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Adegbehingbe O, Asaleye C, Kolawole B, Adegbehingbe A. Sonographic evaluation of the heel pad thickness in diabetics in Nigeria. J Med Ultrasound 2022; 30:176-183. [DOI: 10.4103/jmu.jmu_114_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
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Liu H, Huang C, Chen S, Zheng Q, Ye Y, Ye Z, Lv G. Value of contrast-enhanced ultrasound for detection of synovial vascularity in experimental rheumatoid arthritis: an exploratory study. J Int Med Res 2019; 47:5740-5751. [PMID: 31547746 PMCID: PMC6862898 DOI: 10.1177/0300060519874159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022] Open
Abstract
Objective This 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). Methods We 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. Results The 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. Conclusion CEUS is superior to PDUS for estimating synovial hypervascularity and hyperplasia in experimental rheumatoid arthritis.
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Affiliation(s)
- Hui Liu
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chao Huang
- Department of Nuclear Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuqiang Chen
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing Zheng
- Department of Hematology and Rheumatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuhong Ye
- Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhen Ye
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guorong Lv
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
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Ren J, Zhu J, Li D, Li W, Liu F. The value of contrast-enhanced ultrasonography to detect the sacroiliac joint for predicting relapse after discontinuation of anti-tumor necrosis factor therapy in patients with ankylosing spondylitis. Quant Imaging Med Surg 2019; 9:1110-1117. [PMID: 31367565 PMCID: PMC6629574 DOI: 10.21037/qims.2019.06.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/06/2019] [Indexed: 08/29/2023]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by high relapse. Therefore, the present study aimed to investigate the ultrasonographic features of contrast-enhanced ultrasonography (CEUS) in the sacroiliac joint (SIJ) in patients with AS in remission after discontinuation of anti-tumor necrosis factor (TNF) therapy, and also examined the role of CEUS in predicting relapse. METHODS In this prospective observational study, 130 SIJs in 65 patients with AS (according to modified New York criteria) satisfying Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease after discontinuation of anti-TNF therapy were investigated on color Doppler ultrasonography (CDUS) and CEUS. Vascularization and the resistive index (RI) of the SIJ were observed and measured. We defined no blood flow, high RI of arterial blood flow (RI ≥0.7), the reversed phase in the diastolic phase or venous blood flow in the bilateral SIJs, as negative CDUS/CEUS; meanwhile, low RI of arterial blood flow (RI <0.7) in the unilateral or bilateral SIJs was defined as positive CDUS/CEUS. All the patients were followed up for 52 weeks until relapse. Relapse was defined as an increase of two or more items in comparison with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the time of anti-TNF withdrawal. RESULTS After 52 weeks, 46 of the 65 patients (70.8%) had relapse. The mean time to relapse was 31.4 weeks (±8.4 weeks, range 20 to 52). After discontinuation of anti-TNF therapy, positive CEUS accounted for 61.5%; this was significantly more than positive CDUS (13.8%). The vascularization detected by CEUS for patients of relapse was significantly different from that of patients with remission (P<0.05). In addition, patients with negative CEUS had a longer duration of remission than the patients with positive CEUS (P=0.005). A Cox proportional hazards regression analysis found that the disease duration could also be regarded as a factor predictive of relapse in patients with AS. CONCLUSIONS The use of CEUS distinctly improved the detection of vascularization in the SIJ in patients with AS in remission after anti-TNF withdrawal. The presence of vascularization in the SIJ detected by CEUS at the time of anti-TNF withdrawal could yield a valuable predictor of relapse in patients with AS. A significant limit of this study is the lack of magnetic resonance imaging (MRI) as the standard reference.
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Affiliation(s)
- Jiayu Ren
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing 100044, China
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Kusiak M, Kawczyński A. Ultrasonographic assessment of articular cartilage of the femoral condyle in patients with an increased Q-angle. J Ultrason 2018; 18:181-185. [PMID: 30427128 PMCID: PMC6442209 DOI: 10.15557/jou.2018.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The patella is a sesamoid for the quadriceps, which increases its power during knee extension and thus transfers considerable forces. The etiology of patellofemoral pain is multifactorial. In the absence of injury, the commonly accepted hypothesis is associated with increased compression of articulating surfaces. Aim The aim of the study was to perform an ultrasound evaluation of the thickness of articular cartilage covering the medial and lateral femoral condyle in patients with an increased Q-angle. Materials and methods The study included 26 women aged between 35 and 45 years. A total of 13 patients with Q >15° were included in the study group, and 13 patients with Q ≤15° were included in the control group. A goniometer was used for Q-angle measurement. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using a HONDA HS-2200 ultrasound with a linear HLS-584M transducer. The Shapiro–Wilk test was used for the assessment of data distribution normality; the distribution was normal. The differences in the measured parameters were assessed with the ANOVA test for independent samples. The Bonferroni test was used for a multiple comparison. Results The statistical analysis showed statistically significantly reduced thickness of articular cartilage on the lateral femoral condyle (p = 0.00) in the Q >15° group. No statistically significant differences were demonstrated for the thickness of articular cartilage on the medial femoral condyle (p = 0.47). Conclusions The thickness of the articular cartilage on the lateral femoral condyle is lower than that of the medial femoral condyle in women aged between 35 and 45 years with the Q-angle >15°.
