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Liu S, Zhao C, Zhang R, Wang Q, Wang M, Jiang Y, Yang M. Role of Ultrasonic Microbubbles in Treating Rheumatoid Arthritis: Enhancing the Efficacy of Tocilizumab via Contrast-Enhanced Ultrasound-Monitored, Ultrasound-Targeted Microbubble Destruction. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2407-2412. [PMID: 37659958 DOI: 10.1016/j.ultrasmedbio.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Our aim was to explore the feasibility of using ultrasound-targeted microbubble destruction (UTMD) to deliver tocilizumab and enhance its efficacy in treating rheumatoid arthritis (RA). METHODS Rats with adjuvant-induced arthritis were randomly assigned to one of five treatment groups: group 1, tocilizumab + microbubbles (MBs) + UTMD; group 2, tocilizumab + MBs; group 3, tocilizumab + saline; group 4, MBs + UTMD; group 5, no treatment. We employed a commercially available ultrasound (US) machine capable of performing contrast-enhanced ultrasound (CEUS) and UTMD simultaneously using a single probe. CEUS was performed to monitor the entry and collapse of MBs. After treatment, the rats' left hindlimb paws were harvested for immunohistochemical staining of interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α). RESULTS After injection of the mixture of drugs and MBs with UTMD, significant enhancement was seen in the inflamed hindlimb paw regions, which subsided immediately on exposure to low-frequency US beams and re-appeared in the intervals between beam exposures. IL-6 expression was significantly lower in groups 1, 2 and 3 than in groups 4 and 5 (p < 0.01). Group 1 had the lowest level of IL-6 expression (p [G1 vs. G2] < 0.01, p [G1 vs. G3] < 0.01). The levels of TNF-α expression in groups 1, 2, and 3 were significantly lower than those in groups 4 and 5, but no difference was observed in these levels between groups 1-3. CONCLUSION UTMD shows promise in enhancing the treatment efficacy of anti-IL-6 drugs for RA treatment.
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Affiliation(s)
- Sirui Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Rui Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Ming Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Seskute G, Jasionyte G, Rugiene R, Butrimiene I. The Use of Superb Microvascular Imaging in Evaluating Rheumatic Diseases: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1641. [PMID: 37763760 PMCID: PMC10537482 DOI: 10.3390/medicina59091641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Superb microvascular imaging is an advanced Doppler algorithm that seems to be useful in detecting low-velocity blood flow without using a contrast agent. Increasing evidence suggests that SMI is a more sensitive tool than conventional Doppler techniques for evaluating rheumatic diseases, especially inflammatory arthritis. We aimed to assess the use of SMI in evaluating joints and extraarticular structures. Materials and Methods: Two reviewers independently reviewed the literature to provide a global overview of the possibilities of SMI in rheumatology. Original English-language articles published between February 2014 and November 2022 were identified through database (PubMed, Medline, Ebsco, the Cochrane Library, and ScienceDirect) searching, and analysed to summarise existing evidence according to PRISMA methodology. Inclusion criteria covered original research articles reporting applications of SMI on rheumatic diseases and musculoskeletal disorders secondary to rheumatic conditions. Qualitative data synthesis was performed. Results: A total of 18 articles were included. No systematic reviews fulfilled our inclusion criteria. Most studies focused on characterising the synovial vascularity of rheumatoid arthritis. There have been several attempts to demonstrate SMI's value for evaluating extra-articular soft tissues (fat pads or salivary glands) and large-diameter vessels. The quantitative importance of SMI vascular indices could become a useful non-invasive diagnostic marker. Studies on therapeutic applications are still scarce, and the majority of studies have gaps in reporting the methodology (ultrasound performance technique and settings) of the research. Conclusions: SMI has proved to be useful in characterising low-flow vascularity, and growing evidence indicates that SMI is a non-invasive and lower-cost tool for prognostic assessment, especially in inflammatory arthritis. Preliminary findings also suggest potential interest in evaluating the effect of treatment.
