Power Doppler Ultrasound Score Research Articles

The reliability and validity of superb microvascular imaging as a potential disease activity marker in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown aetiology, that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI), a new ultrasound technique that allows visualizing slow blood flow in synovitis. This study aimed to report the clinical value and utility of the SMI technique and its grading for monitoring RA by determining the correlation with clinical disease activity scores (DAS 28) and power Doppler ultrasound (PDUS). All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis were investigated with PDUS and SMI and each joint was graded semiquantitatively. All assessments were carried out at baseline and repeated at least 4-month follow-up. Correlations between scores were investigated using Spearman's correlation. Sixty RA patients with 552 affected joints were recruited. Clinical and sonographic scores were significantly improved at follow-up (p<0.001). SMI showed significantly more joint count and flow signal scores than clinical examination and PDUS. Moderate correlations were found between SMI score and clinical scores (p<0.001,0.586 for SMI score vs DAS 28-CRP, p=0.001,0.432 for SMI vs DAS 28-ESR). There were also stronger correlations between SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively). SMI provides greater utility and ability to detect synovial vascularity and monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.

Reliability and Availability of the 2017 EULAR-OMERACT Scoring System for Ultrasound Synovitis Assessment: Results From a Training and Reading Exercise.

To evaluate the availability and reliability of the European League Against Rheumatisms Outcome Measures in Rheumatology Synovitis (EULAR-OMERACT) scoring system among radiologists with different levels of musculoskeletal ultrasound (US) experience in assessing synovitis in patients with rheumatoid arthritis (RA). The patients with RA were retrospectively recruited from January 2020 to March 2022. Five radiologists with different levels of US experience were recruited for the reader study (R1-5), which included two parts. The participating radiologists first read 120 gray-scale (GS) and 120 Doppler US images twice, before and after a standard training program. In the first part, they semi-quantitatively scored the images from 0 to 3 based on the EULAR-OMERACT scoring system. In the second part, they read and scored 165 paired GS and Doppler images two times in 1 month using the EULAR-OMERACT scoring system. The correlation between the sum of the GSUS and power Doppler US (PDUS) image scores and the clinical scores was assessed. The intra-rater agreement of the five radiologists was good for the EULAR-OMERACT scoring system, with κ ranging from 0.72 to 0.94 for GSUS and from 0.81 to 0.97 for PDUS. The inter-rater agreement among the experts was good to very good in the EULAR-OMERACT scoring system (κ: 0.76-0.94 for GSUS and 0.80-0.96 for PDUS). The sum of the GSUS and PDUS scores in the EULAR-OMERACT scoring system was moderate to highly positively correlated with the clinical scores (ρ of GSUS: 0.58-0.79, ρ of PDUS: 0.57-0.70 for disease activity score in 28 joints C-reactive protein) after training. The EULAR-OMERACT scoring system is a reliable method for evaluating synovitis in RA and shows potential for disease assessment and follow-up in patients with RA.

Ultrasound and Power Doppler Evaluation of the Distal Interphalangeal Joints in Patients with Psoriatic Arthritis

Objective: 1. To evaluate the frequency of the various lesions in distal interphalangeal joints of patients with psoriatic arthritis by clinical and ultrasound assessment. 2. To determine the correlation between grayscale and Power Doppler ultrasonography score with disease activity score. Methods: This cross-sectional study was performed on 41 patients, who were diagnosed with psoriatic arthritis by CASPAR 2006 criteria. Results: Ultrasound detected more joint lesions than clinical examination. The proportion of patients with clinical distal interphalangeal arthritis was 12,2%. 100% of patients had at least one distal interphalangeal arthritis by ultrasound, and 27,6% of patients had periarticular soft tissue lesions. The frequency of various ultrasound abnormalities was as follows: Synovial hypertrophy was seen in 55,9%, Power Doppler abnormality suggesting hypervascularity in 52,5%. The periarticular lesion frequency: extensor tendonitis in 6,1%; loss of normal fibrillary architecture of extensor tendon erosions was seen in 14,4%; flexor tenositis in 7,1%; and other lesions were seen in 32,8% of patients. Significant correlation was found between DAPSA score and grayscale joint count (GSJC) (Spearman’s R=0,55; p[Formula: see text]0,001), grayscale joint score (GSJS) (R=0,62; P&lt;0,001), Power Doppler joint count (PDJC) (R=0.68; p[Formula: see text]0,001), and Power Doppler joint score (PDJS) (R=78; p[Formula: see text]0,001). Conclusion: Ultrasound can detect more joint lesions than clinical assessment. The severity of lesions on ultrasound correlates with the disease activity score.