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Affiliation(s)
- Maciej Kusiak
- Department of Paralympics Sport, Department of Sport Science, University of Physical Education in Wroclaw, Wroclaw, Poland
| | - Adam Kawczyński
- Department of Paralympics Sport, Department of Sport Science, University of Physical Education in Wroclaw, Wroclaw, Poland
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Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S. The comparisons between thermography and ultrasonography with physical examination for wrist joint assessment in juvenile idiopathic arthritis. Physiol Meas 2017; 38:691-700. [DOI: 10.1088/1361-6579/aa63d8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0046-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jousse-Joulin S, Morvan J, Devauchelle-Pensec V, Saraux A. Ultrasound assessment of the entheses in primary Sjögren syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2485-2487. [PMID: 24035411 DOI: 10.1016/j.ultrasmedbio.2013.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
Abstract
Although tendon pain is commonly reported in primary Sjögren syndrome (pSS), the underlying mechanism is unknown. The objective of this study was to determine whether tendon pain in pSS is related to involvement of the tendons and entheses. We performed a physical examination of 288 entheseal insertion sites in 16 patients with active pSS and 162 entheseal insertion sites in 9 healthy controls without symptoms or medications. Then ultrasound was used to assess entheseal and tendon sites of these patients (n = 208) and controls (n = 117). Ultrasound was performed in B mode first to detect structural damages, and in power Doppler mode to detect blood flow abnormalities. By physical examination, 9 (56%) of the 16 pSS patients had pain to palpation of fibromyalgia tender points, two of whom had more than 11 tender points. The number of positive points ranged from 2 to 18, with a mean of 8 ± 6.0. None of the healthy controls had positive tender points. None had structural or blood-flow abnormalities by ultrasound. To conclude, this study provides the first data on ultrasound findings in patients with active pSS. Although 56% of patients had clinical tender points, none had structural or blood-flow abnormalities by ultrasound, suggesting the absence of inflammation of the tendons and entheses in this disease.
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Affiliation(s)
- Sandrine Jousse-Joulin
- Unit of Rheumatology, Hôpital de la Cavale Blanche, CHU Brest, France and Unit of Immunology, Morvan Hospital, Brest, France
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Kan JH. Juvenile idiopathic arthritis and enthesitis-related arthropathies. Pediatr Radiol 2013; 43 Suppl 1:S172-80. [PMID: 23478933 DOI: 10.1007/s00247-012-2586-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/01/2012] [Accepted: 11/11/2012] [Indexed: 11/28/2022]
Abstract
Juvenile idiopathic arthritis (JIA) represents a spectrum of non-pyogenic inflammatory arthritides affecting children. The purpose of this pictorial review is to illustrate the imaging spectrum of JIA and the role of radiology in disease diagnosis and management.
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Affiliation(s)
- J Herman Kan
- E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030-2399, USA.
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Stramare R, Raffeiner B, Ciprian L, Scagliori E, Coran A, Perissinotto E, Fiocco U, Beltrame V, Rubaltelli L. Evaluation of finger joint synovial vascularity in patients with rheumatoid arthritis using contrast-enhanced ultrasound with water immersion and a stabilized probe. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:147-154. [PMID: 22287501 DOI: 10.1002/jcu.21887] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 12/14/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE.: To assess synovial microvascularity in finger joints with rheumatoid arthritis (RA) by contrast-enhanced ultrasound (CEUS), distinguishing between cases of active disease and those in remission; to standardize the technique for software analysis. METHODS.: Fifty-two finger joints of RA patients (26 with active disease and 26 in remission) were immersed in water and examined by CEUS using a fixed probe. Signal intensity curves were calculated with the software. RESULTS.: Contrast enhancement was detectable in all 26 patients with active RA (100%), but not in 25 of 26 patients in remission (96%); one of the latter patients (4%) showed minimal enhancement. The method's sensitivity and specificity in distinguishing active disease from remission were 100% and 96%. The grades of synovial enhancement correlated with clinical disease activity and software flow parameters. The peak contrast levels correlated with clinical activity, a peak of 9% representing the cutoff between remission and active disease. CONCLUSIONS.: CEUS with a fixed probe on finger joints immersed in water detected synovial vascularization in RA, producing results suitable for standardized software analysis and avoiding artifacts.
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Affiliation(s)
- Roberto Stramare
- Department of Medical Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy
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Blankstein A. Ultrasound in the diagnosis of clinical orthopedics: The orthopedic stethoscope. World J Orthop 2011; 2:13-24. [PMID: 22474631 PMCID: PMC3302037 DOI: 10.5312/wjo.v2.i2.13] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/11/2011] [Accepted: 02/15/2011] [Indexed: 02/06/2023] Open
Abstract
Ultrasonography has advantages over other imaging modalities in terms of availability and comfort, safety, and diagnostic potential. Operating costs are low compared with both computed tomography (CT) and magnetic resonance imaging (MRI). The portable equipment is accessible at locations distant from medical centers. Importantly, ultrasonography is performed while patients lie in a comfortable position, without pain or claustrophobia. Ultrasonography is a totally safe noninvasive imaging technique. In contrast to CT and X-rays, it does not emit ionizing radiation. Unlike MRI, it is safe for all patients, including those with cardiac pacemakers and metal implants, without any contraindications. Of the many indications for musculoskeletal ultrasonography, the evaluation of soft tissue pathology is particularly common. In addition, ultrasonography is useful for the detection of fluid collection, and for visualization of cartilage and bone surfaces. Color or power Doppler provides important physiological information, including that relating to the vascular system. The capability of ultrasonography in delineating structures according to their echotextures results in excellent pictorial representation. This imaging principle is based on physical changes in composition, as compared to imaging with MRI, which is based on changes in chemical composition. This article reviews the contribution of sonography to the evaluation of the musculoskeletal system.
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Usefulness of ultrasound imaging in detecting psoriatic arthritis of fingers and toes in patients with psoriasis. Clin Dev Immunol 2011; 2011:390726. [PMID: 21461353 PMCID: PMC3065047 DOI: 10.1155/2011/390726] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 12/15/2010] [Accepted: 01/10/2011] [Indexed: 11/17/2022]
Abstract
Background. Given that clinical evaluation may underestimate the joint damage and that early treatment can slow down psoriatic arthritis (PsA) progression, screening psoriasis patients with imaging tools that can depict early PsA changes would entail clear benefits. Objective. To compare the ability of X-ray and ultrasound (US) examination in detecting morphological abnormalities consistent with early PsA in patients with psoriasis, using rheumatological evaluation as the gold standard for diagnosis. Methods. Patients with chronic plaque psoriasis and no previous PsA diagnosis attending our outpatient dermatology clinic and reporting finger/toe joint and/or tendon pain underwent X-ray and US evaluation; they were subsequently referred to a rheumatologist for clinical examination and review of imaging findings. Results. Abnormal US and/or X-ray findings involving at least one finger and/or toe (joints and/or tendons) were seen in 36/52 patients: 11 had one or more X-ray abnormalities, including erosion, joint space narrowing, new bone formation, periarticular soft tissue swelling, and periarticular osteoporosis; 36 had suspicious changes on US. Conclusion. US proved valuable in detecting joint and/or tendon abnormalities in the fingers and toes of patients with suspicious changes. The dermatologist should consider US to obtain an accurate assessment of suspicious findings.
