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Larsen AC, Møller-Hansen M, Wiencke AK, Terslev L, Torp-Pedersen S, Heegaard S. Ultrasound-Guided Transcutaneous Injection in the Lacrimal Gland: A Description of Sonoanatomy and Technique. J Ocul Pharmacol Ther 2023; 39:275-278. [PMID: 36944128 DOI: 10.1089/jop.2022.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Purpose: To develop a method of injecting a volume up to 50% of the lacrimal gland (LG) volume while minimizing patient discomfort and maximizing accurate drug delivery. Herein we describe a series of ultrasound (US)-guided transcutaneous injections in the LG and discuss the safety and feasibility of this technique. Methods: Ultrasonography was performed in 40 patients with aqueous deficient dry eye disease using a GE Logic E10 (Milwaukee, Wisconsin, USA) US machine with a 6-24 MHz transducer. US was performed by 2 medical experts in ultrasonography. We recorded the injection and observed an enlargement of the LG ensuring delivery within the LG before the needle was removed. Assessment of injection-related adverse event was performed immediately after the injection. Results: The position of the injection needle within the LG was documented in all 40 patients. Injection of the stem cells and vehicle (N = 20) or solely vehicle (N = 20) led to an enlargement of the glandular structures in all cases. No serious adverse reactions related to the injections were observed. Conclusion: US-guided injection into the LG enables injection on a closed eye causing minimum patient discomfort and maximum certainty of accurate drug delivery. US can provide real-time images and may be used to safely guide the needle ensuring correct placement and injection within the gland capsule. This reduces the risk of injury to the eye and adjacent structures and makes a precise transcutaneous injection possible. Clinical Trial Registration number: NCT04615455.
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Affiliation(s)
| | | | | | - Lene Terslev
- Department of Rheumatology and Spine Diseases, and Rigshospitalet-Glostrup, Copenhagen, Denmark
| | | | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
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2
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Christiansen SN, Hammer HB, Torp-Pedersen S, Terslev L. Comment on: Dual-energy computed tomography vs ultrasound, alone or combined, for the diagnosis of gout: a prospective study of accuracy. Rheumatology (Oxford) 2021; 60:e367-e368. [PMID: 33711101 DOI: 10.1093/rheumatology/keab243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Søren Torp-Pedersen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Andersen M, Boesen M, Ellegaard K, Söderström K, Søe NH, Spee P, Mørch UGW, Torp-Pedersen S, Bartels EM, Danneskiold-Samsøe B, Karlsson L, Bliddal H. Association between IL-6 production in synovial explants from rheumatoid arthritis patients and clinical and imaging response to biologic treatment: A pilot study. PLoS One 2018; 13:e0197001. [PMID: 29787569 PMCID: PMC5963776 DOI: 10.1371/journal.pone.0197001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/24/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction The need for biomarkers which can predict disease course and treatment response in rheumatoid arthritis (RA) is evident. We explored whether clinical and imaging responses to biologic disease modifying anti-rheumatic drug treatment (bDMARD) were associated with the individual’s mediator production in explants obtained at baseline. Methods RA Patients were evaluated by disease activity score 28 joint C-reactive protein (DAS 28-)), colour Doppler ultrasound (CDUS) and 3 Tesla RA magnetic resonance imaging scores (RAMRIS). Explants were established from synovectomies from a needle arthroscopic procedure prior to initiation of bDMARD. Explants were incubated with the bDMARD in question, and the productions of interleukin-6 (IL-6), monocyte chemo-attractive protein-1 (MCP-1) and macrophage inflammatory protein-1-beta (MIP-1b) were measured by multiplex immunoassays. The changes in clinical and imaging variables following a minimum of 3 months bDMARD treatment were compared to the baseline explant results. Mixed models and Spearman’s rank correlations were performed. P-values below 0.05 were considered statistically significant. Results 16 patients were included. IL-6 production in bDMARD-treated explants was significantly higher among clinical non-responders compared to responders (P = 0.04), and a lack of suppression of IL-6 by the bDMARDS correlated to a high DAS-28 (ρ = 0.57, P = 0.03), CDUS (ρ = 0.53, P = 0.04) and bone marrow oedema (ρ = 0.56, P = 0.03) at follow-up. No clinical association was found with explant MCP-1 production. MIP-1b could not be assessed due to a large number of samples below the detection limit. Conclusions Synovial explants appear to deliver a disease-relevant output testing which when carried out in advance of bDMARD treatment can potentially pave the road for a more patient tailored treatment approach with better treatment effects.
