the patients with EN. According to the grading system, at least grade 1 or higher vessel-wall signals were detected in 20 BS (77%) patients with STM, in contrast to only 4 (27%) non-BS patients with STM (Table 1). Fifteen of 26 BS patients (58%) had at least grade 2 signal, and 4 of them had halo shaped signals all around the vessel-wall (Figure 1). On the other hand, 3 of 4 non-BS patients (75%) had only grade 1 signal and none of them had grade 4 signal. The interobserver reliability was good (κ=0.87, p<0.001).ConclusionA high-grade color-coded signal suggesting inflammation of the vessel wall was detected with SMI, in the majority of BS patients with STM. This finding needs to be studied in different vascular lesions of a large number of BS patients together with controls, in order to understand its specificity for BS and its significance.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.