Predictive performance of renal resistive index, semiquantitative power Doppler ultrasound score and renal venous Doppler waveform pattern for acute kidney injury in critically ill patients and prediction model establishment: a prospective observational study

Background This study aimed to explore the performance of renal resistive index (RRI), semiquantitative power Doppler ultrasound (PDU) score and renal venous Doppler waveform (RVDW) pattern in predicting acute kidney injury (AKI) in critically ill patients and establish prediction models. Methods This prospective observational study included 234 critically ill patients. Renal ultrasound was measured within 24 h after intensive care unit admission. The main outcome was the highest AKI stage within 5 days after admission according to the Kidney Disease Improving Global Outcomes criteria. Results Patients in the AKI stage 3 group had significantly higher RRI, RVDW pattern and lower PDU score (p < 0.05). Only lactate, urine volume, serum creatinine (SCr) on admission, PDU score and RVDW pattern were statistically significant predictors (p < 0.05). Model 1 based on these five variables (area under the curve [AUC] = 0.938, 95% confidence interval [CI] 0.899–0.965, p < 0.05) showed the best performance in predicting AKI stage 3, and difference in AUC between it and the clinical model including lactate, urine volume and SCr (AUC = 0.901, 95% CI 0.855–0.936, p < 0.05) was statistically significant (z statistic = 2.224, p = 0.0261). The optimal cut-off point for a nomogram based on Model 1 was ≤127.67 (sensitivity: 95.8%, specificity: 82.3%, Youden’s index: 0.781). Conclusions The nomogram model including SCr, urine volume, lactate, PDU score and RVDW pattern upon admission exhibited a significantly stronger capability for AKI stage 3 than each single indicator and clinical model including SCr, urine volume and lactate.

Serum amyloid a level and musculoskeletal ultrasound in assessment of disease activity in rheumatoid arthritis patients

Aim of the workTo assess serum amyloid A (SAA) level and study its relation to musculoskeletal ultrasound (MSUS) findings and to clinical disease activity indices in rheumatoid arthritis (RA) patients. Patients and methods60 RA patients and 60 matched controls were enrolled. Disease activity score-C-reactive protein (DAS-28-CRP) and simplified disease activity index (SDAI) and clinical disease activity Index (CDAI) were determined. MSUS evaluation was done using 12 -joint power Doppler ultrasound (PDUS) score. SAA was analyzed using an enzyme-linked immunosorbent assay. ResultsSAA levels were highly significant in patients (35.1 ± 3.6 mg/l) than in controls (1.6 ± 0.12 mg/l)(p < 0.001). There was significantly higher SAA level among steroid users (56.7 %)(p = 0.001) and a lower level among leflunomide users (30 %)(p = 0.04). SAA and PDUS significantly increased in patients with low disease activity (n = 13) compared to those in remission (n = 10)(p < 0.001). SAA significantly correlated with disease duration (p = 0.004), morning stiffness duration, swollen joint count, tender joint count, rheumatoid factor, anti-cyclic citrullinated peptide, DAS-28-CRP, SDAI, CDAI, erythrocyte sedimentation rate, CRP and total 12-joint PDUS score (p < 0.001). The highest discriminatory ability of active RA and remission was attributed to the combination of SAA, PDUS and CRP (accuracy = 96.7 %, AUC = 0.99; sensitivity 96 % and specificity 100 %). ConclusionRA patients have a significantly increased level of SAA which indicates a key pathogenic role in the disease. SAA level is a potentially effective biomarker in the assessment of disease activity in RAand allied to PDUS. Combining SAA, PDUS and CRP provide the highest sensitivity and specificity in discrimination of active RA from remission.