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Ultrasonography of hands in rheumatoid arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2009. [DOI: 10.1016/s0973-3698(10)60190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Falsetti P, Frediani B, Filippou G, Acciai C, Baldi F, Storri L, Bisogno S, Marcolongo R. Enthesitis of proximal insertion of the deltoid in the course of seronegative spondyloarthritis. Scand J Rheumatol 2009. [DOI: 10.1080/rhe.31.3.158.162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
The aim of this article is to review the sonographic appearances of common disorders involving the knee joint. Ultrasound is a sensitive method for diagnosis of tendon injuries. Injured ligaments appear swollen with mixed echogenicity. Meniscal injuries and muscle tears can be easily diagnosed. Ultrasound shows synovial thickening and effusion in inflammatory arthropathy and erosions of the articular surface in degenerative arthritis. It can be used effectively in the detection of rheumatoid arthritic activity and for grading degenerative arthritis lesions. Cystic lesions, as well as benign and malignant soft-tissue masses, are clearly delineated. Ultrasound is a safe noninvasive imaging modality that can be used for diagnosis of different disorders involving the knee joint.
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Affiliation(s)
- A A K A Razek
- Department of Diagnostic Radiology and Rheumatology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol 2008; 18:125-31. [PMID: 18306005 DOI: 10.1007/s10165-008-0046-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
Abstract
Musculoskeletal sonography (MSUS) has played a growing role in the diagnosis and management of rheumatic diseases, enabling the imaging of synovitis, bone erosion, and cartilage damage in the early phase of arthritis. "Dynamic" evaluation of tendons and help in guiding needle positioning in interventional manoeuvres are some of the other reasons for its success. MSUS, particularly when coupled with power Doppler (PD) examination, has recently been shown to be an efficient tool for monitoring disease activity and progression in rheumatoid arthritis, spondyloarthritis, crystal-related arthropathy, and osteoarthritis, with general consensus on its interesting results. More specifically, the PD signal has proved to be a simple and promising tool for short-term monitoring of synovial vascularity changes induced by steroids or biological agents in RA patients. MSUS has some limits, because of the physical properties of US and the quality of the equipment; it is, moreover, an operator-related imaging technique, with few standardized protocols. Future goals should be standardization of the examining approach in grey scale and Doppler ultrasound (US), including use of new equipment (3D US), extensive use in other fields (i.e. connective tissue diseases and vasculitis), and possible new applications (e.g. thoracic US).
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De Zordo T, Mlekusch SP, Feuchtner GM, Mur E, Schirmer M, Klauser AS. Value of contrast-enhanced ultrasound in rheumatoid arthritis. Eur J Radiol 2007; 64:222-30. [PMID: 17768022 DOI: 10.1016/j.ejrad.2007.07.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 07/24/2007] [Indexed: 11/20/2022]
Abstract
The purpose of this review is to describe the spectrum of sonographic findings in rheumatic diseases with respect to the diagnostic potential using US contrast media which prove activity or inactivity in synovial tissue where new treatment regimes target. Synovial activity can be found in non-erosive and erosive forms of primary and secondary osteoarthritis, and in inflammatory forms of joint diseases like rheumatoid arthritis and peripheral manifestations of spondyloarthritis including, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis and enteropathic arthritis. It can also be present in metabolic and endocrine forms of arthritis, in connective tissue arthropathies like systemic lupus erythematosus or scleroderma and in infectious arthritis. Ultrasound should be used as first-line imaging modality in suspected early cases of RA and other forms of arthritis, whereas contrast-enhanced ultrasound (CEUS) can further enable for sensitive assessment of vascularity which correlates with disease activity.
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Affiliation(s)
- Tobias De Zordo
- Department of Radiology II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Brown AK, O'Connor PJ, Roberts TE, Wakefield RJ, Karim Z, Emery P. Ultrasonography for rheumatologists: the development of specific competency based educational outcomes. Ann Rheum Dis 2006; 65:629-36. [PMID: 16192291 PMCID: PMC1798129 DOI: 10.1136/ard.2005.039974] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND A competency based approach to the education of rheumatologists in musculoskeletal ultrasonography (MSK US) ensures standards are documented, transparent, accountable, and defensible, with clear benefit to all stakeholders. Specific competency outcomes will facilitate informed development of a common curriculum and structured programme of training and assessment. OBJECTIVE To determine explicit competency based learning outcomes for rheumatologists undertaking MSK US. METHODS International experts in MSK US, satisfying specific selection criteria, were asked to define the minimum standards required by a rheumatologist to be judged competent in MSK US. They reviewed 115 MSK US skills, comprising bone and soft tissue pathology, in seven joints regions of the upper and lower limbs, and rated their relative importance according to specific criteria. These data are presented as specific educational outcomes within designated competency categories. RESULTS 57 expert MSK US practitioners were identified and 35 took part in this study. Ten generic core competency outcomes were recognised including physics, anatomy, technique, and interpretation. Regarding specific regional competencies, 53% (61/115) were considered "must know" core learning outcomes, largely comprising inflammatory joint/tendon/bone pathology and guided procedures; 45% (52/115) were required at an intermediate/advanced level (18/115 "should know", 34/115 "could know"), and 2% (2/115) were deemed inappropriate/unnecessary for rheumatologist ultrasonographers. CONCLUSIONS This is the first study to developing a competency model for the education of rheumatologists in MSK US based on the evidence of international experts. A specific set of learning outcomes has been defined, which will facilitate future informed education and practice development and provide a blueprint for a structured rheumatology MSK US curriculum and assessment process.
