Power Doppler Ultrasound Score Research Articles

AB0044 Correlation of peripheral il17 cytokine with activity parameters and ultrasound scores in rheumatoid arthritis

BackgroundIt is now recognized that some pro-inflammatory cytokines, such as IL-17, contribute to synovial neoangiogenesis and osteocartilaginous destruction in rheumatoid arthritis (RA). The serum concentration of this cytokine has also...

SAT0089 Non-Steroidal Anti-Inflammatory Drugs Have an Independent Effect on Synovial Vascularity Assessed by Musculoskeletal Ultrasound in Rheumatoid Arthritis

BackgroundMusculoskeletal ultrasound (MSUS) is useful in monitoring rheumatoid arthritis (RA) and is emphasized its high sensitivity for detecting synovitis and good correlation with clinical disease activity indices, such as Disease...

AB1280 Diurnal variation of power doppler signal in metacarpophalangeal joints of patients with rheumatoid arthritis

BackgroundIn a preliminary study on 10 patients with active rheumatoid arthritis (RA) we could show for the first time that Power Doppler ultrasonography (PDUS) signal of metacarpophalangeal (MCP) joints has...

THU0095 Early response to abatacept plus MTX in MTX-IR RA patients using power doppler ultrasonography: An open-label study

BackgroundThe global power Doppler ultrasound (PDUS) scoring system combining synovial hypertrophy, joint effusion and PD signal developed by the OMERACT-EULAR-US Task Force has good intra- and inter-observer reliability in metacarpophalangeal...

SAT0488 Sensitivity to Change of a Combined Gray-Scale and Power Doppler Ultrasound Score for Synovitis in Comparison to a Sum Score of 5 Joints of the Wrist and Hand – One-Year Evaluation of an RA Cohort.

BackgroundSeveral ultrasound (US) scoring systems have been proposed for evaluating objectively RA patients’ responsiveness under treatment [1-3].ObjectivesTo evaluate the sensitivity to change over one year of a combined gray-scale (GS)...

SAT0524 Automated Breast Volume Scanner (ABVS), a New Automated Ultrasonic Device, is Useful to Examine Joint Injury in Patients with Rheumatoid Arthritis

BackgroundAutomated Breast Volume Scanner (ABVS) is an ultrasonic device to be developed for the automated scanning for mammary glands. ABVS is able to scan mammary gland automatically in a short...

AB0334 Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis

BackgroundRecent imaging modalities such as musculoskeletal ultrasonography (MSKUS) and magnetic resonance imaging (MRI) are known to detect joint injury very frequently in early arthritis patients.ObjectivesTo investigate whether MSKUS assists the...

FRI0093 Power doppler assessment of synovial vascularity predicts the presence of magnetic resonance imaging-proven osteitis in patients with rheumatoid arthritis

BackgroundMusculoskeletal ultrasonography (MSKUS) and magnetic resonance imaging (MRI) are known as high sensitive imaging modality toward the patients with rheumatoid arthritis (RA). Especially, the synovial vascularity determined by power Doppler...

SAT0489 The Severity of Synovial Inflammation Assessed by Musculoskeletal Ultrasonography Correlates with that of Osteitis Assessed by Magnetic Resonance Imaging in Patients with Rheumatoid Arthritis

BackgroundMRI-proven osteitis is known as the prognostic factor toward radiographic progression in patients with rheumatoid arthritis (RA). Musculoskeletal ultrasonography (MSKUS) is another high sensitive imaging modality to find joint injury...