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Affiliation(s)
- Goda Seskute
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
| | - Gabija Jasionyte
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
| | - Rita Rugiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, LT-08406 Vilnius, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
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Miladi S, Boussaa H, Ben Abdelghani K, Ajlani H, Haddouche A, Slimani S, El Maghraoui A, Bahiri R, Laatar A. Development of a guideline for the use of ultrasonography in rheumatoid arthritis: Preliminary recommendations. LA TUNISIE MEDICALE 2023; 101:609-611. [PMID: 38445421 PMCID: PMC11389828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 03/07/2024]
Abstract
AIM To address the protocol of recommendations for the use of ultrasonography (US) in the management of rheumatoid arthritis (RA) in routine practice. METHODS The present study is a protocol design for practical guidelines. Based on a systematic literature review, the scientific committee (composed of 6 experts on US) decided on key questions which will be used to develop recommendations. These recommendations will be submitted to a group of experts in US in rheumatic and musculoskeletal diseases using the Delphi method. This step will lead to preliminary recommendations. The next step will be to submit the preliminary guideline to an expanded group of US experts to check their relevance. The level of agreement of the experts will be recorded during a web-based meeting. RESULTS Following two rounds of the Delphi method, a consensus will be addressed. The latter will i) Highlight the use of US for the diagnosis of RA in an early stage of the disease; ii) Define the role of US during follow-up; and iii) Underline the importance of US for the management of clinical remission. CONCLUSION These recommendations will harmonize and optimize clinical practice and management of RA patients.
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Affiliation(s)
- Saoussen Miladi
- University Tunis El Manar, faculty of Medicine of Tunis, Mongi Slim hospital, Rheumatology department, Tunis, Tunisia
- North African rheumatology imaging expert committee
| | - Hiba Boussaa
- University Tunis El Manar, faculty of Medicine of Tunis, Mongi Slim hospital, Rheumatology department, Tunis, Tunisia
- North African rheumatology imaging expert committee
| | - Kawther Ben Abdelghani
- University Tunis El Manar, faculty of Medicine of Tunis, Mongi Slim hospital, Rheumatology department, Tunis, Tunisia
- North African rheumatology imaging expert committee
| | - Houda Ajlani
- Ben Arous hospital, Tunisia
- North African rheumatology imaging expert committee
| | - Assia Haddouche
- Department of rheumatology, Ben Aknoun specialized hospital in the musculoskeletal system. Algiers 16306, Algeria
- North African rheumatology imaging expert committee
| | - Samy Slimani
- Atlas clinic of rheumatology. 81, cite 500 logements, Batna 05000, Algeria
- North African rheumatology imaging expert committee
| | - Abdellah El Maghraoui
- Rheumatology private office, Mohamed V, Av Bait Lahm St. ImmB, n6, Rabat, Morocco
- North African rheumatology imaging expert committee
| | - Rachid Bahiri
- Al Ayachi hospital, CHU Rabat-Salé. Rheumatology department, Morocco
- North African rheumatology imaging expert committee
| | - Ahmed Laatar
- University Tunis El Manar, faculty of Medicine of Tunis, Mongi Slim hospital, Rheumatology department, Tunis, Tunisia
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Liu S, Zhang R, Han T, Pan Y, Zhang G, Long X, Zhao C, Wang M, Li X, Yang F, Sang Y, Zhu L, He X, Li J, Zhang Y, Li C, Jiang Y, Yang M. Validation of photoacoustic/ultrasound dual imaging in evaluating blood oxygen saturation. BIOMEDICAL OPTICS EXPRESS 2022; 13:5551-5570. [PMID: 36425613 PMCID: PMC9664893 DOI: 10.1364/boe.469747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Photoacoustic imaging (PAI) was performed to evaluate oxygen saturation (sO2) of blood-mimicking phantoms, femoral arteries in beagles, and radial arteries in humans at various sO2 plateaus. The accuracy (root mean square error, RMSE) of PAI sO2 compared with reference sO2 was calculated. In blood-mimicking phantoms, PAI achieved an accuracy of 1.49% and a mean absolute error (MAE) of 1.09% within 25 mm depth, and good linearity (R = 0.968; p < 0.001) was obtained between PAI sO2 and reference sO2. In canine femoral arteries, PAI achieved an accuracy of 2.16% and an MAE of 1.58% within 8 mm depth (R = 0.965; p < 0.001). In human radial arteries, PAI achieved an accuracy of 3.97% and an MAE of 3.28% in depth from 4 to 14 mm (R = 0.892; p < 0.001). For PAI sO2 evaluation at different depths in healthy volunteers, the RMSE accuracy of PAI sO2 increased from 2.66% to 24.96% with depth increasing from 4 to 14 mm. Through the multiscale method, we confirmed the feasibility of the hand-held photoacoustic/ultrasound (PA/US) in evaluating sO2. These results demonstrate the potential clinical value of PAI in evaluating blood sO2. Consequently, protocols for verifying the feasibility of medical devices based on PAI may be established.
