Power Doppler Ultrasound Findings Research Articles

Associations between power Doppler ultrasound findings and B-mode synovitis and clinical arthritis in juvenile idiopathic arthritis using a standardised scanning approach and scoring system

ObjectivesTo describe power Doppler (PD) ultrasound findings in joint regions with B-mode (BM) synovitis using a standardised scanning protocol and scoring system in patients with juvenile idiopathic arthritis (JIA). Further,...

Gray-Scale and Power Doppler Ultrasound Findings Predictive of Cubital Tunnel Syndrome Severity.

The use of ultrasound in the diagnosis of cubital tunnel syndrome (CuTS) is an attractive alternative to electrodiagnostic (EDX) studies, but its utility is binary with poor severity correlation. We hypothesize that increasing ulnar nerve cross-sectional area (CSA) and power Doppler measurement of intraneural vascularity may predict the extent of disease. We identified 20 elbows from patients with a history of CuTS and 20 elbows in 10 asymptomatic controls. Electrodiagnosis was performed for symptomatic patients. Gray-scale ultrasound and power Doppler ultrasound were performed to measure CSA and intraneural vascularity in all participants. Functional measures, Boston Carpal Tunnel Questionnaire (BCTQ), and Patient-Reported Outcomes Measurement Information System surveys were also completed. A strong positive correlation was found between CSA and motor nerve conduction velocity (MNCV) decrease between elbow and forearm, which increased when BCTQ >2 was used as a screening criterion. Increased CSA also demonstrated a high positive predictive value (PPV) in predicting MNCV changes, but poor ability to predict axonal loss. In contrast, power Doppler ultrasound demonstrated 100% PPV and 94% negative predictive value (NPV) in predicting severe CuTS (defined as compound motor action potential [CMAP] amplitude <6 mV and electromyography [EMG] findings). Cross-sectional area is a sensitive method for identifying changes in MNCV and amplitude but does not stratify disease severity, as defined by diminished CMAP amplitude and/or evidence of denervation on EMG. The presence of increased intraneural vascularity is relatively sensitive but highly specific for axonal loss. The combination of nerve CSA, BCTQ screening, and power Doppler ultrasound may provide an alternative means for CuTS assessment.

Accuracy of power Doppler ultrasonography in the diagnosis and monitoring of idiopathic inflammatory myopathies.

No clear-cut guidelines exist for the use of imaging procedures for the diagnosis of idiopathic inflammatory myopathies (IIM). The aim of the present study was to assess the diagnostic accuracy of power Doppler ultrasonography (PDUS) score in IIM patients compared with a control group and its usefulness during follow-up. All patients evaluated in the Vasculitis and Myositis Clinic, Rheumatology Unit, University of Siena were prospectively collected. All patients underwent US examination of both thighs in axial and longitudinal scans, which were also performed twice (T1) or three times (T2). Forty-five patients with IIM (median [interquartile range] age 55 [45-66] years; 35 female) were enrolled. Receiver operating characteristic curves distinguished patients and controls based on ∑power Doppler (PD), ∑oedema, ∑atrophy and CRP. The best cut-off value for ∑PD was 0.5, ∑oedema 1.5, ∑atrophy 0.5 and CRP 0.22 mg/dl. In a logistic regression analysis, the variables that most influenced diagnosis of IIM were ∑PD and ∑oedema (P = 0.017 and P = 0.013, respectively). ∑Oedema was lower at T1 (P = 0.0108) and T2 (P = 0.0012) than at T0. Likewise, ∑PD was lower at T1 (P = 0.0294) and T2 (P = 0.0420) than at T0. Physician global assessment was lower at T1 (P = 0.0349) and T2 (P = 0.0035) than at baseline. Our findings show that PDUS is a reliable diagnostic tool in the differential diagnosis between inflammatory and non-inflammatory myopathies. Moreover, PDUS can be employed also during the follow-up of patients with IIM. A reduction in disease activity, measured by physician global assessment, led to a concomitant decrease in both oedema and PD, which was directly correlated with their rate of change. This underlines the close link between clinical assessment and PDUS findings, not only at diagnosis but also during monitoring.

