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Laskari K, Siores E, Tektonidou MM, Sfikakis PP. Microwave Radiometry for the Diagnosis and Monitoring of Inflammatory Arthritis. Diagnostics (Basel) 2023; 13:diagnostics13040609. [PMID: 36832097 PMCID: PMC9955117 DOI: 10.3390/diagnostics13040609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
The ability of microwave radiometry (MWR) to detect with high accuracy in-depth temperature changes in human tissues is under investigation in various medical fields. The need for non-invasive, easily accessible imaging biomarkers for the diagnosis and monitoring of inflammatory arthritis provides the background for this application in order to detect the local temperature increase due to the inflammatory process by placing the appropriate MWR sensor on the skin over the joint. Indeed, a number of studies reviewed herein have reported interesting results, suggesting that MWR is useful for the differential diagnosis of arthritis as well as for the assessment of clinical and subclinical inflammation at the individual large or small joint level and the patient level. MWR showed higher agreement with musculoskeletal ultrasound, used as a reference, than with clinical examination in rheumatoid arthritis (RA), while it also appeared useful for the assessment of back pain and sacroiliitis. Further studies with a larger number of patients are warranted to confirm these findings, taking into account the current limitations of the available MWR devices. This may lead to the production of easily accessible and inexpensive MWR devices that will provide a powerful impetus for personalized medicine.
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Affiliation(s)
- Katerina Laskari
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, National & Kapodistrian University of Athens Medical School, 75 Mikras Asias Street, Goudi, 11527 Athens, Greece
- Correspondence: (K.L.); Tel.: +30-213-2061061; Fax: +30-210-7791839
| | - Elias Siores
- University of West Attica, 12243 Athens, Greece
- Institute of Materials Research and Innovation, University of Bolton, Bolton BL3 5AB, UK
| | - Maria M. Tektonidou
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, National & Kapodistrian University of Athens Medical School, 75 Mikras Asias Street, Goudi, 11527 Athens, Greece
| | - Petros P. Sfikakis
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, National & Kapodistrian University of Athens Medical School, 75 Mikras Asias Street, Goudi, 11527 Athens, Greece
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2
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Assessment of disease activity with simplified joint ultrasonography method in rheumatoid arthritis patients. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1014924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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.
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 < 0.01) and knees (r = 0.42, P < 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).
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.
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Wang CC, Wang CT, Tsai KL, Chou CL, Chao JK, Huang HY, Kao CL. Effect of ultrasound-detected synovitis on therapeutic efficacy of hyaluronic acid injection for symptomatic knee osteoarthritis. Rheumatology (Oxford) 2021; 60:4486-4494. [PMID: 33493323 PMCID: PMC8487310 DOI: 10.1093/rheumatology/keab020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Objective To determine whether ultrasound (US)-detected synovitis affects the therapeutic efficacy of hyaluronic acid (HA) injection for treating knee OA. Methods Patients with symptomatic knee OA were recruited. All the patients received HA injection two times at 2-week intervals. Clinical assessments were performed using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities OA Index (WOMAC) at baseline and 1 and 6 months after treatment. Imaging evaluation was based on complete knee US examination and the Kellgren–Lawrence grading. Suprapatellar synovial fluid (SF) depth, synovial hypertrophy (SH) and vascularity were measured through US. Results In total, 137 patients who fulfilled the inclusion criteria were included in the analysis. All patients demonstrated improvement in VAS and WOMAC scores at 1 and 6 months after treatment (P < 0.001). Moreover, regression model-based analysis revealed significant associations of SF depth with the VAS and WOMAC scores in all patients. Each centimetre increase in the effusion diameter was associated with a decrease in the 1-month post-treatment VAS improvement percentage (15.26; 95% CI: 0.05, 29.5; P = 0.042) and 6-month post-treatment WOMAC improvement (37.43; 95% CI: 37.68, 50.69; P < 0.01). However, SH and vascularity were not significantly associated with VAS or WOMAC scores. Conclusion Ultrasound detected suprapatellar effusion predicts reduced efficacy of HA injection in knee OA
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chin-Tien Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Kun-Ling Tsai
- Department of Physical Therapy.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital.,Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Jian-Kang Chao
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien.,Department of Social Work, National Pingtung University of Science & Technology, Pingtung
| | - Hsin-Yi Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei.,Taipei Veterans General Hospital Biostatistics Task Force, Taipei
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital.,Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei.,Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan
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4
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Endo Y, Kawashiri SY, Morimoto S, Nishino A, Okamoto M, Tsuji S, Takatani A, Shimizu T, Sumiyoshi R, Igawa T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Ueki Y, Yoshitama T, Eiraku N, Matsuoka N, Okada A, Fujikawa K, Hamada H, Tsuru T, Nagano S, Arinobu Y, Hidaka T, Tada Y, Kawakami A. Non-TNF inhibitor switchers versus TNF inhibitor cyclers from multicentre rheumatoid arthritis ultrasonography prospective cohort in Japan. Immunol Med 2020; 43:115-120. [DOI: 10.1080/25785826.2020.1757920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Yushiro Endo