Efficacy of guselkumab, a selective IL-23 inhibitor, in Preventing Arthritis in a Multicentre Psoriasis At-Risk cohort (PAMPA): protocol of a randomised, double-blind, placebo controlled multicentre trial

IntroductionPsoriatic arthritis (PsA) is a complex, immune-mediated disease associated with skin psoriasis that, if left untreated, can lead to joint destruction. Up to 30% of patients with psoriasis progress to...

Relation of some clinical composite indices of disease activity in rheumatoid arthritis to a simplified 12 joint power Doppler ultrasound activity index

Aim of the workTo assess the association of some clinical composite disease activity indices with a simplified 12 joint power Doppler ultrasound (PDUS) activity index in rheumatoid arthritis (RA). Patients and methodsOne hundred RA patients who fulfilled the 2010 European league against rheumatism/American college of Rheumatology (EULAR/ACR) classification criteria for RA were recruited from the Rheumatology outpatient clinic, Cairo University Hospitals. Disease activity score (DAS28), the simplified disease activity index (SDAI), clinical disease activity index (CDAI) as well as mean overall index for RA (MOI-RA) were assessed. Grey Scale Ultrasonography (GSUS) and PDUS activity assessment was performed using a simplified 12-joint score. ResultsThe 100 patients were 80 females and 20 males (F:M 4:1). Their mean age was 44.4 ± 10.8 years with disease duration of 6.3 ± 4.7 years. Rheumatoid factor was positive in 77 %. DAS28 was 4.5 ± 1.3, SDAI 27.7 ± 22.7, CDAI 17.5 ± 13.2 and MOI-RA 86.8 ± 25.1. On US, tenosynovitis was present in 10 %, irregularity in 23 % and erosion in 62 %. The mean 12-point PDUS was 3.53 ± 4.16 and the overall US score 10.34 ± 9.3. A significant correlation was found between the US findings of overall synovitis, degree of PD and US score with DAS28 (r = 0.3, p < 0.0001; r = 0.4, p < 0.0001 and r = 0.3, p < 0.0001) with SDAI (r = 0.3, p < 0.0001; r = 0.4,p < 0.0001; r = 0.4, p < 0.0001) and with MOI-RA score (r = 0.3, p < 0.0001; r = 0.4, p < 0.0001 and r = 0.4, p < 0.0001 respectively) but the highest correlations was with CDAI (r = 0.4, p < 0.0001; r = 0.5, p < 0.0001 and r = 0.4, p < 0.0001 respectively). ConclusionSimplified 12 -joint PDUS score is well correlated with activity indices in RA patients.

Correlation of Clinical Disease Activity Score with Ultrasound Disease Activity Score in Rheumatoid Arthritis Patients of Kashmir Valley

Abstract Background: Musculoskeletal ultrasound can aid in assessing disease activity and deciding to taper off disease-modifying antirheumatic drugs in patients of rheumatoid arthritis (RA). With this background, we conducted a study to compare Clinical Disease Activity Score 28 C-reactive protein (DAS28 CRP) with Ultrasound Disease Activity Score 28 CRP (USDAS28 CRP) and its correlation with disease parameters in RA patients. Materials and Methods: Forty-eight RA patients were subjected to clinical and ultrasound assessment of disease activity after subjecting them to history, clinical, and laboratory investigations. The clinical assessment was done by DAS28 CRP and the US assessment was done by USDAS28 CRP score. The swollen joint count and the tender joint count were replaced by GSUS (grayscale ultrasound) score and power Doppler ultrasound score, respectively, in USDAS28 CRP score. Results: The mean age of the patients was 46.31 ± 13.90 years, with a mean duration of illness being 98.3 months. Nineteen patients had inactive disease and 29 patients had active disease on clinical examination. Six out of 19 (31.6%) patients with the inactive disease on clinical assessment had activity (subclinical synovitis) on US assessment. Two out of 29 (6.89%) patients with the active disease on clinical assessment had inactive disease on US assessment. Patients with subclinical synovitis had a longer disease duration (154 ± 114.2 vs. 73.38 ± 54.9 months, P = 0.05) and higher erythrocyte sedimentation rate (28.5[23] vs. 15[5] mm/H, P = 0.017) as compared to RA patients with the inactive disease on US assessment. Correlations between clinical scales and ultrasound scales were good (Pearson’s r = 0.832, P = 0.01). Conclusion: US scoring for disease assessment is a plausible method to assess subclinical activity in RA patients with inactive disease.