Serum and synovial fluid interleukin-17 concentrations in rheumatoid arthritis patients: Relation to disease activity, radiographic severity and power Doppler ultrasound

Aim of the workTo investigate serum and synovial fluid levels of IL-17 in rheumatoid arthritis (RA) patients, and its correlation with disease activity and severity. Patients and methods20 RA patients together with 20 primary knee osteoarthritis (KOA) patients and 15 healthy individuals matched for age and sex as control groups were enrolled in this study. Both RA and KOA patients presented with knee effusion. Paired samples of serum and synovial fluid (SF) were collected from RA, OA patients and serum samples from the healthy individuals. RA disease activity was assessed using DAS-28 score and power Doppler ultrasound (PDUS) according to the European League against Rheumatism (EULAR). Radiographic damage was evaluated according to Larsen score. ResultsSerum levels of IL-17 were significantly elevated in RA patients compared to controls (p < 0.001). Also, SF of IL-17 was significantly higher in RA patients compared to OA patients (p < 0.001). In addition, synovial level of IL-17 was significantly higher in RA patient compared to their serum level (p < 0.001). Regarding disease activity grading among RA patients, significant differences (p < 0.05) in mean serum and synovial IL-17 levels were reported being higher in severe active disease. Positive correlations of serum and SF IL 17 levels with PDUS findings and Larsen score were reported. ConclusionSerum and synovial IL-17 levels were significantly elevated in RA patients which clarifies its possible role in RA pathogenesis and correlates positively with disease activity parameters, PDUS findings and Larsen score. Thus targeting IL-17 may provide a promising role in suppressing RA.

Value of contrast-enhanced ultrasound for detection of synovial vascularity in experimental rheumatoid arthritis: an exploratory study.

ObjectiveThis study aimed to examine the associations between contrast-enhanced ultrasound (CEUS) imaging and synovial hypervascularity and synovitis score in a rabbit model of antigen-induced arthritis (AIA), compared with power Doppler ultrasound (PDUS).MethodsWe investigated 50 knee joints in 25 AIA rabbits (AIA group), and 10 knee joints in five sham-injected rabbits (control group). PDUS and CEUS images were evaluated at the 8th week. Ultrasound-guided synovial biopsies were targeted in the area with hypervascularity, and synovial microvessel density (MVD) was evaluated by immunohistochemical staining of CD31.ResultsThe PDUS score was significantly higher in the AIA group (2.61 ± 0.78) compared with the control group (0.50 ± 0.53). CEUS in the AIA group revealed a fast-in/slow-out pattern of contrast enhancement. MVD revealed by CD31+ vessel count and the synovitis score were significantly higher in the AIA group compared with the control group. In the AIA group, CEUS findings showed a better correlation with MVD revealed by CD31+ and synovitis score than PDUS findings.ConclusionCEUS is superior to PDUS for estimating synovial hypervascularity and hyperplasia in experimental rheumatoid arthritis.

Power Doppler Ultrasound Findings before and after Focused Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Pilot Study on Pain Reduction and Neovascularization Effect

Extracorporeal shock wave therapy (ESWT) has been found to have a positive effect in the treatment of pain in Achilles tendinopathy, although the exact mechanism is not yet completely understood. Among the mechanisms suggested to underlie ESWT effects are direct stimulation of healing, neovascularization and direct suppressive effects on nociceptors and hyperstimulation, which would block the gate-control system. The neovascularization observed in flogistic tissue is associated with stimulated nerve fibers around tendons and induces a painful condition. The objectives of the present study were to evaluate the effect of ESWT on pain and function in patients with non-insertional Achilles tendinopathy (NIAT) and to assess the neovascularization phenomenon using power Doppler ultrasound (PDU). Twelve patients with NIAT underwent five sessions of focused ESWT over 5 wk. Outcome measures were the visual analogue scale, the Victorian Institute of Sport Assessment–Achilles questionnaire and active dorsiflexion and plantar flexion ankle articular range of motion. Moreover, the patients’ clinical impressions of treatment results after ESWT were investigated using the Roles and Maudsley score. Patients were assessed at baseline and 1 and 3 mo after treatment. They had a significant reduction in pain with improvement of arthrokinematic motion and functionality and a positive clinical impression of treatment outcome (50% of patients considered their clinical picture as good/excellent after 3 mo). However, the pulse Doppler ultrasound exam did not reveal neovascularization in 91.7% of the patients 1 and 2 mo after focused ESWT, and in some patients there was a reduction in blood vessels related to flogistic processes. The present observational study confirmed the efficacy of ESWT in pain reduction in NIAT, with a higher degree of patient satisfaction, although doubt persists over the neovascularization effect on the Achilles tendons treated.