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Shin-ya Kawashiri
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Shimpei Morimoto
- Innovation Platform & Office for Precision Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ayako Nishino
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Momoko Okamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Sosuke Tsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Ayuko Takatani
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Remi Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Takashi Igawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Yukitaka Ueki
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Tamami Yoshitama
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Nobutaka Eiraku
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Naoki Matsuoka
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Akitomo Okada
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Keita Fujikawa
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Hiroaki Hamada
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Tomomi Tsuru
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Shuji Nagano
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Yojiro Arinobu
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Toshihiko Hidaka
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Yoshifumi Tada
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
- Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group, Japan
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Jin X, Li F, Liu H, Wang H, Du J. Comparison of three ultrasonographic examinations on the synovial membrane vascularity of RA patients. Phys Eng Sci Med 2020; 43:617-622. [PMID: 32358664 DOI: 10.1007/s13246-020-00862-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/22/2020] [Indexed: 01/13/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease involving multiple joints and often involves the small joints, and the lesions are symmetric, invasive, and disabling. Synovial blood flow in patients with RA was compared using color Doppler flow imaging (CDFI), power Doppler ultrasound (PDUS), and superb microvascular imaging (SMI) to determine the application value of SMI in synovial vasospasm of knee joints. The blood flow signals of the suprapatellar recess in the knee joints of 41 RA patients (49 knees) were measured prior to undergoing total knee arthroplasty (TKA), recorded, and graded by CDFI, PDUS, and SMI. The results of the three ultrasound examination methods were compared and analyzed. The SMI grading was compared with the pathologic grade of the synovial membrane. Forty-one patients underwent 49 TKAs. The display rate of the synovial blood flow signal was 93.9% in the CDFI model, 97.9% in the PDUS model, and 100% in the SMI model. There were statistically significant differences in the results between the three ultrasound examination methods (HC = 11.84, P < 0.05). The consistency of the SMI and pathologic grades of synovial membranes was better than the other methods (kappa = 0.639, P < 0.05). Compared with CDFI and PDUS, the signal of synovia flow detected by SMI was significantly higher in RA patients. SMI classification had a better consistency with the pathologic grade, and SMI has application value in assessing the activity of RA.
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Affiliation(s)
- Xiuli Jin
- Department of Ultrasound Diagnosis, Chengde Central Hospital, No. 11 Guangren Street, Chengde, 067000, Hebei, China
| | - Fengjuan Li
- Department of Ultrasound Diagnosis, Chengde Central Hospital, No. 11 Guangren Street, Chengde, 067000, Hebei, China
| | - Huanyan Liu
- Department of Ultrasound Diagnosis, Chengde Central Hospital, No. 11 Guangren Street, Chengde, 067000, Hebei, China
| | - Hong Wang
- Department of Ultrasound Diagnosis, Chengde Central Hospital, No. 11 Guangren Street, Chengde, 067000, Hebei, China
| | - Jianwen Du
- Department of Ultrasound Diagnosis, Chengde Central Hospital, No. 11 Guangren Street, Chengde, 067000, Hebei, China.
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Laskari K, Pentazos G, Pitsilka D, Raftakis J, Konstantonis G, Toutouzas K, Siores E, Tektonidou M, Sfikakis PP. Joint microwave radiometry for inflammatory arthritis assessment. Rheumatology (Oxford) 2020; 59:839-844. [PMID: 31504966 DOI: 10.1093/rheumatology/kez373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/17/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Increased in-depth joint temperature measured by the rapid, easy-to-perform microwave radiometry (MWR) method may reflect inflammation, even in the absence of clinical signs. We hypothesized that MWR is useful for RA and spondyloarthritis patients' assessment. METHODS Clinical examination, joint ultrasound and/or MRI and MWR were performed in two independent patient-control cohorts (n = 243). RESULTS Among single RA joints MWR performed best in the knee using ultrasound as reference, with 75% sensitivity-73% specificity for grey-scale synovitis score ⩾2, and 80% sensitivity-82% specificity for power Doppler positivity. A stronger agreement was evident between increased knee relative temperature (Δt) and power Doppler positivity (82%) than with clinical examination (76%). In a different patient cohort with painful knees, a knee Δt ⩽0.2 predicted power Doppler positivity with 100% positive and negative predictive values. A thermo-score summing 10 Δt values of three large and seven small RA joints (elbow, knee, ankle, wrist, four hand and two foot joints of the clinically dominant arm or hand and leg or foot) correlated with ultrasound scores of synovitis/tenosynovitis (all P < 0.001) and the 28-joint Disease Activity Score (DAS28) (P = 0.004). The agreement of the thermo-score with ultrasound-defined joint inflammation (82%) was stronger than with DAS28 (64%). The thermo-score improved significantly after 90 days of treatment in patients with active RA at baseline (P = 0.004). Using MRI as reference, Δt of sacroiliac joints could discriminate between spondyloarthritis patients with or without sacroiliitis with 78% sensitivity-74% specificity. CONCLUSION In-depth increased MWR-derived joint temperature reflects both subclinical and clinically overt inflammation and may serve as a biomarker in arthritis.