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Affiliation(s)
- Sirui Liu
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- The authors contributed equally to this manuscript
| | - Rui Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- The authors contributed equally to this manuscript
| | - Tao Han
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Yinhao Pan
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Guangjie Zhang
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Xing Long
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Chenyang Zhao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ming Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xuelan Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fang Yang
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Yuchao Sang
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Lei Zhu
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Xujin He
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Changhui Li
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Meng Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Singh E, Banerjee R. In vivo efficacy & phantom imaging connote the theranostic potential of a drug-loaded lipid nanobubble. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diao XH, Shen Y, Chen L, Zhan J, Fang L, Liu YC, Chen Y. Superb microvascular imaging is as sensitive as contrast-enhanced ultrasound for detecting synovial vascularity in rheumatoid arthritis. Quant Imaging Med Surg 2022; 12:2866-2876. [PMID: 35502398 PMCID: PMC9014166 DOI: 10.21037/qims-21-859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/07/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND Detection of synovitis is essential for assessing rheumatoid arthritis (RA) activity and predicting prognosis. This study aimed to compare the diagnostic performance of superb microvascular imaging (SMI) with that of contrast-enhanced ultrasound (CEUS) in patients with RA in clinical remission. METHODS SMI and CEUS were applied to 63 patients with active RA and 48 patients with RA in clinical remission. Differences in positive synovial vascularity (SV) and its semi-quantitative scale were observed, and the correlations of SMI and CEUS results with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were analyzed. RESULTS For the 63 joints with active RA, the detection rates of SV as determined by SMI and CEUS were 90.5% (95% CI: 83.0-97.9%) and 93.7% (95% CI: 87.5-99.8%), respectively, with no significant difference observed between the two modalities (t=-1.137; P=0.260). There was good agreement between the two modalities in detecting positive blood flow (Kappa =0.784) and blood flow signal score (Kappa =0.792). For the 48 joints with clinical remission, the detection rates of SV determined by SMI and CEUS were 79.2% (95% CI: 67.2-91.1%) and 83.3% (95% CI: 72.4-94.3%), respectively, with no significant difference found between the two modalities (t=1.000; P=0.322). There was high consistency between the two modalities in detecting positive blood flow (Kappa =0.727) and blood flow signal score (Kappa =0.661). The vascularity scores of SMI and CEUS were positively correlated with CRP, ESR, and RF in the joints with active RA, but not in those with clinical remission. CONCLUSIONS SMI is as sensitive as CEUS for detecting vessels in the synovium and displaying local SV in patients with RA who achieve clinical remission.
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Affiliation(s)
- Xue-Hong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yan Shen
- Department of Rheumatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Ying-Chun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
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Jana M, Mittal D, Bagri N, Yadav R, Parihar V, Bagri NK. Role of Imaging in Childhood Arthritis. J Clin Rheumatol 2022; 28:e539-e544. [PMID: 33843776 DOI: 10.1097/rhu.0000000000001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Imaging plays a pivotal role in the management of various childhood arthritis. Conventional radiography is the most commonly ordered imaging modality for the evaluation of arthritis. Owing to their higher sensitivity for detecting synovitis, magnetic resonance imaging and ultrasonography are increasingly being used to guide clinical management of various forms of arthritis, especially juvenile idiopathic arthritis. Magnetic resonance imaging is a preferred modality for evaluating more complex sites such as the sacroiliac joint. In this review, we have discussed the rational use and the characteristic imaging features of common childhood arthritis.
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Affiliation(s)
- Manisha Jana
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Disha Mittal
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Neha Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Richa Yadav
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Vivek Parihar
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Narendra Kumar Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
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Gong Y, Huang Y, Su Y, He J, Chen S. Value of Contrast-Enhanced Ultrasonography in Evaluating Rheumatoid Arthritis: Preliminary Research Based on an Animal Model. Med Sci Monit 2021; 27:e931327. [PMID: 34172694 PMCID: PMC8243804 DOI: 10.12659/msm.931327] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of grayscale ultrasound (GSUS), power Doppler imaging (PDI), and contrast-enhanced ultrasonography (CEUS) in early rheumatoid arthritis (RA) diagnosis through animal experiments. MATERIAL AND METHODS A rabbit RA model was constructed. The animals were randomly divided into 2 groups, namely, the RA model group and the control group. GSUS, PDI, and CEUS were performed in the model group during early RA and were compared with pathology of synovial biopsies. The consistency of 3 types of ultrasonography was evaluated in tandem with pathological grading. RESULTS 23 rabbits in the RA model group completed the experiment. GSUS showed that the synovial thickening of grades 1, 2 and 3 occurred in 12, 19, and 15 joints, respectively. The sensitivity, specificity, and accuracy of PDI in the diagnosis of knee joint synovitis in RA grades 1, 2, and 3 were 80.56% (29/36), 60.00% (6/10), and 76.09% (35/46), respectively, while those with CEUS were 94.44% (34/36), 90.00% (9/10), and 93.47% (43/46), respectively. The differences in diagnostic sensitivity, specificity, and accuracy of the 2 methods were statistically significant. Additionally, the thickness of the synovium measured with GSUS precontrast was greater than that of postcontrast. CONCLUSIONS RA evaluated with GSUS is often more hypertrophied than when evaluated with CEUS, while evaluation by PDI is less hypertrophied than that by CEUS. However, from a practical view point, GSUS and PDI are of sufficient practical value, except for in a few special cases.