Value of power Doppler ultrasound to evaluate acute kidney injury

To explore the value of power Doppler ultrasound (PDU) in the evaluation of acute kidney injury(AKI). Renal blood flow of 40 AKI cases was monitored by power Doppler ultrasound and 4-level semiquantitative PDU score method employed. All cases were divided into 3 groups by PDU score. AKI stage and duration were compared. And the co-variables of death and (continuous renal replacement therapy) CRRT days (> 3) were also analyzed by Logistic regression analysis. A total of 40 AKI case were recruited. The 3-score group (n = 13)has lower mortality in intensive care unit and at 28 days than the 2-score group (n = 15) and the 1-score group (n = 12). The number of stage-3 AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 1, 4, 9 correspondingly, χ(2) = 16.103, degree of freedom = 4, P = 0.003). The number of persistent AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 3, 9, 10 correspondingly, P < 0.05). Age, APACHEII score and PDU score (< 3) were closely correlated with death while age, APACHEII score, level of serum creatinine and PDU score (< 3) with CRRT days (> 3) (P < 0.05). PDU may be used to monitor renal hemodynamics in AKI patients and its score helps clinicians to evaluate the severity and prognosis of AKI.

Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power Doppler ultrasonography: Correlation with disease activity

Aim of the workAssessment of synovitis in rheumatoid arthritis (RA) is a major issue for proper treatment; it has been proven that high resolution ultrasound (US) examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity. Patients and methodsWe evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 (DAS 28). Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls. ResultsSerum CXCL13 level was significantly increased in early RA patients vs. controls (p<0.001). High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 (r=0.42, p=0.02), synovial thickness (r=0.39, p=0.03) and power Doppler US score (r=0.43, p=0.02). Serum CXCL13 level correlated with synovial thickness (r=0.63, p=0.001) and power Doppler US score (r=0.69, p=0.001). ConclusionRecent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28.

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

To introduce and evaluate a new standardized ultrasound (US) score developed for large joints in patients with rheumatoid arthritis (RA). A US score was designed to determine the degree of inflammation in the shoulder, the elbow, the hip, and the knee joint in patients with RA (Sonography of Large Joints in Rheumatology [SOLAR] score). Synovitis and synovial vascularity were scored semiquantitatively (grade 0-3) by gray-scale US (GSUS) and power Doppler US (PDUS). Patients with RA were examined at baseline and 3, 6, and 12 months after initiation of local or systemic therapy (disease-modifying antirheumatic drugs [DMARDs]/biologic agents). Erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibodies, and the clinical Disease Activity Score in 28 joints (DAS28) were determined. A cohort of 199 patients were analyzed and followed up over 12 months. At baseline, before modification of the therapy, patients received either DMARDs (n = 131), DMARDs plus biologic agents (n = 46), biologic monotherapy (n = 8), or no DMARD therapy (n = 14). At baseline, the mean DAS28 score was 4.6 and decreased to 3.2 after 1 year of therapy (P < 0.001). All US scores demonstrated a statistically significant improvement except for the PDUS scores for the shoulder and the hip. In detail, the mean synovitis GSUS score for the knee decreased from 5.2 at baseline to 2.2 after 12 months of followup. The mean GSUS score for the shoulder fell from 2.6 to 1.6, for the elbow fell from 5.2 to 2.6, and for the hip fell from 2.2 to 0.4 (P < 0.05 for each). The SOLAR score is a feasible tool for the qualitative and quantitative evaluation of large joint involvement in patients with RA using US.

Contrast-Enhanced Ultrasonography is More Sensitive Than Grayscale and Power Doppler Ultrasonography Compared to MRI in Therapy Monitoring of Rheumatoid Arthritis Patients

To evaluate wrist and finger joints in patients with rheumatoid arthritis (RA) by grayscale, power Doppler (PD) and contrast-enhanced musculoskeletal ultrasonography (US) and to compare these findings with MRI, clinical (DAS28) and laboratory (ESR; CRP) data. US was performed at baseline (t0) and after three, six and twelve (t12) months before and after a change of medical treatment. MRI was carried out at t0 and t12 and used as the reference method. Contrast-enhanced US was used to assess one clinically most affected joint region. Different semiquantitative synovitis scores were calculated by grayscale and PD US. Contrast-enhanced US results evaluated by enhancement, slope and semi-quantitative assessment significantly correlated to each other, to grayscale US, CRP, as well as to MRI with the highest correlation coefficients for the used contrast-enhanced US modes (r = 0.56, r = 0.55, r = 0.57; each p < 0.05). Sum scores evaluated by grayscale US showed that synovial inflammation in finger joints was detected significantly more frequently in the palmar aspect than on the dorsal side (p = 0.001). Using power Doppler US, the wrists were significantly more inflamed from dorsal than on the palmar side (p = 0.0004). Significant longitudinal correlations between grayscale and power Doppler US scores were detected. Grayscale, power Doppler and contrast-enhanced US are accurate tools for the detection and follow-up of synovitis in RA wrist and finger joints, with contrast-enhanced US being most sensitive compared to MRI. All imaging methods reflected a good response to TNFα blocking therapy.