Characteristics of late-onset spondyloarthritis in Japan: A retrospective cohort study.

Spondyloarthritis may be increasingly present in older patients as life expectancy increases. We investigated clinical differences between early-onset and late-onset spondyloarthritis in Japan.We retrospectively reviewed 114 patients consecutively diagnosed with spondyloarthritis. The clinical course of each patient was observed for ≥1 year. We defined early-onset and late-onset spondyloarthritis as <57 or ≥57 years at a median age of this study group, respectively. We compared clinical characteristics between these 2 groups.Disease duration was significantly shorter before diagnosis in the late-onset group (P < .01). Inflammatory back pain (IBP) was significantly more common in the early-onset group (P < .01), whereas dactylitis frequency was significantly higher in the late-onset group. Significantly more patients with early-onset spondyloarthritis were human leukocyte antigen (HLA) B27-positive (P < .01). Articular synovitis, particularly of the wrist, was significantly more common on power Doppler ultrasound (PDUS) in the late-onset group (P < .01). Tenosynovitis or peritendinitis, particularly in the finger and wrist flexors were also more frequent in the late-onset group (P < .001 and P < .05, respectively). Enthesitis of the finger collateral ligament and lateral collateral ligament were significantly more common in the late-onset group (both P < .05). Multiple logistic regression analysis revealed that, comparatively, IBP was significantly and independently much more likely to occur in the early-onset group.The patients with late-onset spondyloarthritis had a lower frequency of IBP and HLA B27 and a higher frequency of dactylitis and PDUS findings in peripheral involvement.

Simplified profunda artery perforator (PAP) flap design using power Doppler ultrasonography (PDU): A prospective study.

Optimal design of PAP flaps requires precise perforator mapping. In a systematic review, Doppler ultrasonography demonstrated the highest sensitivity and positive predictive value (PPV). We present a prospective study of PAP flap design comparing PDU, handheld Doppler (HHD), and clinical findings. From May to July 2016, 12 head and neck cancer patients receiving PAP flaps were examined with PDU and HHD. We used PDU to evaluate number, course, emergence point, peak systolic velocity (PSV), and arterial diameter of perforators. PDU skin markings were measured in relation to the groin and gracilis. Distances to the adjacent HHD marking were determined. Diagnostic results were compared with intraoperative findings. All perforators identified with PDU were confirmed intraoperatively. No sizable perforators found surgically were missed by PDU. Detecting perforators with diameters of ≧0.5 mm, false-negative rate of PDU was zero percent, sensitivity was 100%. Musculocutaneous courses were identified in all perforators and sensitivity of PDU was 96.7%. Arterial diameter was overestimated by PDU (1.49 ± 0.39 vs. 0.75 ± 0.31 mm, P > .05). PSV at the emergence point was 24.5 ± 11.9 cm/s. Average distance from the emergence point to the PDU marking was 2.45 ± 1.90 mm (0-6 mm). The PPV of PDU was calculated at 93.10%. Mean distance from the HHD to the PDU markings was 20.76 ± 16.5 mm (1-70 mm). Assuming PDU findings demonstrated the true anatomy, sensitivity of HHD was calculated with 89.7%, and PPV was 66.7%. All PAP flaps were successful, only minor revisions were needed. PDU facilitated PAP flap design in all cases and offers a precise, non-invasive diagnostic tool for flap planning.

An ultrasonographic study of enthesis in early psoriatic arthritis patients naive to traditional and biologic DMARDs treatment.