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Affiliation(s)
- Yiran Gong
- Department of Ultrasonic Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yinan Huang
- Department of Ultrasonic Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yiming Su
- Department of Ultrasonic Imaging, First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China (mainland)
| | - Juxin He
- Department of Ultrasonic Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Shuqiang Chen
- Department of Ultrasonic Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
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Abstract
OBJECTIVE. The purpose of this article is to cover technical advances in musculo-skeletal ultrasound from the viewpoint of the radiologist. CONCLUSION. Among the advances in musculoskeletal ultrasound that we highlight the use of ultrahigh-frequency transducers to visualize ever-finer anatomic detail, the expanding practical clinical applications for microvascular imaging, and the use of elastography to predict function and, possibly, healing potential.
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Zhao C, Zhang R, Luo Y, Liu S, Tang T, Yang F, Zhu L, He X, Yang M, Jiang Y. Multimodal VEGF-Targeted Contrast-Enhanced Ultrasound and Photoacoustic Imaging of Rats with Inflammatory Arthritis: Using Dye-VEGF-Antibody-Loaded Microbubbles. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2400-2411. [PMID: 32522458 DOI: 10.1016/j.ultrasmedbio.2020.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
Owing to the heavy health burdens from rheumatoid arthritis, a sensitive and objective imaging method is needed for early diagnosis and accurate evaluation of the disease. We aimed to fabricate vascular epithelial growth factor (VEGF)-targeted microbubbles (MBs) to evaluate the expression levels of VEGF within the inflammatory lesions of rats with adjuvant-induced arthritis (AIA) using a multimodal photoacoustic (PA)/ultrasound (US) imaging system. Fluorescein isothiocyanate-biotin double-labeled vascular endothelial growth factor receptor 2 antibodies and Cy5.5-biotin double-labeled VEGF2 antibodies were added to the avidin-labeled MBs to synthesize VEGF-targeted MBs. The antibodies could specifically bind to the MBs according to the flow cytometry and fluorescence imaging. In vitro experiments on the cellular uptake of the target MBs also validated the interaction of the VEGF antibodies and the MBs. Multimodal contrast-enhanced US (CEUS)/PA imaging was performed in sequence on the inflamed paws of the AIA rats with a single PA/US imaging system after the injection of the targeted MBs. The CEUS and PA signals were then quantified and verified by the pathologic results. A CEUS pattern of fast wash in and slow washout was observed in the AIA rats after injection of targeted MBs. Compared with AIA rats injected with unconnected VEGF antibodies and naked MBs, AIA rats injected with targeted MBs presented a higher peak intensity (p = 0.0079 and 0.0079 respectively) and a longer time to peak (p = 0.0117 and 0.0117, respectively). The PA signals were also significantly enhanced after injection of targeted MBs (p = 0.0112 and 0.0119, respectively), which was in accordance with the pathologic and immunohistochemical results. In conclusion, VEGF-targeted MBs can be used as agents for multimodal CEUS/PA imaging and to detect VEGF expression in the inflammatory lesions of AIA rats in vivo. This strategy may be useful in imaging evaluation of arthritis by identifying inflammation-related molecules in different imaging modes.