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Affiliation(s)
- Katerina Laskari
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, Athens, Greece
| | - George Pentazos
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, Athens, Greece
| | - Despina Pitsilka
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, Athens, Greece
| | | | - George Konstantonis
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, Athens, Greece
| | - Konstantinos Toutouzas
- 1st Department of Cardiology, 'Hipokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Elias Siores
- University of West Attica, Athens, Greece.,Institute of Materials Research and Innovation, University of Bolton, Bolton, UK
| | - Maria Tektonidou
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, Athens, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, 1st Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, University of Athens, Medical School, Athens, Greece
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Gitto S, Messina C, Chianca V, Tuscano B, Lazzara A, Corazza A, Pedone L, Albano D, Sconfienza LM. Superb microvascular imaging (SMI) in the evaluation of musculoskeletal disorders: a systematic review. Radiol Med 2020; 125:481-490. [DOI: 10.1007/s11547-020-01141-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
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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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9
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Horie T, Nishida M, Tanimura S, Kamishima T, Tamai E, Morimura Y, Nishibata Y, Masuda S, Nakazawa D, Tomaru U, Atsumi T, Ishizu A. Detection of Increased Vascular Signal in Arthritis-Prone Rats Without Joint Swelling Using Superb Microvascular Imaging Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2086-2093. [PMID: 31085028 DOI: 10.1016/j.ultrasmedbio.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/10/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to determine whether ultrasonography (US) can detect increased vascular signal in the synovial tissue before overt synovitis in rheumatoid arthritis (RA). Env-pX rats that spontaneously develop RA-like synovitis were used. Ankle joints of 15 pre-morbid env-pX rats were observed with power Doppler and superb microvascular imaging (SMI) using an ultrahigh-frequency (8-24 MHz) probe. Signal values were counted as the number of pixels. The total number of vessels and vessel area in the synovial tissue were histologically evaluated. Dilated vessels were determined from the mean value of synovial vessels in three wild-type rats. In all env-pX rats, apparent synovial proliferation was not observed. However, vasodilation was evident. Only SMI values were significantly correlated with the number of dilated vessels (r = 0.585, p = 0.022) but not with the total number of vessels. US with SMI using ultrahigh-frequency probe can detect increased vascular signal in the synovial tissue of arthritis-prone rats.
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Affiliation(s)
- Tatsunori Horie
- Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-ku, Sapporo, Japan; Department of Radiological Technology, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-ku, Sapporo, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Shun Tanimura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tamotsu Kamishima
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Erika Tamai
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Yutaka Morimura
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Yuka Nishibata
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Sakiko Masuda
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Utano Tomaru
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan.
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10
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The superb microvascular imaging is more sensitive than conventional power Doppler imaging in detection of active synovitis in patients with rheumatoid arthritis. Clin Rheumatol 2019; 38:2613-2620. [DOI: 10.1007/s10067-019-04550-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
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11
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Kondo Y, Suzuki K, Inoue Y, Sakata K, Takahashi C, Takeshita M, Kassai Y, Miyazaki T, Morita R, Niki Y, Kaneko Y, Yasuoka H, Yamaoka K, Yoshimura A, Takeuchi T. Significant association between joint ultrasonographic parameters and synovial inflammatory factors in rheumatoid arthritis. Arthritis Res Ther 2019; 21:14. [PMID: 30630515 PMCID: PMC6327469 DOI: 10.1186/s13075-018-1802-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonography (US) can directly demonstrate joint inflammation, including grayscale (GS) signs of synovial hypertrophy and power Doppler (PD) techniques to demonstrate increased blood flow and vascularization. Recently, echogenicity, especially hypoechoic synovium, has also been associated with local inflammatory activity. However, only a few studies have demonstrated correlation between histopathologic and immunopathologic evaluation and US findings. The aim of this study was to clarify whether joint US findings including synovial hypertrophy, vascularity, and echogenicity can accurately characterize synovial pathophysiology in patients with active rheumatoid arthritis (RA). METHODS A total of 44 patients with RA were included, both treated (n = 25) and untreated (n = 19) and scheduled for US examination of the knee joint with synovial fluid (SF) aspiration and two treated patients also underwent synovial biopsy. US images were quantitatively analyzed using grayscale assessment of synovial hypertrophy and PD for vascularity and echogenicity. Levels of nine SF cytokines and growth factors were also measured. RESULTS Both US synovial hypertrophy and PD vascularity significantly correlated with SF inflammatory cytokine levels such as IL-6, IL-8, IL-1β and IL-10 in untreated patients. Angiogenic factors, including vascular endothelial growth factor (VEGF), only correlated with PD vascularity. In the treated patients, the associations between synovial hypertrophy and any cytokines were diminished, although synovial vascularity and echogenicity correlated with IL-6 and VEGF (p < 0.05). Histopathologic analysis revealed that hypoechogenicity of the synovium correlated with marked infiltration of lymphocytes and hypervascularity. CONCLUSIONS We demonstrated the pathophysiological origins of US findings in the joint. The degree of US vascularity of the synovium correlated with local inflammatory cytokine levels and angiogenetic factors in patients with active RA. Synovial echogenicity, and not hypertrophy, correlated with inflammation, especially in treated patients with RA.