The aim of this study was to evaluate the rate of power Doppler ultrasound (PDUS) abnormalities at entheseal sites in patients with early psoriatic arthritis (PsA) naïve to traditional and biologic DMARDs and to compare the PDUS findings with clinical examination. PsA patients with early disease and naïve to traditional and biologic DMARDs were consecutively enrolled in this study. Patients underwent PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its insertion at the tibial tuberosity; medial collateral ligament at its proximal insertion and Achilles tendon at its insertion at the calcaneus. The Leeds enthesitis index (LEI) was used to assess clinical entheseal involvement. Twenty-one early PsA patients completed the clinical and PDUS examinations. Clinical entheseal involvement was found in 9 (42.9%) and PDUS abnormalities in 20 (95.5%) of the 21 early PsA patients. Achilles tendon insertion was the site with the major entheseal abnormalities. Active (power Doppler positive) entheseal lesions were found in 4.7, 9.5, 14.3 and 14.3% of patients at the lateral humeral epicondyle; quadriceps tendon, patellar tendon insertions, and Achilles tendon insertions, respectively. Concordance between clinical (LEI) and PDUS was poor. The present study confirms that PDUS allows detecting structural and inflammatory abnormalities of enthesis in early PsA patients. Our study shows that, in early disease, active abnormalities seem to have a low prevalence.

Valeur de l’échographie pour prédire le cancer de l’endomètre dans les métrorragies post-ménopausiques

ObjectiveTo build mathematical models for evaluating the individual risk of endometrial malignancy in women with postmenopausal bleeding and a thick endometrium using clinical data, sonographic endometrial thickness and power Doppler ultrasound findings. MethodsA total of 117 patients underwent transvaginal two-dimensional gray-scale and power Doppler ultrasound examination of the endometrium before getting endometrial biopsy. Inclusion criteria were post-menopausal bleeding and a thick endometrium greater than 5mm. The ultrasound image showing the most vascularized section through the endometrium as assessed by power Doppler was frozen to estimate endometrial thickness and features. The vascularity index was calculated using computer software. A structured history was taken to collect clinical information. Multivariate logistic regression analysis was used to create mathematical models to predict endometrial malignancy. ResultsThere were 31 (26.4%) malignant and 86 (74.6%) benign endometria… Women with a malignant endometrium were older (median age 61 vs 56years, P=0.036) and had a thicker endometrium (median thickness 18.8mm vs 12.5; P=0.002) and higher values for vascularity index. When using only clinical data to build a model for estimating the risk of endometrial malignancy, a model including the variables age had the largest area under the receiver–operating characteristics curve (AUC), with a value of 0.69 (95% confidence interval [CI], 0.59–0.79). A model including age and endometrial thickness had an AUC of 0.72 (95% CI, 0.50–0.96), and one including age, endometrial thickness and vascularity index had an AUC of 0.91 (95% CI, 0.62–0.97). Using a risk cut-off of 12%, the latter model had sensitivity 89%, specificity 74%, positive likelihood ratio 3.42 and negative likelihood ratio 0.14. DiscussionPostmenopausal bleeding is a frequent cause of consultation in gynecological particularly in peri- or post-menopausal period. They are the main alarm sign of endometrial carcinoma. Vaginal ultrasound has become the “gold standard” in the initial exploration. It is a powerful tool to estimate the individual risk of malignancy in symptomatic postmenopausal women in order to optimize the management. The diagnostic performance of models predicting endometrial cancer increases substantially when sonographic and power Doppler information are added to clinical variables. This model seems to be clinically useful but need to be prospectively validated.