Assessment of disease activity with simplified joint ultrasonography method in rheumatoid arthritis patients

Background/Aim: Ultrasound (US) is a highly useful tool for assessing the disease activity of rheumatoid arthritis (RA). On the other hand, examining all joints could be time-consuming and unfeasible. Defining the number of joints and which joints should be tested is essential to accurately measuring RA activity. Several simplified US methods are undergoing development for this purpose. The aim of this study was to assess the correlation between simplified 12-joint US findings and physical examination findings/disease activity in RA patients.&#x0D; Methods: This cohort study included 62 RA patients who had been undergoing treatment for at least three months. Multiplanar grayscale images and power Doppler (PD) of the 12 joints (bilateral elbow, wrist, second and third metacarpophalangeal [MCP] joints, knee, and ankle) were acquired and compared with clinical assessments. Disease activity was assessed using the clinical disease activity and simplified disease activity indices and disease activity score-28 (CDAI, SDAI, and DAS28, respectively). Synovial effusion, synovial proliferation, and PD US scores were calculated for 12 joints. Correlations between US scores and disease activity, clinical examination, and acute phase reactants were assessed.&#x0D; Results: The number of joints with PD activity and US total and US synovial proliferation scores showed weak correlations with clinical activity scores (r = 0.25, r = 0.26, and r = 0.28 for SDAI and r = 0.23, r = 0.26, and r = 0.28 for DAS28, respectively). The CDAI did not present any statistically significant correlations. The agreement between US findings and clinical joint examination was generally weak. PD activities of the second MCP joints (r = 0.84, P &lt; 0.01) and knees (r = 0.42, P &lt; 0.01) mostly correlated with clinical examination although it was weakly correlated at the third MCP (r = 0.152) and wrist (r = 0.148), and not correlated at the elbow (r = 0.125).&#x0D; Conclusion: The weak correlation between US findings and clinical examination/disease activity suggests that clinical examination alone may not be sufficient to determine joint inflammation and disease activity. US could provide a more accurate assessment of RA patients and aid in medication selection.

Performance of resistive index and semi-quantitative power doppler ultrasound score in predicting acute kidney injury: A meta-analysis of prospective studies.

This study aimed to assess the predictive value of the renal resistive index (RRI) and power Doppler ultrasound (PDU) on subsequent acute kidney injury (AKI) risk using a meta-analytic approach. We searched eligible studies in PubMed, EmBase, and the Cochrane library from inception until August 2021. The parameters included the sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC). Twenty-three prospective studies involving 2,400 patients were selected. The pooled sensitivity and specificity of the RRI and PDU were 0.76 and 0.79, and 0.64 and 0.90, respectively. The pooled PLR and NLR were 3.64 and 0.31, and 6.58 and 0.40 for the RRI and PDU, respectively. The DORs of the RRI and PDU for predicting AKI were 11.76, and 16.32, respectively. The AUCs of the RRI and PDU for predicting AKI were 0.83, and 0.86, respectively. There were no significant differences between the RRI and PDU for predicting AKI in terms of sensitivity, PLR, NLR, DOR, and AUC. The specificity of the RRI was lower than that of the PDU for predicting AKI. This study found that the predictive performance of the RRI and PDU from the Doppler ultrasound for AKI was similar, which need to be further verified based on the direct comparison results.

Diffuse Peripheral Enthesitis in Metabolic Syndrome: A Retrospective Clinical and Power Doppler Ultrasound Study

ObjectivesTo investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH). MethodsSixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group. ResultsPatients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p<.00001). PD signals (15% of patients) were associated with entheseal pain (p=.0138). US scores correlated with body mass index (BMI), pain, type 2 diabetes. In 28 (46%) patients a concurrent DISH was diagnosed, correlating with older age (p<.0001), CRP (p=.0428), ESR (p=.0069) and PDUS scores (p=.0312 inflammatory, p=.0071 structural). MetS had a strong association (OR 4.375, p=.0007) with concurrent DISH. ConclusionsDiffuse peripheral enthesitis is very common in MetS. Almost half of MetS patients can have a concurrent diagnosis of DISH; they are older, with higher inflammation, and higher PDUS enthesitis scores.