Contrast-Enhanced Ultrasonography for the Detection of Joint Vascularity in Arthritis – Subjective Grading Versus Computer-Aided Objective Quantification

To compare joint inflammation assessment using subjective grading of power Doppler ultrasonography (PDUS) and contrast-enhanced ultrasonography (CEUS) versus computer-aided objective CEUS quantification. 37 joints of 28 patients with arthritis of different etiologies underwent B-mode ultrasonography, PDUS, and CEUS using a second-generation contrast agent. Synovial thickness, extent of vascularized pannus and intensity of vascularization were included in a 4-point PDUS and CEUS grading system. Subjective CEUS and PDUS scores were compared to computer-aided objective CEUS quantification using Qontrast® software for the calculation of the signal intensity (SI) and the ratio of SI for contrast enhancement. The interobserver agreement for subjective scoring was good to excellent (κ = 0.8 - 1.0; P < 0.0001). Computer-aided objective CEUS quantification correlated statistically significantly with subjective CEUS (P < 0.001) and PDUS grading (P < 0.05). The Qontrast® SI ratio correlated with subjective CEUS (P < 0.02) and PDUS grading (P < 0.03). Clinical activity did not correlate with vascularity or synovial thickening (P = N. S.) and no correlation between synovial thickening and vascularity extent could be found, neither using PDUS nor CEUS (P = N. S.). Both subjective CEUS grading and objective CEUS quantification are valuable for assessing joint vascularity in arthritis and computer-aided CEUS quantification may be a suitable objective tool for therapy follow-up in arthritis.

The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis

We evaluated the significance of the power Doppler ultrasonography (PDUS) score by comparing it with serum biomarkers and clinical disease activity. We measured the PDUS scores of 24 synovial sites in 12 joints in 22 RA patients. For convenience, the PDUS scores of six synovial sites in six joints were also examined. Each joint was scored for a power Doppler (PD) signal on a scale from 0 to 3. The PDUS scores are the sums of the PD signal scores for the 24 synovial sites or the 6 synovial sites. On the same day, serum variables as well as clinical disease activity were evaluated. The PDUS scores from the 24 joint sites were significantly positively correlated with DAS of 28 joints (DAS-28), simplified disease activity index (SDAI), clinical disease activity index (CDAI) and serum biomarkers including MMP-3, VEGF and tissue inhibitor of metalloproteinases-1 (TIMP-1). Accordingly, the PDUS scores from the six synovial sites greatly correlated with those from the 24 joint sites. Clinical disease activities as well as serum variables were also clearly correlated with the PDUS scores from the six synovial sites. The standard as well as the simplified PDUS scores well reflected clinical disease activity and serum variables, including angiogenic factors. Our data reaffirm the utility of ultrasonography for monitoring disease activity in patients with RA.

Urinary type II collagen C-terminal peptide is associated with synovitis and predicts structural bone loss in very early inflammatory arthritis

ObjectivesIn rheumatoid arthritis, high levels of the cartilage turnover biomarker C-terminal cross-linking telopeptide of type II collagen (CTX-II) predict an increased risk of radiological progression. In very early inflammatory arthritis...