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Affiliation(s)
- Martin Andersen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Translational Immunology, Biopharmaceutical Research Unit, Måløv, Novo Nordisk, Denmark
- * E-mail: (MA); (HB)
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Karen Ellegaard
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kalle Söderström
- Translational Immunology, Biopharmaceutical Research Unit, Måløv, Novo Nordisk, Denmark
| | - Niels H. Søe
- Department of Orthopaedics, Section of Hand Surgery, Gentofte University Hospital, Hellerup, Denmark
| | - Pieter Spee
- Translational Immunology, Biopharmaceutical Research Unit, Måløv, Novo Nordisk, Denmark
| | | | - Søren Torp-Pedersen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Else M. Bartels
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bente Danneskiold-Samsøe
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Karlsson
- Translational Immunology, Biopharmaceutical Research Unit, Måløv, Novo Nordisk, Denmark
| | - Henning Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- * E-mail: (MA); (HB)
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4
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Thorsmark AH, Christensen OM, Torp-Pedersen S, Overgaard S, Frich LH. Changes in clavicle length in acute fractures within 3 weeks: a prospective ultrasonographic study of 59 patients. BMC Musculoskelet Disord 2017; 18:503. [PMID: 29187197 PMCID: PMC5706375 DOI: 10.1186/s12891-017-1842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within traumatology a common indication for acute surgery of fractured clavicles is bone shortening over 2 cm. This indication is among but a few indications; which are recommended to be treated operatively within the very first weeks after a fracture. Theoretically clavicle fractures could become less shortened over time due to decreasing muscle pull. If this reduced shortening does indeed happen, some patients with initial bone shortening over 2 cm could perhaps be treated conservatively? However, it is unknown what happens to the length of the clavicle within the first weeks after a fracture. The aim of this study was to investigate if the length of the fresh fractured clavicles changes within the first three weeks. METHODS Rested length measurements using navigation ultrasound were done on 59 patients with a fractured clavicle. Measurements were performed within the first three weeks after a lateral or mid-clavicular fracture. The inclusion period was from March 2014 to February 2016. Median age was 40 years and age range was 18-81 years. The data was analyzed using mixed linear models. RESULTS The clavicle length showed no change within the first three weeks after fracture (p = 0.24). CONCLUSION Fractured clavicles retain their length for the first three weeks.
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Affiliation(s)
- A. H. Thorsmark
- Department of Orthopedic Surgery and Traumatology, Holbæk Hospital, 4300 Holbæk, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odensen, Denmark
| | - O. M. Christensen
- Department of Orthopedic Surgery and Traumatology, Holbæk Hospital, 4300 Holbæk, Denmark
| | - S. Torp-Pedersen
- Department of Radiology, Rigshospitalet Glostrup, 2600 Glostrup, Denmark
| | - S. Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odensen, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - L. H. Frich
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odensen, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Bliddal H, Torp-Pedersen S, Falk-Riecke B, Bartels E. [Bursitis after vaccination in the shoulder region]. Ugeskr Laeger 2017; 179:V05170423. [PMID: 29076454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Shoulder pain may develop after vaccination in the deltoid area due to inadvertent injection of the vaccine into the subdeltoid bursa, which may be located close to the skin. As far as we know, such vaccination reactions occur more frequently than officially registered, and doctors may not be aware of the problem. We present two of these cases of a suspected inflammatory reaction in the shoulder bursa after vaccination. Injection of cortisone in the bursa may relieve the reaction to some extent, but chronic shoulder pain may develop.