Diffuse Peripheral Enthesitis in Metabolic Syndrome: A Retrospective Clinical and Power Doppler Ultrasound Study.

To investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH). Sixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group. Patients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p<.00001). PD signals (15% of patients) were associated with entheseal pain (p=.0138). US scores correlated with body mass index (BMI), pain, type 2 diabetes. In 28 (46%) patients a concurrent DISH was diagnosed, correlating with older age (p<.0001), CRP (p=.0428), ESR (p=.0069) and PDUS scores (p=.0312 inflammatory, p=.0071 structural). MetS had a strong association (OR 4.375, p=.0007) with concurrent DISH. Diffuse peripheral enthesitis is very common in MetS. Almost half of MetS patients can have a concurrent diagnosis of DISH; they are older, with higher inflammation, and higher PDUS enthesitis scores.

Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis.

This study was aimed to explore the renal Doppler ultrasound in the evaluation of renal function in patients with sepsis. Fifty patients with sepsis or septic shock were classified into the acute kidney injury (AKI) group (n =25) and the non-AKI group (n =25) according to whether they had AKI. The measurements of renal resistance index (RRI) and power Doppler ultrasound (PDU) were performed on all patients within 7 days of admission to the intensive care unit (ICU). The patient's renal function was assessed. The results showed that the RRI of the two groups showed a slight upward trend over time, and the RRI of the AKI group was higher than that of the non-AKI group. After 7 days in AKI group, the areas under the receiver operating characteristic (ROC) curves of RRI were 0.745, 0.683, 0.729, 0.856, 0.793, 0.819, and 0.836 (P <0.05). There were no statistically considerable differences in areas under ROC curves between the two groups (P >0.05). The grouping of AKI and the time were both fixed effects, and the individual patients were randomized effects. Besides, the linear models were statistically analyzed. The results showed that the differences between the two groups were statistically insignificant (P >0.05). There was no significant difference in the PDU scores measured at different times within 7 days after ICU admission between the two groups (P >0.05). In conclusion, renal Doppler ultrasound had a good adoption effect in the evaluation of the renal function of patients with severe sepsis, which is worth promoting in clinical practice.

The value of renal color Doppler ultrasound in evaluating the severity and prognosis of patients with acute organophosphorus pesticide poisoning complicated by acute kidney injury

Objective: To analyze the value of renal color Doppler ultrasound examination and clinical indicators in evaluating the severity and prognosis of acute organophosphorus pesticide poisoning (AOPP) complicated by acute kidney injury (AKI) . Methods: In November 2019, 86 AOPP patients complicated by AKI who were admitted from May 2018 to May 2019 were selected as the observation group, and they were divided into AKI stage 1 group (n=37) , AKI stage 2 group (n=32) and AKI stage 3 group (n=17) . 40 healthy people were selected as the control group. The differences in power Doppler ultrasound (PDU) score, renal interlobular artery resistance index (RI) value and related clinical indicators of each group were measured and analyzed, and the correlations between the indicators were analyzed. At the same time, binary logistic regression was used to analyze the risk factors of death in AOPP patients complicated by AKI. Results: There were statistically significant differences in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱscore, mean arterial pressure (MAP) , serum creatinine (SCr) and the length of continuous renal replacement therapy (CRRT) between different groups (P<0.05) . Compared with the control group, the APACHE Ⅱscores and SCr of patients in the AKI stage 2 and resistance index AKI stage 3 groups increased, while the MAP decreased (P<0.05) . Compared with the control group, AKI stage 1 group and AKI stage 2 group, the PDU score of patients in the AKI stage 3 group was significantly decreased, and the renal interlobular artery RI value was significantly increased (P<0.05) . SCr was positively correlated with the RI value of renal interlobular arteries and CRRT days (r=0.435, 0.713, P<0.05) , and was negatively correlated with renal PDU score (r=-0.643, P<0.05) . The renal PDU score was negatively correlated with the RI value of renal interlobular arteries and CRRT days (r=-0.350, -0.556, P<0.01) . Binary logistic regression analysis showed that SCr (OR=1.017, 95%CI: 1.004-1.041) and APACHE Ⅱ score (OR=1.289, 95%CI: 1.019-1.827) were risk factors for death in patients with AOPP complicated by AKI (P<0.05) . Conclusion: Both PDU score and the RI value of renal interlobular artery can reflect the severity and stage of patients with AOPP complicated by AKI to a certain extent, but neither of them is a key factor affecting the death of patients.