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Affiliation(s)
- A K Brown
- Academic Unit of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
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Klauser AS, Moriggl B, Duftner C, Smekal V, Pallwein L, Mur E, Schirmer M. Sonographie synovialer und erosiver entzündlicher Veränderungen. Radiologe 2006; 46:365-75. [PMID: 16715223 DOI: 10.1007/s00117-006-1361-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
High-frequency sonography enables excellent detection of early erosions and synovial proliferations. Power Doppler sonography (PDUS) allows for an improved characterization of articular and peritendinous augmented volume, because detection of hypervascularity correlates with inflammatory activity and further is helpful in differentiation from effusion and inactive pannus. The use of contrast media improves the sensitivity of vascularity detection, because they allow for a delineation of vessels at the microvascular level. This is of increased interest, as the development of new therapeutic options targeting the microvascular level calls for earlier diagnosis and optimal assessment of disease activity. Because of good availability, cost effectiveness, and patient acceptance, sonography facilitates early diagnosis of synovial proliferations and erosions as well as therapy follow-up.
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Affiliation(s)
- A S Klauser
- Universitätsklinik für Radiodiagnostik, Klinische Abteilung für Radiodiagnostik II, Medizinische Universität Innsbruck, Anichstrasse 35, 6020 Innsbruck, Osterreich.
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Mayordomo-González L. [Not Available]. REUMATOLOGIA CLINICA 2006; 2:1-3. [PMID: 21794294 DOI: 10.1016/s1699-258x(06)73012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 02/17/2005] [Indexed: 05/31/2023]
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Milosavljevic J, Lindqvist U, Elvin A. Ultrasound and power Doppler evaluation of the hand and wrist in patients with psoriatic arthritis. Acta Radiol 2005; 46:374-85. [PMID: 16134314 DOI: 10.1080/02841850510021256] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the ability of high-resolution and power Doppler sonography in detecting joint and tendon abnormalities in patients with psoriatic arthritis (PsA) of the hands and wrists compared with clinical and radiological findings. MATERIAL AND METHODS Thirty-six patients with psoriatic arthritis of the hands and wrists and 10 healthy controls were examined with ultrasound (US). The degree of synovial proliferation, tenosynovitis, presence of joint effusion as well as the vascularity of synovial tissue was estimated. US findings were scored using a newly devised scoring system. RESULTS Thirty-two patients had articular synovial proliferation and/or tenosynovitis/ tendinitis or joint effusion in one or more joints according to US. Twenty-two patients had tendon changes; only five had joint effusion. The synovial, Doppler, and total articular-teno scores were all significantly correlated to the number of swollen joints. The scores, however, did not correlate to other clinical or laboratory measurements of disease activity. CONCLUSION US proved effective in demonstrating PsA involvement of the hands and wrists and was more sensitive than clinical examination in detecting pathology. Long-term follow-up studies are needed to evaluate whether this can change the traditional approach for assessing involvement of joints and tendons in PsA.
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Affiliation(s)
- J Milosavljevic
- Department of Oncology, Radiology and Clinical Immunology, Uppsala University Hospital, Uppsala, Sweden.
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Abstract
Over the last few years a sonographic revolution has occurred in rheumatology. Ultrasonography has been shown to be capable of substantially changing the traditional approach to most clinical problems in daily rheumatological practice because of its ability to allow a quick, safe and inexpensive access to otherwise undetectable anatomical information on the early targets of most rheumatic diseases. Ultrasonography completes the physical examination in a rapid and accurate manner and allows the detection of a wide spectrum of pathological findings involving different anatomical structures in the musculoskeletal system. Guidance for intervention (joint aspiration, synovial or soft tissue biopsy, joint or tendon sheath injection) is a major application of ultrasonography. Sonographic guidance is particularly useful when fluid collections are very small or when the inflammatory process is adjacent to anatomical structures that could be seriously damaged by the injection.
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Affiliation(s)
- Walter Grassi
- Cattedra di Reumatologia-Università Politecnica delle Marche, Ospedale A. Murri, Via dei Colli, 52, 60035 Jesi, Ancona, Italy.
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Manger B. New developments in imaging for diagnosis and therapy monitoring in rheumatic diseases. Best Pract Res Clin Rheumatol 2005; 18:773-81. [PMID: 15501182 DOI: 10.1016/j.berh.2004.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The availability of therapeutic modalities that are able to stop inflammatory joint damage has also markedly influenced recent developments in muskuloskeletal imaging. One focus of interest is the detection of joint pathology as early as possible in order to prevent erosive bony changes. Ultrasonography and magnetic resonance imaging are the most valuable technologies in this respect. Another focus is on the exact assessment and documentation of joint damage using scoring systems not only in therapeutic trials, but also in clinical practice. In addition to these recent advances in peripheral and axial joint imaging, this chapter also discusses advances in vascular imaging and scintigraphy in rheumatoid diseases as well as interventional procedures guided by imaging technologies.
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Affiliation(s)
- Bernhard Manger
- Department of Medicine III, Institute for Clinical Immunology and Rheumatology, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
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Yang CP, Lee CL, Chen TW, Lee S, Weng MC, Huang MH. Ultrasonographic Findings in Hemiplegic Knees of Stroke Patients. Kaohsiung J Med Sci 2005; 21:70-7. [PMID: 15825692 DOI: 10.1016/s1607-551x(09)70280-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical and radiologic asymmetric arthritic differences between paralyzed and nonparalyzed limbs of stroke patients have been reported. Arthritic pathology aggravates motor dysfunction and compromises rehabilitation. Musculoskeletal ultrasonography plays an important role in showing soft tissue and the articular cartilage of the knee. Fifty-nine patients with either ischemic or hemorrhagic stroke-induced right or left hemiplegia were recruited to evaluate soft-tissue and intra-articular cartilage changes in hemiplegic knees of stroke patients using ultrasonography. An additional 15 subjects (30 knees) without knee disease or a history of knee trauma or surgery were used as controls. There were significant differences in suprapatellar effusion and patellar tendinitis between hemiplegic and nonhemiplegic knees. Suprapatellar effusion and pes anserinus tendinitis were correlated with Brunnstrom stage. The length of time since stroke onset was not significantly correlated with positive ultrasonographic findings in hemiplegic knees. In conclusion, ultrasonography is useful for detecting periarticular soft-tissue changes and intra-articular lesions in hemiplegic knees of stroke patients.