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Thorsmark Høj A, Villa C, Christensen OM, Torp-Pedersen S, Overgaard S, Frich LH. Validation of Navigation Ultrasound for Clavicular Length Measurement. Ultrasound Med Biol 2017; 43:1722-1728. [PMID: 28533004 DOI: 10.1016/j.ultrasmedbio.2017.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 06/07/2023]
Abstract
Accurate clavicular length measurement is considered important for the selection of patients requiring surgical treatment after a midclavicular fracture. As radiographic length measurements can be inaccurate to varying degrees, new measurement methods are needed. Use of novel technology, navigation ultrasound, to deliver accurate measurements seems promising. To examine the reliability and validity of navigation ultrasound for length measurements of the clavicle, a study was performed using length measurements performed before forensic autopsies from 2012 to 2013. In total, 38 bodies with a median age of 52.5 (range: 21-78 y) were included. Navigation ultrasound exhibited high reliability (intra-class correlation coefficient: 0.942-0.997, standard error of the mean: 0.7-2.9 mm, minimal detectable change: 2.3-8.1 mm) and validity (measurement error: 1.3%-1.8%, limits of agreement (95% confidence interval): approximately ± 7.5 mm, Pearson's correlation R: 0.948-0.974). Navigation ultrasound can measure clavicular length with an intra-rater reliability matching that of 3-D rendered computed tomography scans and with high validity. Its use could spread to other fields requiring accurate musculoskeletal length measurements.
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Affiliation(s)
- Anders Thorsmark Høj
- Department of Orthopedic Surgery and Traumatology, Holbæk Hospital, Holbæk, Denmark; Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
| | - Chiara Villa
- Department of Forensic Medicine, Laboratory of Biological Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ole M Christensen
- Department of Orthopedic Surgery and Traumatology, Holbæk Hospital, Holbæk, Denmark
| | | | - Søren Overgaard
- Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Lars H Frich
- Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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7
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Abstract
Ultrasound is used increasingly for diagnosing large vessel vasculitis (LVV). The application of Doppler in LVV is very different from in arthritic conditions. This paper aims to explain the most important Doppler parameters, including spectral Doppler, and how the settings differ from those used in arthritic conditions and provide recommendations for optimal adjustments. This is addressed through relevant Doppler physics, focusing, for example, on the Doppler shift equation and how angle correction ensures correctly displayed blood velocity. Recommendations for optimal settings are given, focusing especially on pulse repetition frequency (PRF), gain and Doppler frequency and how they impact on detection of flow. Doppler artefacts are inherent and may be affected by the adjustment of settings. The most important artefacts to be aware of, and to be able to eliminate or minimize, are random noise and blooming, aliasing and motion artefacts. Random noise and blooming artefacts can be eliminated by lowering the Doppler gain. Aliasing and motion artefacts occur when the PRF is set too low, and correct adjustment of the PRF is crucial. Some artefacts, like mirror and reverberation artefacts, cannot be eliminated and should therefore be recognised when they occur. The commonly encountered artefacts, their importance for image interpretation and how to adjust Doppler setting in order to eliminate or minimize them are explained thoroughly with imaging examples in this review.
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Affiliation(s)
- L Terslev
- Center for Rheumatology and Spinal Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - A P Diamantopoulos
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - U Møller Døhn
- Center for Rheumatology and Spinal Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - W A Schmidt
- Medical Centre for Rheumatology, Immanuel Krankenhaus, Berlin, Germany
| | - S Torp-Pedersen
- Department Radiology, Copenhagen University Hospital. Rigshospitalet, Copenhagen, Denmark