Linking Power Doppler Ultrasound to the Presence of Th17 Cells in the Rheumatoid Arthritis Joint

BackgroundPower Doppler ultrasound (PDUS) is increasingly used to assess synovitis in Rheumatoid Arthritis (RA). Prior studies have shown correlations between PDUS scores and vessel counts, but relationships with T cell immunopathology have not been described.Methodology/Principal FindingsPBMC were isolated from healthy controls (HC) or RA patients and stimulated ex vivo with PMA and ionomycin for 3 hours in the presence of Golgistop. Paired synovial fluid (SF) or synovial tissue (ST) were analysed where available. Intracellular expression of IL-17, IFNγ, and TNFα by CD4+ T cells was determined by flow cytometry. Synovial blood flow was evaluated by PDUS signal at the knees, wrists and metacarpophalangeal joints of RA patients. Serum, SF and fibroblast culture supernatant levels of vascular endothelial growth factor-A (VEGF-A) were measured by ELISA. The frequency of IL17+IFNγ-CD4+ T cells (Th17 cells) was significantly elevated in peripheral blood (PB) from RA patients vs. HC (median (IQR) 0.5 (0.28–1.59)% vs. 0.32 (0.21–0.54)%, p = 0.005). Th17 cells were further enriched (mean 6.6-fold increase) in RA SF relative to RA PB. Patients with active disease had a higher percentage of IL-17+ T cells in ST than patients in remission, suggesting a possible role for Th17 cells in active synovitis in RA. Indeed, the percentage of Th17 cells, but not Th1, in SF positively correlated with CRP (r = 0.51, p = 0.04) and local PDUS-defined synovitis (r = 0.61, p = 0.002). Furthermore, patients with high levels of IL-17+CD4+ T cells in SF had increased levels of the angiogenic factor VEGF-A in SF. Finally, IL-17, but not IFNγ, increased VEGF-A production by RA synovial fibroblasts in vitro.Conclusions/SignificanceOur data demonstrate a link between the presence of pro-inflammatory Th17 cells in SF and local PDUS scores, and offer a novel immunological explanation for the observation that rapid joint damage progression occurs in patients with persistent positive PDUS signal.

Ovarian stromal vascularity evaluated by Doppler correlates with the dose of FSH used during in vitro fertilization(IVF) stimulation

OBJECTIVE: Consistent with other biological models, the delivery of nutrients via the bloodstream to a developing ovum must have some impact on follicular growth. While direct measurement is experimentally difficult, ultrasound blood flow analysis has been suggested to be an acceptable surrogate. This study was designed to assess a correlation between ovarian blood flow prior to stimulation and the dose of FSH required for IVF stimulation.DESIGN: Prospective, observational, comparative, single center.MATERIALS AND METHODS: Reproductive endocrinology tertiary care private institution. Patients: Cohort of 59 patients undergoing 60 cycles of IVF stimulation enrolled between April and June 2008. Observational Data Collected: Ovarian Stromal Doppler was performed prior to IVF stimulation, and included Power Doppler Ultrasound (PDU) and Color Doppler Ultrasound (CDU) with pulsed Doppler (PW) Flow Velocity Waveform (FVW). Both semi-quantitative and quantitative evaluations were performed using a semi-quantitative grading system by PDU and calculation by CDU/PW/FVW of Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV) and Time Averaged Maximum Velocity (TAMX). Main Outcome Measures: The dose of FSH used during IVF stimulation in relation to the above parameters.RESULTS: Analysis of non-experimental background variables showed no significant differences between the pregnant and non-pregnant groups. Statistically significant correlations were noted between pre-stimulation ovarian stromal PSV, TAMX, PDU score and the dose of FSH administered during stimulation. The statistical significance of these findings was confirmed by multivariable regression analysis. Doppler findings were more predictive of FSH dose than was patient age.CONCLUSIONS: The pre-stimulation Ovarian stromal ultrasound vascular evaluation accurately predicts the dose of FSH required to achieve optimal IVF stimulation. OBJECTIVE: Consistent with other biological models, the delivery of nutrients via the bloodstream to a developing ovum must have some impact on follicular growth. While direct measurement is experimentally difficult, ultrasound blood flow analysis has been suggested to be an acceptable surrogate. This study was designed to assess a correlation between ovarian blood flow prior to stimulation and the dose of FSH required for IVF stimulation. DESIGN: Prospective, observational, comparative, single center. MATERIALS AND METHODS: Reproductive endocrinology tertiary care private institution. Patients: Cohort of 59 patients undergoing 60 cycles of IVF stimulation enrolled between April and June 2008. Observational Data Collected: Ovarian Stromal Doppler was performed prior to IVF stimulation, and included Power Doppler Ultrasound (PDU) and Color Doppler Ultrasound (CDU) with pulsed Doppler (PW) Flow Velocity Waveform (FVW). Both semi-quantitative and quantitative evaluations were performed using a semi-quantitative grading system by PDU and calculation by CDU/PW/FVW of Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV) and Time Averaged Maximum Velocity (TAMX). Main Outcome Measures: The dose of FSH used during IVF stimulation in relation to the above parameters. RESULTS: Analysis of non-experimental background variables showed no significant differences between the pregnant and non-pregnant groups. Statistically significant correlations were noted between pre-stimulation ovarian stromal PSV, TAMX, PDU score and the dose of FSH administered during stimulation. The statistical significance of these findings was confirmed by multivariable regression analysis. Doppler findings were more predictive of FSH dose than was patient age. CONCLUSIONS: The pre-stimulation Ovarian stromal ultrasound vascular evaluation accurately predicts the dose of FSH required to achieve optimal IVF stimulation.