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Affiliation(s)
- Chao-Pin Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Brown AK, O'Connor PJ, Wakefield RJ, Roberts TE, Karim Z, Emery P. Practice, training, and assessment among experts performing musculoskeletal ultrasonography: toward the development of an international consensus of educational standards for ultrasonography for rheumatologists. ACTA ACUST UNITED AC 2005; 51:1018-22. [PMID: 15593176 DOI: 10.1002/art.20844] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the training and practice of specialist practitioners in musculoskeletal ultrasonography (MUS) with the aim of developing an expert-derived consensus of educational standards for rheumatologists performing MUS. METHODS A panel of worldwide experts in MUS was identified by literature review, consultation with members of training committees, and peer recommendation. Using a postal questionnaire, information was obtained about personal experience, current practice, training regimen, and participation in competency assessment. RESULTS International experts in MUS were identified (57 in total: 37 radiologists, 20 rheumatologists). Response rate was 70%. Radiologists had been performing MUS for longer than rheumatologists. Both rheumatologists and radiologists conducted the same number of MUS sessions per week, although radiologists examined more patients. More radiologists performed MUS for muscle and ligament injury, nerve lesions, soft tissue masses, and of the groin (P <0.01). The number of training hours was similar. Approaches to training varied, although attending a training course and scanning with an expert was more common among rheumatologists (P <0.001). More than two-thirds of the group had not undergone any form of competency assessment. CONCLUSION This study highlights differences in training and practice between individual expert ultrasonographers and between specialty backgrounds. In particular, there appears to be no formal training regimen and competency assessment is uncommon. The establishment of a core set of internationally applicable educational standards for MUS training for rheumatologists is required.
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d'Agostino MA, Ayral X, Baron G, Ravaud P, Breban M, Dougados M. Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. ACTA ACUST UNITED AC 2005; 53:284-92. [PMID: 15818652 DOI: 10.1002/art.21078] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the impact of ultrasonography (US) on local corticosteroid (CS) injections of painful ankle, hindfoot, and midfoot in chronic inflammatory diseases. METHODS Consecutive patients with chronic rheumatic diseases admitted to the hospital for local CS injections of painful ankle, hindfoot, or midfoot were enrolled in this study. Clinical and radiographic evaluation was performed by the physician in charge of CS injections, and US examination was performed by an independent examiner blinded to the clinical and radiologic findings. According to a randomized weekly-periods design, the physician planned CS injections either aware (G1 group) or unaware (G2 group) of US results. In the latter case, he was nonetheless informed of US results after he had performed the injections. Impact of this information on the treatment planning was assessed in all cases. Prognostic impact of US was also evaluated by comparing the change in global assessment of efficacy of CS injections, in activity of the disease, and in the Western Ontario and McMaster Universities (WOMAC) subscales after 1 and 3 months, between G1 and G2 groups. RESULTS The knowledge of US findings led the physician to change his decision of local CS injections in 56 (82%) of 68 patients studied. Among 1,131 assessed sites, by clinical, radiographic, and US evaluation, injection was cancelled in 37 (15%) of 242 proposed sites, whereas it was decided in 74 (8%) additional sites. After 1 month, there was an improvement in G1 as compared with G2 groups. The mean +/- SD change in WOMAC physical function subscale was 15.6 +/- 17.5 in G1 versus 8 +/- 13 in G2 (P = 0.0305). After 3 months, only the global assessment of efficacy of CS injections was statistically greater in G1 than in G2 group (P = 0.0170). CONCLUSION US frequently led the physician to change his diagnosis of inflammatory lesions in painful foot, and consequently his planning of CS injections. Moreover, US could improve the response to local treatment.
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Brown AK, O'connor PJ, Roberts TE, Wakefield RJ, Karim Z, Emery P. Recommendations for musculoskeletal ultrasonography by rheumatologists: Setting global standards for best practice by expert consensus. ACTA ACUST UNITED AC 2005; 53:83-92. [PMID: 15696575 DOI: 10.1002/art.20926] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To establish an expert consensus of best practice for rheumatologists performing musculoskeletal ultrasonography (MUS). METHODS A panel of worldwide experts in MUS was identified by literature review, membership of teaching faculty, and peer recommendation. They were invited to take part in a 4-stage Delphi process employing 2 iterative rounds to establish a consensus of specific indications, anatomic areas, and knowledge and skills required by rheumatologists performing MUS. RESULTS Experts in MUS were identified (n = 57; 37 radiologists, 20 rheumatologists). Successive rounds of this rigorous Delphi exercise enabled group consensus to be achieved in 30 of the proposed 37 categories comprising 8 of 13 indications (inflammatory arthritis, tendon pathology, effusion, bursitis, monitoring disease activity, monitoring disease progression, guided aspiration, and injection), 8 of 10 anatomic areas (hand, wrist, elbow, shoulder, hip, knee, ankle and heel, and forefoot), and 14 categories of knowledge and skills (physics, anatomy, pathology, equipment, clinical application and relevance, indications and limitations, artifact, machine function and operation, patient and probe position, planes and system of examination, image optimization, dynamic assessment, color Doppler, and power Doppler). CONCLUSION We have produced the first expert-derived, interdisciplinary consensus of recommendations for rheumatologists performing MUS. This represents a significant advance that will not only direct future rheumatology MUS practice, but will facilitate informed educational development. This is an important step towards the introduction of a specific training curriculum and assessment process to ensure competent rheumatologist ultrasonographers.
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Cho KH, Lee YH, Lee SM, Shahid MU, Suh KJ, Choi JH. Sonography of bone and bone-related diseases of the extremities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:511-521. [PMID: 15558611 DOI: 10.1002/jcu.20066] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Kil-Ho Cho
- Department of Diagnostic Radiology, College of Medicine, Yeungnam University, 317-1, Daemyung-Dong, Nam-Ku, Daegu, 705-717, Korea
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Daenen B, Houben G, Bauduin E, Debry R, Magotteaux P. Sonography in wrist tendon pathology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:462-469. [PMID: 15558631 DOI: 10.1002/jcu.20071] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Wrist tendons may be affected by a variety of pathologic conditions, including those caused by trauma and overuse, inflammatory and metabolic disorders, or infection. Sonography is a very sensitive means of detecting tendinous pathology because of its spatial resolution and its comparative and dynamic capabilities. Its wide availability makes it the preferred first-line imaging modality in the case of wrist pain. This article reviews the pathologic conditions that may involve the wrist and their sonographic appearances.