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Affiliation(s)
- Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yumiko Inoue
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Koumei Sakata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Chihiro Takahashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yoshiaki Kassai
- Immunology Unit, Research, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan
| | - Takahiro Miyazaki
- Immunology Unit, Research, Takeda Pharmaceutical Company Limited, Fujisawa, Kanagawa, Japan.,Nektar Therapeutics, San Francisco, CA, USA
| | - Rimpei Morita
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hidekata Yasuoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kunihiro Yamaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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The role of Doppler Ultrasonography in evaluating disease activity in a group of juvenile idiopathic arthritis patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Nishino A, Kawashiri S, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Ueki Y, Yoshitama T, Eiraku N, Matsuoka N, Okada A, Fujikawa K, Hamada H, Tsuru T, Nagano S, Arinobu Y, Hidaka T, Kawakami A. Ultrasonographic Efficacy of Biologic and Targeted Synthetic Disease‐Modifying Antirheumatic Drug Therapy in Rheumatoid Arthritis From a Multicenter Rheumatoid Arthritis Ultrasound Prospective Cohort in Japan. Arthritis Care Res (Hoboken) 2018; 70:1719-1726. [DOI: 10.1002/acr.23551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Ayako Nishino
- Nagasaki University, Nagasaki, Japan, and Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Shin‐ya Kawashiri
- Nagasaki University, Nagasaki, Japan, and Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | | | | | | | | | | | | | - Yukitaka Ueki
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Tamami Yoshitama
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Nobutaka Eiraku
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Naoki Matsuoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Akitomo Okada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Keita Fujikawa
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Hiroaki Hamada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Tomomi Tsuru
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Shuji Nagano
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Yojiro Arinobu
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Toshihiko Hidaka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
| | - Atsushi Kawakami
- Nagasaki University, Nagasaki, Japan, and Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group Kyushu Japan
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14
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Serum matrix metalloproteinase 3 levels are associated with an effect of iguratimod as add-on therapy to biological DMARDs in patients with rheumatoid arthritis. PLoS One 2018; 13:e0202601. [PMID: 30138480 PMCID: PMC6107217 DOI: 10.1371/journal.pone.0202601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to clarify whether serum matrix metalloproteinase 3 (MMP-3) levels are associated with an effect of iguratimod as add-on therapy to biological DMARDs (bDMARDs) in patients with rheumatoid arthritis (RA). METHODS Forty three patients with RA were treated with iguratimod as add-on therapy to bDMARDs. They were classified into remission and non-remission groups at 24 weeks of iguratimod therapy. Remission was defined as a state with a disease activity score (DAS) <2.6 in 28 joints (termed DAS remission) and total power Doppler ultrasound (US) score <3 (termed US remission). The serum MMP-3 levels at baseline and at 12 weeks were compared between these two groups. RESULTS There were no significant differences in the serum MMP-3 levels at baseline between the DAS and US remission groups and the non-remission group. The serum MMP-3 levels at 12 weeks in the US remission group were significantly lower than those in the non-remission group. The ratios of the serum MMP-3 levels at baseline to those at 12 weeks in both the DAS and US remission groups were significantly lower than those in the non-remission group. An MMP-3 ratio <0.86 was determined as the cut-off value to predict US remission at 24 weeks. CONCLUSION Our findings suggest that the ratios of the serum MMP-3 levels at baseline to those at 12 weeks could be used to predict remission in RA patients who are administered iguratimod as an add-on to bDMARDs.
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15
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Carotti M, Galeazzi V, Catucci F, Zappia M, Arrigoni F, Barile A, Giovagnoni A. Clinical utility of eco-color-power Doppler ultrasonography and contrast enhanced magnetic resonance imaging for interpretation and quantification of joint synovitis: a review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:48-77. [PMID: 29350637 PMCID: PMC6179068 DOI: 10.23750/abm.v89i1-s.7010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
With the introduction of new biologics such as anti-TNF-alpha antibodies and other therapies in the treatment of inflammatory arthritis, capable of halting joint destruction and functional disability, there are new pressures on diagnostic and prognostic imaging. Early demonstration of pre-erosive inflammatory features and monitoring of the long-term effects of treatment are becoming increasingly important. Early detection of synovitis offers advantages in terms of allowing early instigation of therapy and may allow the identification of those patients displaying more aggressive disease who might benefit from early intervention with expensive DMARD therapy. Advanced imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) have focussed on the demonstration and quantification of synovitis and allow early diagnosis of inflammatory arthropathies such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Synovitis represents a potential surrogate measure of disease activity that can be monitored using either MRI or US; the techniques have, generally, focused on monitoring synovial volume or quality as assessed by its vascularity. However to achieve these goals, standardisation and validation of US and MRI are required to ensure accurate diagnosis, reproducibility and reliability. Each modality has different strengths and weaknesses and levels of validation. This article aims to increase the awareness of radiologists and rheumatologists about this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration, it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. The first part addresses the role of US and colour or power Doppler sonography (PDUS) in the detection and monitoring of synovitis in inflammatory arthropathies. The second part will look at advanced MR imaging and Dynamic contrast-enhanced MRI techniques and in particular how they are applied to the monitoring of the disease process.