Joint functional impairment and thermal alterations in patients with Psoriatic Arthritis: A thermal imaging study

BackgroundFunctional infrared imaging (fIRI) is used to provide information on circulation, thermal properties and thermoregulatory function of the cutaneous tissue in several clinical settings. ObjectivesThis study aims to evaluate the application of fIRI in Psoriatic Arthritis (PsA) assessment, evaluating the thermoregulatory alterations due to joint inflammation in PsA patients both in basal conditions and after a mild functional (isometric) exercise; fIRI outcomes were compared with those provided by Power Doppler Ultrasonography (PWD-US). Methods10 patients with PsA and 11 healthy controls were enrolled in the study. The cutaneous temperature dynamics of 20 regions of interest located on the dominant hand were recorded by means of high-resolution thermal imaging at baseline and after a functional exercise. ResultsHigher temperature values and faster temperature variations characterized the PsA group compared to healthy controls, confirming that the PsA-related inflammatory state alters the normal thermal proprieties of the skin overlying inflamed joints. fIRI outcomes correlated with the PWD-US findings. ConclusionsfIRI applied to the study of the response to a functional stimulus may represent an innovative, non-invasive, and operator-independent method for the assessment of peripheral PsA.

Ultrasound Findings in Hand Joints Involvement in Patients with Psoriatic Arthritis and Its Correlation with Clinical DAS28 Score

Objective. To determine the frequency of the various ultrasound findings in hand joints in patients with psoriatic arthritis and correlate grayscale and Power Doppler ultrasonography findings with Disease Activity Score 28. Methods. This prospective study was performed in 30 patients. Ultrasound evaluation of 28 joints of both hands was undertaken and various findings were recorded including synovial hypertrophy, Power Doppler abnormality, soft tissue thickening, tendonitis, joint effusion, periosteal reaction, and erosions. Composite ultrasound scores and Disease Activity Score 28 were calculated and compared. Spearman correlation was used to see relationship between the ultrasound and DAS28 scores. Results. Ultrasound detected more abnormalities in the hand joints than did clinical examination. The frequency of various ultrasound abnormalities was as follows: Synovial hypertrophy was seen in 100%, Power Doppler abnormality suggesting hypervascularity was seen in 36.7%, soft tissue thickening was seen in 66.7%, periosteal reaction was seen in 33.3%, erosions were seen in 30% (mostly in DIP and PIP joints), and flexor tendonitis was seen in 6.7% of patients. Significant correlation was found between Disease Activity Score 28 and grayscale joint score (GSJS) (Spearman's ρ: 0.499; P: 0.005), grayscale joint count (GSJC) (ρ: 0.398; P: 0.029), and Power Doppler joint score (PDJS) (ρ: 0.367; P: 0.046). There was a statistically significant difference between remission and low disease activity group and moderate disease activity group in terms of GSJC, GSJS, PDJC, and PDJS (P < 0.05). These ultrasound measures were higher in moderate disease activity zone patients. Conclusion. Ultrasound is a useful modality for the objective assessment of psoriatic arthritis. Ultrasound including Power Doppler can be used as a modality for assessment of severity of psoriatic arthritis as it correlates with the clinical scoring.

Serum YKL-40 in psoriasis with and without arthritis; correlation with disease activity and high-resolution power Doppler ultrasonographic joint findings.

YKL-40 may be involved in angiogenesis in psoriasis and psoriatic arthritis (PsA). High-resolution power Doppler ultrasound (PDUS) can detect angiogenesis of synovium in PsA. To assess serum YKL-40 in psoriasis patients with or without PsA, and to correlate its levels with disease activity and high-resolution PDUS findings. In this case-control study, 48 patients with psoriasis (26 of them also had PsA) and 30 controls were assessed by high-resolution PDUS, and assayed for serum levels of YKL-40 by ELISA. Patients were clinically assessed using Composite Psoriatic Disease Activity Index (CPDAI). Total joint score (TJS) was used to assess joint involvement in PsA. A statistically significant elevation was found in YKL-40 levels in psoriatics with or without PsA compared with controls (P<0.001), as well as in PsA (group II) compared to patients without arthritis (group I) (P=0.002). CPDAI, synovial thickness score and colour Doppler ultrasound (CDUS) score were highly significantly higher in group II vs. group I (P<0.001). In all patients, CPDAI, synovial thickness and CDUS score were positively correlated to each other, and each of them was positively correlated to serum YKL-40 levels (P<0.05). In either group I or II, serum YKL-40 levels correlated positively with CPDAI (P<0.05). In group II, TJS, synovial thickness and CDUS score were positively correlated to each other (P<0.05). Serum YKL-40 can be used as a new biological marker for angiogenesis and disease activity in psoriasis with or without PsA. High-resolution PDUS is a non-invasive tool for the evaluation of angiogenesis in PsA patients as well as for the detection of early synovial changes in psoriasis patients without arthritis.