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Affiliation(s)
- Bénédicte Daenen
- Medical Imaging Department, Clinique Saint Joseph, Rue de Hesbaye, 75, B-4000 Liege, Belgium
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Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 2004; 63:988-94. [PMID: 15249327 PMCID: PMC1755091 DOI: 10.1136/ard.2003.015081] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine standard reference values for musculoskeletal ultrasonography in healthy adults. METHODS Ultrasonography was performed on 204 shoulders, elbows, hands, hips, knees, and feet of 102 healthy volunteers (mean age 38.4 years; range 20-60; 54 women) with a linear probe (10-5 MHz; Esaote Technos MP). Diameters of tendons, bursae, cartilage, erosions, hypoechoic rims around tendons and at joints were measured with regard to established standard scans. Mean, minimum, and maximum values, as well as two standard deviations (2 SD) were determined. Mean values +/-2 SD were defined as standard reference values. RESULTS Hypoechoic rims were normally present in joints and tendon sheaths owing to physiological synovial fluid and/or cartilage. Similarly, fluid was found in the subdeltoid bursa in 173/204 (85%), at the long biceps tendon in 56 (27%), in the suprapatellar recess in 158 (77%), in the popliteal bursae in 32 (16%), and in the retrocalcaneal bursa in 49 (24%). Erosions of >1 mm were seen at the humeral head in 47 (23%). Values for important intervals were determined. The correlation between two investigators was 0.96 (0.78-0.99). The reliability of follow up investigations was 0.83 (0.52-0.99). CONCLUSIONS Fluid in bursae as well as hypoechoic rims within joints and around tendons are common findings in healthy people. This study defines standard reference values for musculoskeletal ultrasonography to prevent misinterpretation of normal fluid as an anatomical abnormality.
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Affiliation(s)
- W A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Karower Strasse 11, 13125 Berlin.
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Ribbens C, André B, Marcelis S, Kaye O, Mathy L, Bonnet V, Beckers C, Malaise MG. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 2003; 229:562-9. [PMID: 12970463 DOI: 10.1148/radiol.2292020206] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate by using B-mode and power Doppler ultrasonography (US) and clinical assessment the response of hand joint synovitis in patients with active rheumatoid arthritis (RA) to treatment with the anti-tumor necrosis factor-alpha agent infliximab. MATERIALS AND METHODS Wrists, metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints in 11 patients with active RA were assessed before and 6 weeks after three infliximab infusions. US assessment was performed at a single site in the MCP and PIP joints and at two sites (radiocarpal and intercarpal) in the wrists. Twenty measurements were performed in the wrists; 110 measurements, in the MCP joints; and 103 measurements, in the PIP joints. Two wrists and seven PIP joints were excluded owing to complete joint destruction. US parameters (synovial thickness, number of US-positive joints [ie, with synovial thickness > or = 1 mm], cumulative synovial thickness index, and presence of Doppler signal) and clinical parameters (swollen joint count) were independently assessed and compared with baseline values by using the McNemar chi2 and paired Student t tests. RESULTS After infliximab treatment, there was a significant decrease in the mean numbers of swollen and US-positive joints and in the cumulative synovial thickness (P <.05). The mean synovial thickness decreased in all joints swollen at baseline and in the MCP and PIP joints not swollen at baseline (P <.01). Change from baseline cumulative synovial thickness correlated significantly with change in disease activity score (r = 0.69, P <.05). The number of positive Doppler US signals decreased significantly (in 13 US-positive joints at baseline, in five after treatment; P <.05). CONCLUSION US is a feasible imaging modality for measurement of the response of RA small-joint synovitis to therapy.
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Affiliation(s)
- Clio Ribbens
- Department of Rheumatology, Center for Cellular and Molecular Therapy, University Hospital of Liège, Room 155 BC + 3, CHU Sart-Tilman B35, B-4000 Liège, Belgium.
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Terslev L, Torp-Pedersen S, Savnik A, von der Recke P, Qvistgaard E, Danneskiold-Samsøe B, Bliddal H. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. ARTHRITIS AND RHEUMATISM 2003; 48:2434-41. [PMID: 13130462 DOI: 10.1002/art.11245] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare the quantitative and qualitative information obtained by Doppler ultrasound (US) measurements of the wrist joints and the small joints of the hand with the information obtained by postcontrast magnetic resonance imaging (MRI) and to correlate the imaging results with clinical observations in patients with rheumatoid arthritis (RA). METHODS Twenty-nine consecutive RA patients were studied; 196 joints (29 wrist and 167 finger joints) were examined by both US and MRI. Parameters of inflammation were the color fraction and the resistance index (RI) obtained with color Doppler US and the thickness of enhanced synovium (in mm) and the MRI score obtained with postcontrast MRI. Clinical examination and measurements of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were performed on the same day as the imaging studies. RESULTS There was a highly significant association between US indices of inflammation and postcontrast MRI scores. The mean values for both the color fraction and the RI were significantly different in the group without joint swelling compared with the other groups. The mean RI values were significantly different in the group without joint tenderness compared with the other groups. The mean thickness of enhanced synovium on postcontrast MRI was significantly different between the group without joint swelling and the other groups, but this difference was statistically significant only for the comparison of the group without joint tenderness versus the group with maximum tenderness. No association between the MRI or US estimates of inflammation and values on the visual analog scale for pain, Health Assessment Questionnaire, duration of morning stiffness, ESR, or CRP was found. CONCLUSION Estimates of synovial inflammatory activity by Doppler US and postcontrast MRI were comparable. Estimation of synovial inflammatory activity by the RI and color fraction parameters of US appears to be a promising method of detecting and monitoring inflammatory activity in patients with RA.
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Affiliation(s)
- L Terslev
- The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark.
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Abstract
The conceptual understanding of SpA and the ability to image sites of skeletal inflammation accurately and confirm that enthesitis is the primary lesion has occurred around the same time as the greatest therapeutic advances in AS and SpA with the advent of potent anti-TNF therapies for enthesitis. These therapies have transformed the understanding of enthesitis and revolutionized therapy of what was often an intractable problem. Now that clinicians better understand enthesitis-related disease mechanisms and have the ability to image them in early disease and monitor them, there is an urgent need to assess optimal conventional drug therapy in these conditions.
