Superb microvascular imaging (SMI) for evaluating hand joint lesions in patients with rheumatoid arthritis in clinical remission

Xiaolong Yu,Zun Li,Min Ren,Jing Xi,Yaxiang Ji,Jiabiao Wu

doi:10.1007/s00296-018-4112-3

Xiaolong Yu, Zun Li + Show 4 more

Open Access

https://doi.org/10.1007/s00296-018-4112-3

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Journal: Rheumatology International	Publication Date: Jul 30, 2018
Citations: 27	License type: open-access

Affiliation: Jiangsu University

Abstract

The utility of superb microvascular imaging (SMI) for evaluating hand joint lesions in patients with rheumatoid arthritis (RA) in clinical remission is unreported. This study aimed to compare SMI and power Doppler imaging (PDI) for the evaluation of hand joint lesions in these patients. Twenty-six patients with RA in clinical remission were enrolled. A total of 572 joints (52 wrist, 260 proximal interphalangeal, and 260 metacarpophalangeal joints) were detected by SMI and PDI. A semi-quantitative scale of 0–3 was used to compare the detection of synovial blood flow signal by SMI and PDI. Inter-observer agreement for the assessment of SMI and PDI scores was measured with kappa values. In the ten healthy volunteers, SMI and PDI signals were both scored 0. In the 26 RA patients, the remission rate via PDI was 65.4% but was only 42.3% via SMI. SMI also detected microvessel flow signal in seven patients diagnosed with clinical remission via PDI. Moreover, a total of 106 blood flow signals (18.5%) were detected by SMI, while 50 blood flow signals (8.7%) were detected by PDI. Compared with PDI, SMI increased 18.0% of power flow signals from Grade 0–1 and increased 13.7% of power flow signals from Grade 1–2. One joint classified as Grade 1 by PDI was classified as Grade 0 by SMI. Inter-observer agreement for PDI and SMI semi-quantitative scoring was moderate (kappa = 0.463). SMI seems more sensitive than PDI for detecting hand joint lesions in RA in clinical remission PDI, and could aid the achievement of true remission in RA patients.

Highlights

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by polyarticular inflammation and pannus formation, leading to joint destruction and severe disability [1, 2]
Remission is important for RA patients and persistent subclinical synovitis in RA patients who achieve clinical remission highlights the importance of true remission [17]
We showed that Superb microvascular imaging (SMI), a new microvascular flow imaging modality, was more sensitive than power Doppler imaging (PDI) for detecting synovial vessel signals of the hand joint in RA patients who achieved clinical remission, suggesting that SMI has great potential for improving diagnostic accuracy in evaluating RA remission

Summary

Introduction

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by polyarticular inflammation and pannus formation, leading to joint destruction and severe disability [1, 2]. Remission or low disease activity is the ultimate aim for the treatment of RA [3, 4]. Several studies have shown infra-clinical synovitis and disease exacerbation has persisted in patients who achieved clinical remission [6]. It is important to identify true remission in RA patients. Imaging modalities, such as magnetic resonance imaging, have been reported to detect persistent inflammation in RA patients in clinical remission; they require contrast enhancement [7, 8]. Power Doppler imaging (PDI) can detect modifications in synovial vascularity but it is not very sensitive to microvascular patterns and low blood flow velocity [9]. Superb microvascular imaging (SMI) is a recent innovative and effective ultrasound (US)

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