AB0759 Efficacy of Intra-Articular Etanercept Injections in Active Monoarthritis Resistant to Intra-Articular Steroids in Otherwise Stable Psoriatic Arthritis Patients

BackgroundPersistent synovitis in one joint is a common clinical problem that could be debilitating and lead to joint destruction in otherwise stable patients with inflammatory arthritis on systemic immunosuppressive treatment....

AB0948 Power Doppler Ultrasound Monitoring of Response to Anti-TNFα Treatment in Patients with Rheumatoid Arthritis

BackgroundJoint synovial inflammation is the primary abnormality in rheumatoid arthritis (RA) and monitoring of the response of synovitis to treatments has a fundamental importance in the management of RA patients....

SAT0172 Prevalence of Ultrasonographic Joint Inflammation in Rheumatoid Arthritis (RA): A Comparative Study of 230 Early and 212 Established RA Patients Starting DMARD Treatment

BackgroundThe use of ultrasonography (US) in RA is rapidly increasing. However, to our knowledge there have not been any studies directly comparing the prevalence and distribution of US joint inflammation...

AB1015 Ultrasound Features of Synovitis and Tenosynovitis in Patients with Systemic Lupus Erythematosus

BackgroundInvolvement of musculoskeletal system in Systemic lupus erythematosus (SLE) includes the presence of arthralgias, deforming arthritis, usually with a non-erosive (Jaccoud's) pattern and tenosynovitis. In a small percentage of patients...

THU0333 Ultrasonographic Characterization of the Shoulder Pain as Reason for Consultation in the Emergency Deparment of A Spanish Tertiary Center

BackgroundThe acute atraumatic shoulder pain is a frequent complaint in the emergency room. The power-Doppler ultrasonography (PDUS) is a useful tool in the evaluation of shoulder pathology in outpatients, but...

Sternoclavicular Joint Involvement in Rheumatoid Arthritis: Clinical and Ultrasound Findings of a Neglected Joint

To describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and ultrasound (US) findings in patients with rheumatoid arthritis (RA). One hundred three consecutive patients with RA and 103 age- and sex-matched healthy individuals were enrolled. Clinical evaluation and blinded US examinations of the SC joint were performed bilaterally in both groups. The presence of gray-scale synovitis, osteophytes, erosions, and intraarticular power Doppler (PD) was recorded. Interobserver agreement was calculated. A total of 412 SC joints were evaluated: 206 from patients with RA and 206 from healthy controls. In the RA group, 39 joints (19%) were found to be clinically involved (pain/swelling), in contrast to only 4 (1.9%) in the control group (P = 0.0001). In the RA group, US abnormalities were recorded in 89 SC joints (43%) compared with 36 (17%) in the healthy control group (P = 0.0001), comprising osteophytes in 59 (29%) versus 25 (12%; P = 0.0001), synovitis in 31 (15%) versus 5 (2%; P = 0.0001), erosions in 23 (11%) versus none (P = 0.0001), and intraarticular PD in 5 (2%) versus none (P = 0.03). Furthermore, a correlation between the presence of US synovitis (P < 0.001) and intraarticular PD (P < 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found. In patients with RA, US detected a higher number of involved SC joints than with clinical assessment. Our results indicate that both gray-scale and PD US findings were more prevalent in patients with RA than in healthy controls. US synovitis and synovial hyperperfusion correlated with the DAS28, suggesting that SC joints actively participate in the systemic inflammatory process of RA.

FRI0508 Correlation of power doppler ultrasonographic findings with site-matched histopathology of the synovial tissue

BackgroundUltrasonography (US) has been recently established as an imaging modality to evaluate inflamed joints of patients with rheumatoid arthritis (RA). It is reported that power doppler ultrasonography (PDUS) is capable...