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Affiliation(s)
- Dennis McGonagle
- Academic Department of Rheumatology, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, West Yorkshire, UK.
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Wamser G, Bohndorf K, Vollert K, Bücklein W, Schalm J. Power Doppler sonography with and without echo-enhancing contrast agent and contrast-enhanced MRI for the evaluation of rheumatoid arthritis of the shoulder joint: differentiation between synovitis and joint effusion. Skeletal Radiol 2003; 32:351-9. [PMID: 12719926 DOI: 10.1007/s00256-003-0632-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2002] [Revised: 01/03/2003] [Accepted: 02/12/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate patients with clinically active rheumatoid arthritis (RA) of the shoulder for joint effusion and synovitis using conventional sonography, power Doppler (PD) sonography with and without echo-enhancing contrast agent, and contrast-enhanced MRI. DESIGN AND PATIENTS Twenty-four patients (mean age 64 years) with known RA had one symptomatic shoulder evaluated by conventional gray-scale sonography and PD sonography before and after intravenous administration of the echo-enhancing contrast agent Levovist (300 mg/ml, 2.5 g). The degree and extent of the altered echo pattern in the subacromial bursa, axillary recess and glenohumeral joint seen by conventional gray-scale sonography and the intensity of vascular signals of PD sonography were compared with the findings of MRI obtained with T2-weighted turbo spin-echo sequences and contrast-enhanced T1-weighted fat-saturated spin-echo sequences. MRI was evaluated by two readers in consensus without knowledge of the sonographic findings. RESULTS MRI, which was used as the reference examination, detected joint effusion in 71% (17/24) and synovitis in 92% (22/24) of the patients. Conventional sonography revealed an abnormal articular echo pattern in 96% (23/24) of the patients, especially in the axillary recess and subacromial bursa, but failed to attribute the altered echo pattern to either fluid or specific synovitis. PD sonography allowed a specific diagnosis of synovitis in 33% (8 patients), which increased to 50% (12 patients) after administration of an echo-enhancing contrast agent. In 42% (10/24) of the patients, the findings of synovitis demonstrated by MRI corresponded to an altered echo pattern by conventional sonography, but vascular signals were absent by PD sonography with or without echo-enhancing contrast agent. CONCLUSIONS Using MRI as the "gold standard," PD sonography with and without echo-enhancing contrast agent cannot reliably identify synovitis or distinguish synovial inflammation from effusion in the shoulder joint.
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Affiliation(s)
- G Wamser
- Department of Diagnostic Radiology, Klinikum Augsburg, Augsburg, Germany.
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Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP, Valle M, Derchi LE. US of the shoulder: non-rotator cuff disorders. Radiographics 2003; 23:381-401; quiz 534. [PMID: 12640155 DOI: 10.1148/rg.232025100] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The most common indication for shoulder ultrasonography (US) is the diagnosis of rotator cuff disease. However, there is a spectrum of non-rotator cuff abnormalities that are amenable to US examination, including instability of the biceps tendon, glenohumeral joint, and acromioclavicular joint; arthropathies and bursites (inflammatory diseases, degenerative and infiltrative disorders, infections); nerve entrapment syndromes; and space-occupying lesions. Many of these conditions may be overlooked clinically or can even mimic rotator cuff tears, and US can help redirect the diagnosis if a complete shoulder examination rather than a simple rotator cuff assessment is performed. In addition, US can be remarkably helpful in guiding either needle aspiration procedures or local injection therapy in patients with synovial processes. Although radiography, magnetic resonance (MR) imaging, and computed tomographic and MR arthrography are effective modalities for the evaluation of non-rotator cuff disorders, US is both less costly and less invasive and will likely be used more frequently in this setting as experience increases. Once adequate radiographs have been obtained to exclude apparent bone disorders, high-resolution US should be the first-line imaging modality in the assessment of non-rotator cuff disorders of the shoulder, assuming the study is performed with high-end equipment by an experienced examiner.
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Affiliation(s)
- Carlo Martinoli
- Cattedra "R" di Radiologia-DICMI, Università di Genova, Largo Rosanna Benzi 8, 16132 Genoa, Italy.
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Wakefield RJ, Brown AK, O'Connor PJ, Emery P. Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease. ARTHRITIS AND RHEUMATISM 2003; 48:285-8. [PMID: 12571834 DOI: 10.1002/art.10818] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. ARTHRITIS AND RHEUMATISM 2003; 48:523-33. [PMID: 12571863 DOI: 10.1002/art.10812] [Citation(s) in RCA: 427] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the prevalence and severity of peripheral enthesitis among the different subtypes of spondylarthropathy (SpA) by using ultrasonography (US) in B mode with power Doppler. METHODS One hundred sixty-four consecutive patients with SpA (according to the criteria of the European Spondylarthropathy Study Group) and 64 control patients (34 with mechanical low back pain [MBP] and 30 with rheumatoid arthritis [RA]) underwent US examination of major entheses of their limbs. Particular attention was given to the detection of vascularization at the following sites: cortical bone insertion of entheses, junction between tendon and entheses, body of tendon, and bursa. RESULTS Abnormal US findings consistent with at least one enthesitis were observed in 161 of 164 SpA patients (98%), affecting 1,131 of 2,952 entheses examined (38%). In contrast, only 132 of 1,152 entheses (11%) were found to be abnormal in 33 of 64 control patients (52%). US enthesitis was most commonly distributed in the distal portion of the lower limbs, irrespective of SpA subtype and of skeletal distribution of clinical symptoms. None of the abnormal entheses in control patients showed vascularization, compared with 916 of 1,131 abnormal entheses in SpA patients (81%), where it was always detected at the cortical bone insertion and sometimes also in the bursa. In SpA patients, the US pattern depended on the clinical presentation, with a higher prevalence of the most severe stages in those with peripheral forms. CONCLUSION US in B mode combined with power Doppler allowed the detection of peripheral enthesitis in a majority of SpA patients, but not in MBP or RA patients. The presence of entheseal involvement was independent of SpA subtype, but its degree of severity appeared to be greater in peripheral forms. US could be very useful for both the diagnosis and the assessment of SpA activity.