Fatigue in patients with early rheumatoid arthritis undergoing treat-to-target therapy: predictors and response to treatment

ObjectivesFatigue is a frequent symptom in rheumatoid arthritis (RA) and has high impact on quality of life. We explored associations between disease activity and fatigue in patients with early RA...

Synovitis evaluation in Egyptian patients with early rheumatoid arthritis

Background Evaluation of synovitis in early rheumatoid arthritis (RA) is a crucial subject for appropriate management. Ultrasound (US) with high-resolution study has been confirmed a helpful aid in synovitis evaluation. Chemokine CXC ligand 13 protein (CXCL13), a potent B-cell chemoattractant, is expected to play a valuable role in pathobiology of RA. Aim To evaluate synovitis in early RA using serum CXCL13, US with high resolution, and power Doppler ultrasonography (PDUS), and their correlation with disease activity. Patients and methods A total of 40 patients with early RA fulfilling 2010 EULAR/ACR criteria of RA were assessed using disease activity score 28 for disease activity in RA, serum CXCL13, and US with high resolution. Moreover, 20 healthy age-matched and sex-matched patients were included as a control group. Results Serum CXCL13 levels were highly significantly increased in patients with early RA than controls (P&lt;0.001). Regarding US with high resolution, patients with early RA had a significant increase in thickness of synovium and PDUS score compared with controls (P&lt;0.001). In patients with early RA, serum CXCL13 significantly correlated with erythrocyte sedimentation rate, C-reactive protein, anti-cyclic citrullinated peptide, disease activity score 28, synovial thickness, and PDUS score. Moreover, there was a significant increase in serum CXCL13, synovial thickness, and PDUS score in patients with active RA when compared with patients with remitting RA (P&lt;0.001). Conclusion Serum CXCL13 appears to be a new marker of synovitis in patients with early RA and correlates with thickening of synovium and PDUS scores that might reflect disease activity.

Sentinel joint scoring in rheumatoid arthritis: an individualized power Doppler assessment strategy.

Musculoskeletal ultrasound quantifies the total synovial inflammatory burden in rheumatoid arthritis (RA) but is time consuming when scanning numerous joints. This study evaluated a novel patient-centered method for constructing a longitudinal ultrasound score in RA patients. Fifty-four RA patients starting intravenous tocilizumab were evaluated with power Doppler ultrasound (PDUS) of 34 joints and DAS28-ESR was assessed at baseline and weeks 4, 12, 16, and 24. The sentinel joint score (SJS) was derived from the reduced subset of joints with PDUS ≥ 1 at baseline. Total PDUS (tPDUS) score and US7 were also calculated. Changes in tPDUS and SJS were correlated. Effect sizes were calculated for tPDUS, SJS, and US7. The proportion of "flipped" joints without baseline PDUS signal that later developed PDUS signal was estimated. At baseline, 1236/1829 joints scanned (67.5%) did not have PDUS signal. The proportion of "flipped" joints at 24 weeks was 5.6% for ≥ 1, 2.9% for ≥ 2, and 1.0% for = 3 PD. tPDUS and SJS scores were highly correlated (r = 0.91 to 0.97). Overall the effect sizes for tPDUS, SJS, and US7 increased over 24 weeks, where SJS was the highest (SJS 1.00 4-week, 1.07 12-week, 1.26 24-week) and tPDUS and US7 were comparable (tPDUS 0.32 4-week, 0.52 12-week, 0.84 24-week; US7 0.23 4-week, 0.52 12-week, 0.74 24-week). In RA patients starting a biologic, scanning only joints with baseline PDUS signal can substantially reduce the number of joints requiring follow-up scanning by 67.5% and improves feasibility. "Flipped" joints are infrequently seen after starting therapy. ClinicalTrials.gov NCT01717859 Key messages • Only a small percent of joints develop power Doppler signal after baseline scanning. • Changes in the SJS correlate well with changes in clinical activity measured by DAS28-ESR over time. • The SJS effect size is higher than total PDUS and US7 scores, and may improve examination feasibility.