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16
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Anti-TNF-Alpha-Adalimumab Therapy Had Time Lag of Improvement in Synovial Hypertrophy Compared to Rapid Response in Power Doppler Synovial Vascularity. Mediators Inflamm 2017; 2017:1658397. [PMID: 29104376 PMCID: PMC5606135 DOI: 10.1155/2017/1658397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives The quantification of synovitis is of great significance for follow-up in patients with rheumatoid arthritis (RA). This study aimed to validate the use of power Doppler ultrasonography (PDUS) for evaluating synovial vascularity and synovial hypertrophy for synovitis in patients with rheumatoid arthritis treated with adalimumab. Materials and Methods The synovial disease activity and vascularity of RA on both wrists (radio-carpal joint) were assessed using GS and PDUS to derive the composite US scores based on abnormal counts and severity. The relationship between each measure was determined. Results The 71 patients who received adalimumab therapy had significantly decreased DAS28, ESR, and CRP. After one month, PD score decreased and then remained low for 12 months. Synovial hypertrophy did not change until 3-6 months after, when it started to improve (p = 0.017). By multivariate analysis, sex, age, BMI, and DAS28 did not lead to any difference between synovial hypertrophy and PDUS changes (p = 0.498). Discussion Composite US markers of synovial hypertrophy correlate significantly to the DAS28 score and ESR/CRP in adult RA. The time needed for synovial hypertrophy to decrease may be up to 3-6 months after adalimumab therapy. Switching to biological therapy before 3-6 months is inappropriate and ineffective.
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17
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Orlandi D, Gitto S, Perugin Bernardi S, Corazza A, De Flaviis L, Silvestri E, Cimmino MA, Sconfienza LM. Advanced Power Doppler Technique Increases Synovial Vascularity Detection in Patients with Rheumatoid Arthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1880-1887. [DOI: 10.1016/j.ultrasmedbio.2017.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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18
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Komarova EB, Rebrova OA, Pokrushka II, Kindritskaya YG. Specific features of joint ultrasound study in patients with rheumatoid arthritis. TERAPEVT ARKH 2017; 89:53-56. [DOI: 10.17116/terarkh2016881153-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim. To study the specific features of joint ultrasound readings in rheumatoid arthritis (RA) in relation to its duration. Subjects and methods. A total of 162 patients (mean age, 43.54±11.1 years) with a mean RA duration of 3.22±3.13 years were examined. Gray-scale ultrasound study (USS) of hand and ankle joints was performed using color Doppler energy imaging. Group 1 included 78 patients with a RA duration of less than 2 years; Group 2 consisted of 84 patients with a RA duration of more than 2 years. Results. Joint USS diagnosed osteochondral erosions twice more frequently than conventional radiography. 82% of the patients with RA were found to have synovitis; 77% had thickening of the synovial membrane (SM) with hypervascularization, the vascularization intensity scores of 2—3 being predominant; and 54% had tenosynovitis of the carpal extensor tendon. Effusion into the joint cavity, SM hypervascularization scores of 2—3, and tenosynovitis were most common in Group 1. SM thickening and osteochondral erosions were prevalent in Group 2. Conclusion. Joint USS revealed that angiogenesis and inflammation were dominant in the patients with a RA duration of less than 2 years and the proliferative-destructive processes were prevalent in those with a RA duration of more than 2 years. Identifying the predominance of pathophysiological processes in each specific patient with RA will be able to individualize therapy and to improve the prognosis of the disease.
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19
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Wang CC, Lee SH, Lin HY, Liu FW, Chiou HJ, Chan RC, Chou CL. Short-term effect of ultrasound-guided low-molecular-weight hyaluronic acid injection on clinical outcomes and imaging changes in patients with rheumatoid arthritis of the ankle and foot joints. A randomized controlled pilot trial. Mod Rheumatol 2017; 27:973-980. [DOI: 10.1080/14397595.2016.1270496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Si-Huei Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Wei Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veteran General Hospital Puli Branch, Nantou, Taiwan
| | - Hong-Jen Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Rai-Chi Chan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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20
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De Dea M, L Loizou C, Allen GM, Wilson DJ, Athanasou N, Uchihara Y, Cooke P, Cosker T. Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function. Br J Radiol 2016; 90:20160816. [PMID: 27993094 DOI: 10.1259/bjr.20160816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the prevalence of injury of the talonavicular ligament (TNL) in ankle sprains, its anatomy and the stability of the talonavicular joint (TNJ) before and after dividing the TNL in a cadaver. METHODS During a prospective study of 100 patients to assess the outcome of ankle injuries, we noted high incidence of TNL injuries; we will discuss here the TNL findings. Each patient had undergone ultrasound and cone beam CT examination of the ankle. Six TNLs were dissected off fresh-frozen cadaveric feet for histological analysis. In further six cadaveric feet, the stability of the TNJ was assessed by mechanical stress before and after division of the TNL; movement at the joint was assessed by measuring the distance between the talus and navicular bone [talonavicular distance (TD)] using ultrasound. The TD was measured on ten randomly selected ultrasound images by three independent observers and repeated twice by a single observer to determine the inter- and intraobserver reliability. RESULTS 21% of the patients had an injury to the TNL. Histological examination demonstrated a dense connective tissue composed of bundles of collagen in parallel arrangement along the ligament length. The interobserver and intraobserver reliability of the TD showed almost perfect agreement. Displacement at the TNJ after stress with the TNL intact measured 0.18 ± 0.08 cm and 0.29 ± 0.07 cm (p < 0.005) when divided. CONCLUSION The TNL is surprisingly commonly injured in ankle sprains. Its anatomy and histology suggest a role in tensile force transmission during the windlass mechanism in gait. Advances in knowledge: Injury to the TNL is common and has not been described. Its anatomy suggests resistance to tensile forces and its injury allows excessive movement at the TNJ.