Hepatocellular carcinoma treated with chemoembolization: assessment with contrast-enhanced doppler ultrasonography.

To report our preliminary experience concerning the use of Doppler ultrasonography (DUS) techniques after intravenous injection of the galactose-based contrast agent Levovist in the assessment of hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). The sonographic findings are correlated with those obtained using iodized oil (Lipiodol) helical computed tomography (CT). For 7 months we studied 28 patients with cirrhosis and HCC (a total of 43 nodules) who had undergone TACE between 18 and 30 days previously. The lesions were investigated with color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS), before and after infusion of the echo-contrast agent (300 mg/ml, maximum 1 injection for each nodule, administered at constant velocity within 60-90 sec), and with helical Lipiodol-CT (0-7 days after DUS). In the retrospective analysis, special attention was given to the Doppler signals related to pulsatile intra- and perinodular flow and to the detection of new vessels after contrast agent injection. The signal intensity was graded as 0 (absent), 1 (low), 2 (medium), or 3 (high), while its distribution was classified as peripheral, central, or diffuse. Oily agent retention on CT scans was assessed as 0 (absent), I (<10%), II (<50%), III (>50%), or IV (homogeneous). These scores were awarded separately, without knowledge of the other judgments. An hepatic global echo-enhancing effect was identified in all cases and always lasted long enough to allow an accurate analysis of all parenchymal lesions (at least 8 min). The signal scores could be evaluated in 39 of 43 HCCs, as follows: basal CDUS: grade 0 in 17 lesions, grade 1 in 16, grade 2 in 6; contrast-enhanced CDUS: grade 0 in 12 lesions, grade 1 in 10, grade 2 in 14, grade 3 in 3; basal PDUS: grade 0 in 15 lesions, grade 1 in 13, grade 2 in 9, grade 3 in 2; contrast-enhanced PDUS: grade 0 in 11 lesions, grade 1 in 9, grade 2 in 15, grade 3 in 6. Lipiodol-CT scoring was: grade 0 in 1 lesion, grade I in 7, grade II in 11, grade III in 9, grade IV in 11. In all but one nodule the difference between CDUS and PDUS scores, compared both with each other and with nonenhanced and contrast-enhanced examinations, was never greater than one grade. Contrast-enhanced DUS is a simple and fast procedure allowing a valuable, constant echo-enhancing effect of sufficient duration. DUS techniques, especially contrast-enhanced PDUS, offer an effective and realistic analysis of HCC nodules treated with TACE and show more evident agreement with Lipiodol-CT findings than baseline studies.