Renal echography for predicting acute kidney injury in critically ill patients: a prospective observational study

Objective To investigate the diagnostic performances of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting acute kidney injury (AKI) stage 3 in critically ill patients. Methods This prospective observational study included 148 patients (80 with reduced cardiac index [CI], 68 with maintained CI). RRI and semiquantitative PDU scores were measured within 6 h after intensive care unit admission. AKI was defined according to Kidney Disease Improving Global Outcomes criteria. Results A negative correlation between RRI and PDU score (r = −0.517, p < 0.001) and a positive correlation between PDU score and CI (r = 0.193, p = 0.019) were found, whereas RRI was not correlated with CI (r = 0.131, p = 0.121). The predictive value of RRI for AKI stage 3 was similar between CI-reduced (area under the curve [AUC] 0.761, 95% confidence interval 0.650–0.851, p < 0.001) and CI-maintained (AUC 0.786, 95% confidence interval 0.665–0.878, p < 0.001) patients. Conversely, PDU score could effectively predict AKI stage 3 in CI-reduced patients (AUC 0.872, 95% confidence interval 0.778–0.936, p < 0.001) but not in CI-maintained patients (AUC 0.669, 95% confidence interval 0.544–0.778, p = 0.071). The predictive value of PDU score for AKI stage 3 was statistically different between CI-reduced and CI-maintained patients (p = 0.021). Conclusions PDU scores could effectively predict AKI stage 3 in CI-reduced patients but not in CI-maintained patients. RRI is a poor predictor of AKI stage 3 in patients with reduced or maintained CI.

Semiquantitative Power Doppler Ultrasound Score to Predict Acute Kidney Injury in Patients With Sepsis or Cardiac Failure: A Prospective Observational Study.

Diagnosing acute kidney injury (AKI) stage 3 in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary output and serum creatinine, which may be of limited value. This study aimed to explore the diagnostic performance of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting AKI stage 3 in patients with sepsis or cardiac failure. This study is a prospective observational study that included 83 patients (40 with sepsis and 43 with cardiac failure). Renal resistive index and semiquantitative PDU scores were measured within 6 hours following admission to the intensive care unit. Acute kidney injury was defined according to the criteria set by Kidney Disease Improving Global Outcomes. The predictive values of RRI (area under the curve [AUC] = 0.772, 95% confidence interval [CI] = 0.658-0.886) and PDU score (AUC = 0.780, 95% CI = 0.667-0.892) were similar in all patients. Power Doppler ultrasound score (AUC = 0.910, 95% CI = 0.815-1.000) could effectively predict AKI stage 3 in the cardiac failure subgroup, and the optimal cutoff for this parameter was ≤ 1 (sensitivity = 87.5%, specificity = 92.6%, Youden index = 0.801, accuracy in our population = 90.7%). However, PDU scores (AUC = 0.620, 95% CI = 0.425-0.814) could not predict AKI stage 3 in the sepsis subgroup. The predictive values of RRI for AKI stage 3 in the cardiac failure (AUC = 0.820, 95% CI = 0.666-0.974) and sepsis (AUC = 0.724, 95% CI = 0.538-0.910) subgroups were similar. Power Doppler ultrasound scores could effectively predict AKI stage 3 in patients with cardiac failure but not in patients with sepsis. Renal resistive index is a poor predictor of AKI stage 3 in patients with sepsis or cardiac failure.

Renal echography and cystatin C for prediction of acute kidney injury: very different in patients with cardiac failure or sepsis

To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis. A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3. Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor. RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.