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Affiliation(s)
- Miriam De Dea
- 1 Department of Radiology, St Lukes Radiology, Oxford, UK
| | - Constantinos L Loizou
- 2 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - David J Wilson
- 1 Department of Radiology, St Lukes Radiology, Oxford, UK
| | - Nick Athanasou
- 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - Yoshinobu Uchihara
- 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - Paul Cooke
- 2 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Thomas Cosker
- 4 Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK
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21
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In arthritis the Doppler based degree of hypervascularisation shows a positive correlation with synovial leukocyte count and distinguishes joints with leukocytes greater and less than 5/nL. Joint Bone Spine 2016; 83:517-23. [DOI: 10.1016/j.jbspin.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
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22
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Pascart T, Herbaux C, Lemaire A, Soncin F, Hachulla E, Hatron PY, Terriou L. Coexistence of rheumatoid arthritis and TEMPI syndrome: New insight in microangiogenic-related diseases. Joint Bone Spine 2016; 83:587-8. [DOI: 10.1016/j.jbspin.2015.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
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23
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Bellis E, Scirè CA, Carrara G, Adinolfi A, Batticciotto A, Bortoluzzi A, Cagnotto G, Caprioli M, Canzoni M, Cavatorta FP, De Lucia O, Di Sabatino V, Draghessi A, Filippou G, Farina I, Focherini MC, Gabba A, Gutierrez M, Idolazzi L, Luccioli F, Macchioni P, Massarotti MS, Mastaglio C, Menza L, Muratore M, Parisi S, Picerno V, Piga M, Ramonda R, Raffeiner B, Rossi D, Rossi S, Rossini P, Sakellariou G, Scioscia C, Venditti C, Volpe A, Matucci-Cerinic M, Iagnocco A. Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology. Rheumatology (Oxford) 2016; 55:1826-36. [PMID: 27354688 DOI: 10.1093/rheumatology/kew258] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of US-detected tenosynovitis in RA patients in clinical remission and to explore its clinical correlates. METHODS A total of 427 RA patients in clinical remission were consecutively enrolled from 25 Italian rheumatology centres. Tenosynovitis and synovitis were scored by US grey scale (GS) and power Doppler (PD) semi-quantitative scoring systems at wrist and hand joints. Complete clinical assessment was performed by rheumatologists blinded to the US results. A flare questionnaire was used to assess unstable remission (primary outcome), HAQ for functional disability and radiographic erosions for damage (secondary outcomes). Cross-sectional relationships between the presence of each US finding and outcome variables are presented as odds ratios (ORs) and 95% CIs, both crude and adjusted for pre-specified confounders. RESULTS The prevalence of tenosynovitis in clinical remission was 52.5% (95% CI 0.48, 0.57) for GS and 22.7% (95% CI 0.19, 0.27) for PD, while the prevalence of synovitis was 71.6% (95% CI 0.67, 0.76) for GS and 42% (95% CI 0.37, 0.47) for PD. Among clinical correlates, PD tenosynovitis associated with lower remission duration and morning stiffness while PD synovitis did not. Only PD tenosynovitis showed a significant association with the flare questionnaire [OR 1.95 (95% CI 1.17, 3.26)]. No cross-sectional associations were found with the HAQ. The presence of radiographic erosions associated with GS and PD synovitis but not with tenosynovitis. CONCLUSIONS US-detected tenosynovitis is a frequent finding in RA patients in clinical remission and associates with unstable remission.
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Affiliation(s)
| | | | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Antonella Adinolfi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | | | | | - Giovanni Cagnotto
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo
| | - Marta Caprioli
- Medicine Department, Istituti Clinici di Pavia e Vigevano, Pavia
| | | | | | - Orazio De Lucia
- Division and Chair of Rheumatology, Gaetano Pini Orthopaedic Institute, Milan
| | - Valentina Di Sabatino
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | - Antonella Draghessi
- Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi
| | - Georgios Filippou
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | - Ilaria Farina
- Rheumatology Department, S. Anna di Cona University Hospital, Ferrara
| | | | - Alessandra Gabba
- Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato
| | - Marwin Gutierrez
- Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi
| | | | | | | | | | | | - Luana Menza
- Rheumatology Unit, Moriggia-Pelascini Hospital, Gravedona
| | | | - Simone Parisi
- SC Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin
| | - Valentina Picerno
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | - Matteo Piga
- Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, DIMED, University of Padova, Padova
| | | | | | - Silvia Rossi
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo
| | - Paola Rossini
- Rheumatology Unit, P.O. Destra Secchia, Pieve di Coriano
| | | | | | | | | | | | - Annamaria Iagnocco
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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Biswas SK, van Es P, Steenbergen W, Manohar S. A Method for Delineation of Bone Surfaces in Photoacoustic Computed Tomography of the Finger. ULTRASONIC IMAGING 2016; 38:63-76. [PMID: 26048066 DOI: 10.1177/0161734615589288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Photoacoustic (PA) imaging of interphalangeal peripheral joints is of interest in the context of using the synovial membrane as a surrogate marker of rheumatoid arthritis. Previous work has shown that ultrasound (US) produced by absorption of light at the epidermis reflects on the bone surfaces within the finger. When the reflected signals are backprojected in the region of interest, artifacts are produced, confounding interpretation of the images. In this work, we present an approach where the PA signals known to originate from the epidermis are treated as virtual US transmitters, and a separate reconstruction is performed as in US reflection imaging. This allows us to identify the bone surfaces. Furthermore, the identification of the joint space is important as this provides a landmark to localize a region-of-interest in seeking the inflamed synovial membrane. The ability to delineate bone surfaces allows us to identify not only the artifacts but also the interphalangeal joint space without recourse to new US hardware or a new measurement. We test the approach on phantoms and on a healthy human finger.