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D'Agostino MA, Breban M. Ultrasonography in inflammatory joint disease: why should rheumatologists pay attention? Joint Bone Spine 2002; 69:252-5. [PMID: 12102270 DOI: 10.1016/s1297-319x(02)00394-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
During the last decade, articular ultrasonography (US) has been found effective in evaluating inflammatory, degenerative, and traumatic abnormalities of articular and periarticular tissues. In clinical practice, US used in combination with a thorough clinical evaluation can help rheumatologists to confirm or to refute diagnostic hypotheses. US is safer than computed tomography (CT), an advantage shared by magnetic resonance imaging (MRI). As compared to CT and MRI, US is less expensive; in addition, it can be performed immediately, for several joints, as often as needed. Furthermore, US allows dynamic studies. Several articles published in rheumatology journals emphasize the value of US in patients with musculoskeletal diseases. The present review article discusses the indications, efficacy, and limitations of articular US.
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Klauser A, Frauscher F, Schirmer M, Halpern E, Pallwein L, Herold M, Helweg G, ZurNedden D. The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2002; 46:647-53. [PMID: 11920400 DOI: 10.1002/art.10136] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A prospective study was performed to assess the usefulness of contrast-enhanced color Doppler ultrasound (CDUS) in the evaluation of intraarticular vascularization of finger joints in patients with rheumatoid arthritis (RA). METHODS We investigated 198 finger joints in 46 patients with RA, and 80 finger joints in 10 healthy volunteers. Joints with varying levels of clinical activity of inflammation were classified as being active, moderately active, or inactive. CDUS was performed with a high-frequency multi-D linear array transducer. A microbubble-based ultrasound (US) contrast agent (Levovist; Schering, Berlin, Germany) was intravenously infused. Doppler findings were rated on the basis of both unenhanced and contrast-enhanced CDUS images. RESULTS Healthy joints showed no intraarticular vascularization on either unenhanced or contrast-enhanced CDUS. Unenhanced CDUS detected intraarticular vascularization in 7 (8%) of 83 inactive joints, in 31 (52%) of 60 moderately active joints, and in 32 (58%) of 55 active joints. Contrast-enhanced CDUS detected intraarticular vascularization in 41 (49%) of 83 joints with inactive RA, in 59 (98%) of 60 joints with moderately active RA, and in all 55 joints with active RA. Detection of intraarticular vascularization was improved by administration of the microbubble-based US contrast agent (P < 0.001). Contrast-enhanced CDUS demonstrated differences in intraarticular vascularization between joints with inactive RA and those with active RA (P < 0.001), between joints with inactive RA and those with moderately active RA (P < 0.001), and between joints with moderately active RA and those with active RA (P < 0.001). CONCLUSION The use of a microbubble-based US contrast agent significantly improved the detection of intraarticular vascularization in the finger joints of patients with RA. This technique seems to be a useful adjunct in the assessment of disease activity.
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Affiliation(s)
- Andrea Klauser
- Department of Radiology II, University Hospital Innsbruck, Tyrol, Austria.
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Abstract
Childhood arthritis has now been reclassified into a single internationally recognized entity of juvenile idiopathic arthritis (JIA). Radiology provides an important role in the management of JIA, in helping in the differential diagnosis, monitoring disease progression and detecting complications. Traditionally, plain radiographs have been the imaging investigation of choice but magnetic resonance imaging (MRI) and ultrasound are now providing a more effective and safer alternative. The appropriate use of sequences in MR imaging is important in the early detection of joint abnormalities in JIA.
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Affiliation(s)
- Karl Johnson
- Department of Paediatric Radiology, Birmingham Children's Hospital, Birmingham, UK.
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Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, Wakefield RJ, Manger B. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60:641-9. [PMID: 11406516 PMCID: PMC1753749 DOI: 10.1136/ard.60.7.641] [Citation(s) in RCA: 631] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Humboldt University, Berlin, Germany
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Grassi W, Filippucci E, Farina A, Salaffi F, Cervini C. Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis 2001; 60:98-103. [PMID: 11156539 PMCID: PMC1753465 DOI: 10.1136/ard.60.2.98] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To demonstrate the diagnostic efficacy of ultrasonography in depicting erosions in patients with rheumatoid arthritis and to compare sonographic and radiographic findings. METHODS Sonographic images were obtained with an AU-4 Idea Esaote Biomedica (Genoa, Italy) equipped with a 13 MHz linear transducer. RESULTS The images reported in this essay are representative examples of the ability of ultrasonography to detect and characterise even minimal bone margin changes in rheumatoid arthritis. CONCLUSION Ultrasonography with very high frequency transducers can depict bone erosions in early target areas of bone resorption. However, further studies are needed to validate this technique and to evaluate the relation between sonographic findings and those obtained with other imaging techniques (standard radiology, magnetic resonance).
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Affiliation(s)
- W Grassi
- Department of Rheumatology, University of Ancona, Italy.
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Fraser A, Veale DJ. What practical skills do rheumatologists of the future need? Best Pract Res Clin Rheumatol 2000; 14:635-48. [PMID: 11092793 DOI: 10.1053/berh.2000.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this chapter, we consider future practical skills required for rheumatologists. While difficult to predict against a background of rapid technological advance and successive changes to health-care provision world wide, a number of questions are examined. The first question is what core skills are essential in the curriculum? This has been addressed in at least one joint European effort by UEMS. Great diversity in both clinical practice and training was found across Europe; clearly, the difference across continents may prove even more significant. Second, the role of arthroscopy is considered, the evidence for its therapeutic benefit in clinical rheumatology practice being inconclusive. Issues concerning diagnostic methods including electrophysiology and ultrasound (US) are also discussed in this chapter. There is evidence to support the use of electrophysiology in routine diagnosis for specific diseases. US has become popular as technology improves. It is cheap but highly operator dependent, and the feasibility of rheumatologists using US in the clinic remains to be proved. In conclusion, health care is changing rapidly, and training must adapt, and is adapting, to meet its challenges. A number of opportunities will present to the rheumatologist of the future, but the feasibility of these in routine clinical practice remains to be seen.
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Affiliation(s)
- A Fraser
- Rheumatology Rehabilitation Research Unit, Department of Rheumatology, Old Home, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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