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Affiliation(s)
- Chenyang Zhao
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanwen Luo
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sirui Liu
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianhong Tang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Yang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Lei Zhu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Xujin He
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Meng Yang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yuxin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Korvatko Y, Bogar WC. Radiographically Occult Manifestation of Rheumatoid Arthritis in a Patient With Prolonged Clinical and Laboratory Evidence of Rampant Disease: A Case Report. J Chiropr Med 2020; 19:128-135. [PMID: 33318731 PMCID: PMC7729203 DOI: 10.1016/j.jcm.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to present a case of rampant rheumatoid synovitis and arthritis of a patient with a long duration of symptoms and no radiographic abnormalities of rheumatoid arthritis at the initial diagnosis. CLINICAL FEATURES A 49-year-old Hispanic woman presented to a chiropractic teaching clinic with an 8-month history of bilateral, symmetrical hand pain and stiffness noted specifically in her second and third metacarpophalangeal joints. The patient has reported no other health changes and no history of rheumatoid arthritis in the family. INTERVENTION AND OUTCOME Based on this patient's complaint, initial bilateral 3-view radiographic examination of the hands using computed radiography was performed. Despite prolonged history of inflammatory joint pain and rheumatoid arthritis confirmed by abnormally high levels of rheumatoid factor, C-reactive protein, and anti-cyclic citrulline peptide antibodies, the patient had no radiographic evidence of rheumatoid arthritis during the initial and repeat radiographic studies. CONCLUSION Some patients with rheumatoid arthritis may present with rampant clinical and laboratory abnormalities despite an apparent lack of radiographically detectable rheumatoid arthritis. This case demonstrates that astute clinicians should primarily rely on the results of clinical and laboratory abnormalities of rheumatoid arthritis and not be deterred or mislead by an apparent lack of radiographic changes at diagnosis. If the diagnosis of rheumatoid arthritis requires diagnostic imaging confirmation, then magnetic resonance imaging or diagnostic ultrasound of the hands should be used, especially if the initial radiographic assessment remains unrewarding.
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Affiliation(s)
- Yuri Korvatko
- Diagnostic Imaging Department, Clinical Sciences Department, National University of Health Sciences, Lombard, Illinois
| | - William C. Bogar
- Diagnostic Imaging Department, Clinical Sciences Department, National University of Health Sciences, Lombard, Illinois
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Chen YY, Wu XS, Tian YY, Zhao P, Sun SW, Yang CB. Evaluation of Femoral Head Perfusion by Contrast-Enhanced Ultrasound in a Rabbit Model of Steroid-Induced Osteonecrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:987-995. [PMID: 31789475 DOI: 10.1002/jum.15184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/03/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To study the technical feasibility of contrast-enhanced ultrasound (CEUS) in evaluating femoral head perfusion in a rabbit model of steroid-induced femoral head osteonecrosis. METHODS Twenty rabbits were divided randomly into a control group (n = 8) and an experimental group (n = 12). Rabbits in the experimental group were induced by lipopolysaccharide and methylprednisolone to build a model of steroid-induced femoral head osteonecrosis. Contrast-enhanced ultrasound examinations were performed at 3 and 5 weeks after induction. Then, pathologic examinations and microvessel density (MVD) calculations were performed on the excised rabbit femoral heads. RESULTS The MVD of the experimental group decreased significantly 3 and 5 weeks after induction compared with that of the control group. According to the CEUS examination results, significant differences existed in the ascending slope, descending slope, mean transit time, and time to peak between the groups at 5 weeks (P < .05). A correlation analysis showed that the descending slope had a certain correlation with the MVD (correlation coefficient, 0.376). A receiver operating characteristic curve was used to analyze the capacity of the CEUS parameters to predict the occurrence of osteonecrosis. The areas under the curve for the ascending slope and descending slope were 0.758 and 0.760, respectively (P < .05). CONCLUSIONS Contrast-enhanced ultrasound can visualize the microcirculation in steroid-induced osteonecrosis of the femoral head in rabbits and may be a useful imaging method for the early monitoring and prediction of femoral head osteonecrosis.
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Affiliation(s)
- Yu-Yi Chen
- Department of Ultrasound, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Xian-Sheng Wu
- Guangdong Medical Laboratory Animal Center, Foshan, China
| | - Yuan-Yuan Tian
- Department of Ultrasound, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Ping Zhao
- Department of Ultrasound, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Shu-Wei Sun
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cheng-Bin Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases. World J Pediatr 2020; 16:52-59. [PMID: 31515696 DOI: 10.1007/s12519-019-00312-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades, but its use has only recently been explored by pediatric rheumatologists. The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases. DATA SOURCES We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far, on the applications of ultrasound in juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, dermatomyositis, enthesitis, Sjogren's syndrome, and other rheumatic diseases. In addition, articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed. RESULTS In JIA, ultrasound can be used to detect subclinical synovitis, to improve the classification of patients in JIA subtypes, to capture early articular damage, to monitor treatment response, and to guide intraarticular injections. Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms, assessment of parotid gland pathology, and measurement of skin thickness and pathology. Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders. CONCLUSIONS Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders. However, standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.
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