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Affiliation(s)
- S K Biswas
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore, India
| | - P van Es
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - W Steenbergen
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - S Manohar
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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25
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Uson J, Miguélez-Sánchez R, de Los Riscos M, Martínez-Blasco MJ, Fernández-Espartero C, Villaverde-García V, Garrido J, Naredo E. Elbow clinical, ultrasonographic and radiographic study in patients with inflammatory joint diseases. Rheumatol Int 2015; 36:377-86. [PMID: 26597491 DOI: 10.1007/s00296-015-3394-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
Abstract
The main objective of this cross-sectional observational study was to investigate the relationship between clinical, ultrasonographic (US) and radiographic elbow features in patients with inflammatory joint diseases (IJD). The secondary objective was to evaluate the association between regional clinical elbow diagnoses and imaging findings. Consecutive patients with IJD attending follow-up visits were assessed for elbow pain and standardized elbow examination. Seven regional clinical diagnoses were defined. Digital elbow radiographs were read for 9 abnormalities. A standardized elbow grayscale (GS) and power Doppler (PD) scan recorded 13 defined abnormalities. Analysis encompassed 361 clinical, 361 US and 340 radiographic elbow assessments from 181 patients. US and clinical assessments showed an overall higher agreement than radiographic and clinical assessments (68.8 vs 59.1%, p = 0.001). When structural US abnormalities were compared with radiographic findings, agreement was slightly higher than when comparing all US abnormalities with radiographic findings (77.3%, k 0.533 and 73.5%, k 0.492). Enthesophytes, the most common abnormalities, were not associated with clinical findings. Subclinical US-synovitis and US-enthesopathy were found, respectively, in 17.3 and 14.1% of the clinically normal elbows. Clinical elbow arthritis prevalence and bias-adjusted kappa (PABAK) agreement was good for radiographic fat pad sign, PD-synovitis and GS-synovitis. Clinical elbow enthesopathy PABAK agreement was moderate for GS-enthesopathy and radiographic calcifications. US showed acceptable agreement with clinical and radiographic assessments for detecting elbow inflammatory and structural abnormalities in patients with IJD. Because US detected more abnormalities than radiography and has the capability to detect more subclinical abnormalities, US may be potentially used as a first-line elbow diagnostic tool in this clinical setting.
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Affiliation(s)
- Jacqueline Uson
- Department of Rheumatology, Hospital Universitario Móstoles, Rey Juan Carlos University, Rio Jucar SN, 28932, Mostoles, Madrid, Spain.
| | - Roberto Miguélez-Sánchez
- Department of Rheumatology, Hospital Universitario Móstoles, Rey Juan Carlos University, Rio Jucar SN, 28932, Mostoles, Madrid, Spain
| | - Marina de Los Riscos
- Department of Rheumatology, Hospital Universitario Móstoles, Rey Juan Carlos University, Rio Jucar SN, 28932, Mostoles, Madrid, Spain
| | - María Jesús Martínez-Blasco
- Department of Rheumatology, Hospital Universitario Móstoles, Rey Juan Carlos University, Rio Jucar SN, 28932, Mostoles, Madrid, Spain
| | - Cruz Fernández-Espartero
- Department of Rheumatology, Hospital Universitario Móstoles, Rey Juan Carlos University, Rio Jucar SN, 28932, Mostoles, Madrid, Spain
| | - Virginia Villaverde-García
- Department of Rheumatology, Hospital Universitario Móstoles, Rey Juan Carlos University, Rio Jucar SN, 28932, Mostoles, Madrid, Spain
| | - Jesús Garrido
- Department of Social Psychology and Methodology, Faculty of Psychology, Autonoma University, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain
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Mancarella L, Addimanda O, Pelotti P, Pignotti E, Pulsatelli L, Meliconi R. Ultrasound detected inflammation is associated with the development of new bone erosions in hand osteoarthritis: a longitudinal study over 3.9 years. Osteoarthritis Cartilage 2015; 23:1925-32. [PMID: 26521738 DOI: 10.1016/j.joca.2015.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/15/2015] [Accepted: 06/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the association between ultrasound (US) detected inflammation at baseline and the subsequent development of new bone erosions at follow-up in patients with hand osteoarthritis (HOA). METHOD 32 of the 35 (10 controls, 12 patients with non erosive HOA (non-EHOA), 13 with EHOA subjects originally studied were re-evaluated 3.9 years after the initial study, by means of standard radiography and US examination. Kellgren-Lawrence (K-L) and Kallman scores were utilized to evaluate 576 interphalangeal (IP) joints. US detected synovial inflammation features were scored as present/absent. US detected bone erosions were also investigated. The association between synovial inflammation features at baseline and the development of new bone erosions was evaluated using the generalized linear mixed model (GLMM) after adjustment for patient effect, age, gender, body mass index. RESULTS In HOA patients, radiographic scores worsened and bone erosions progressed. In HOA patients similar percentages of joints with Power Doppler Signal (PDS) and gray scale (GS) synovitis were found comparing baseline and follow-up examinations, whilst a significant increase was found in the joints with effusions. Only a minority of joints were positive on both occasions (between 2 and 6 %), the majority fluctuated between positive and negative and vice versa. PDS positivity was associated with new radiographic central erosions and US-detected bone erosions, whereas GS synovitis and effusion were not. CONCLUSIONS Radiographic scores and bone erosions increased over a period of about 4 years. Synovial inflammation as detected by PDS was associated with the appearance of new bone erosions.
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Affiliation(s)
- L Mancarella
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - O Addimanda
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - P Pelotti
- Ultrasound Unit, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - E Pignotti
- Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - L Pulsatelli
- Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - R Meliconi
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy; Dept of Biomedical & Neuromotor Sciences, University of Bologna, Italy.
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Kawashiri SY, Suzuki T, Nishino A, Nakashima Y, Horai Y, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Isomoto I, Uetani M, Aoyagi K, Kawakami A. Automated Breast Volume Scanner, a new automated ultrasonic device, is useful to examine joint injuries in patients with rheumatoid arthritis. Mod Rheumatol 2015; 25:837-41. [PMID: 25867232 DOI: 10.3109/14397595.2015.1040226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the clinical application of automated scanning of wrist and finger joints by an Automated Breast Volume Scanner (ABVS) in patients with rheumatoid arthritis (RA). METHODS A total of 140 metacarpophalangeal (MCP) joints and 28 wrist joints from the 14 active RA patients were examined by both an ABVS system (the ACUSON S2000) from dorsal sites and by conventional ultrasonography (US) from multiple directions on the same day. We used a semiquantitative scale from 0 to 3 of synovial hypertrophy and the presence of bone erosion by grayscale for both methods; the efficacy of the two methods for identifying synovial hypertrophy and bone erosion were evaluated by kappa coefficient. RESULTS The scanning time of the ABVS was 2 min per patient and that of conventional US was 15 min per patient. The kappa coefficients of synovial hypertrophy in the MCP joints were 0.60 and 0.79 in wrist joints. These values were increased in the joints where synovial hypertrophy was moderate to severe (scores greater than 2). The kappa coefficients for the presence of bone erosion in the MCP joints were 0.74 and 0.93 in wrist joints. CONCLUSION The present data showed a substantial agreement between ABVS and conventional US for assessments of the synovial hypertrophy and bone erosion of wrist and finger joints in patients with RA. Since ABVS can scan the wrist and finger joints automatically in a short time, ABVS is a helpful new ultrasonic method to examine joint injuries in patients with RA.
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Affiliation(s)
- Shin-Ya Kawashiri
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Takahisa Suzuki
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ayako Nishino
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshikazu Nakashima
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshiro Horai
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Naoki Iwamoto
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kunihiro Ichinose
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Mami Tamai
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hideki Nakamura
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomoki Origuchi
- c Health Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ichiro Isomoto
- d Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masataka Uetani
- d Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kiyoshi Aoyagi
- b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Atsushi Kawakami
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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Artul S, Habib G. Ultrasound findings of the painful ankle and foot. J Clin Imaging Sci 2014; 4:25. [PMID: 24991476 PMCID: PMC4078419 DOI: 10.4103/2156-7514.133257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/08/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To document the prevalence and spectrum of musculoskeletal ultrasound (MSKUS) findings at different parts of the foot. MATERIALS AND METHODS All MSKUS studies conducted on the foot during a 2-year period (2012-2013) at the Department of Radiology were reviewed. Demographic parameters including age, gender, and MSKUS findings were documented. RESULTS Three hundred and sixty-four studies had been conducted in the 2-year period. Ninety-three MSKUS evaluations were done for the ankle, 30 studies for the heel, and 241 for the rest of the foot. The most common MSKUS finding at the ankle was tenosynovitis, mostly in female patients; at the heel it was Achilles tendonitis, also mostly in female patients; and for the rest of the foot it was fluid collection and presence of foreign body, mainly in male patients. The number of different MSKUS abnormalities that were reported was 9 at the ankle, 9 at the heel, and 21 on the rest of the foot. CONCLUSIONS MSKUS has the potential for revealing a huge spectrum of abnormalities. The most common finding was collection/hematoma and foreign bodies at the foot, tenosynovitis at the ankle, and Achilles tendinitis at the heel.
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Affiliation(s)
- Suheil Artul
- Department of Radiology, EMMS Nazareth Hospital, Nazareth, Israel ; Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - George Habib
- Rheumatology Clinic, EMMS Nazareth Hospital, Nazareth, Israel
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