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Ammitzbøll-Danielsen M, Glinatsi D, Torp-Pedersen S, Møller JM, Naredo E, Ostergaard M, Terslev L. Tenosynovitis Evaluation Using Image Fusion and B-Flow - A Pilot Study on New Imaging Techniques in Rheumatoid Arthritis Patients. Ultraschall Med 2017; 38:285-293. [PMID: 28511227 DOI: 10.1055/s-0043-101228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aim The aim of this study was to compare the assessment of tenosynovitis by ultrasound (US) and magnetic resonance imaging (MRI) using the image fusion technique and to investigate whether US B-flow imaging (BFI) is an alternative to Doppler US when assessing tenosynovitis. Materials and Methods 15 patients with rheumatoid arthritis (RA) had US-verified tenosynovitis in the wrist/hand. An MRI was performed of the wrist/hand with subsequent repeated US and image fusion. Images were compared in three steps: 1. Visual image comparison, 2. Quantitative measurement of transverse areas of the affected tendon and tendon sheath, using two tendon measures on MRI, area 1 and area 2, excluding and including partial volume artifacts, respectively, 3. Assessment using the OMERACT semi-quantitative scoring systems for US and MRI. Furthermore, BFI was assessed as: 0: No flow, 1: Focal flow, 2: Multifocal flow, 3: Diffuse flow, in the tendon sheath. Results The median areas on US and MRI (areas 1 and 2) were 0.16 cm2 (25;75 pctl: 0.10; 0.25), 0.9 cm2 (0.06; 0.18) and 0.13 cm2 (0.10; 0.25), respectively, for included tendons and 0.18 cm2 (0.13; 0.26), 0.27 cm2 (0.20; 0.45) and 0.23 cm2 (0.16; 0.40) for tendon sheaths. No statistically significant difference was found between US tendon area and MRI tendon area 2 (Wilcoxon's test; p = 0.47). Overall, the agreement between grayscale and color Doppler (CD) US and MRI tenosynovitis visualization and scoring was good, but not between CD and BFI. Conclusion US and MRI have high agreement using image fusion for the assessment of tenosynovitis when partial volume artifacts are taken into account. BFI is not an alternative to CD for the measurement of slow flow in tenosynovitis.
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Affiliation(s)
- Mads Ammitzbøll-Danielsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen Universitet, Copenhagen, Denmark
| | - Daniel Glinatsi
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen Universitet, Copenhagen, Denmark
| | | | - Jacob M Møller
- Department of Radiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen Universitet, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark
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Abstract
A 37-year-old man presented with hypertension and elevated urine catecholamine. Ultrasound scanning revealed a solid tumour of the right adrenal gland and two solid tumours in the retroperitoneum. The findings were confirmed with computed tomography and abdominal angiography. At surgery only the tumour of the right adrenal gland was removed. The histopathologic diagnosis was pheochromocytoma. Postoperatively the symptoms and biochemistry were unchanged and the patient was referred for further treatment. At ultrasonography and abdominal aortography 6 remaining tumours were demonstrated. Surgery was performed and 8 pheochromocytomas were extirpated (3 were closely spaced small tumours in a conglomerate corresponding to one of the visualized tumour sites). On histopathologic examination no signs of invasive growth were found. The patient recovered completely. The blood pressure was still normal 2 1/2 years later. Angiography and non-invasive examination of the entire abdomen and pelvis should be routine when pheochromocytomas are searched for.
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Abstract
Percutaneous gastrostomy, utilizing a dedicated catheterization kit, with a combination of ultrasonographic (US) and fluoroscopic guidance, was carried out in 27 patients. The main indication for gastrostomy was the need for nutritional support in malignant esophageal stricture. After distending the stomach with water via a nasogastric tube, the gastric antrum was punctured under US guidance and a guide wire was inserted, followed by fluoroscopically guided tract dilatation and insertion of a 2.5-mm Cope-loop catheter. In all patients but one (96%) the procedure was successfully completed in one or 2 attempts. Two complications occurred: one case of a small subcutaneous abscess near the puncture site, and one late incident of dislodgement of a catheter without string-loop fixation, which had been inserted at a catheter exchange after 6 weeks. Percutaneous gastrostomy guided by US and fluoroscopy is a safe and efficacious alternative to endoscopic and surgical gastrostomy.
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Abstract
Twenty-two patients with liver abscesses demonstrated by ultrasonography (US) were treated over a nine-year period. The diagnosis was in all cases verified by puncture. The patients were treated by US-guided puncture or catheter drainage. Seventeen patients (77%) were cured without surgical drainage. Four patients were cured after subsequent surgical intervention. One patient died later of pancreatic carcinoma. There were no complications from the US-guided therapy. For the treatment of liver abscesses we recommend US-guided drainage as the first choice. Close collaboration between surgeon and radiologist is mandatory since some of these patients still need surgical treatment.
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Terslev L, Torp-Pedersen S, Qvistgaard E, Bliddal H. Spectral Doppler and resistive index: A promising tool in ultrasonographic evaluation of inflammation in rheumatoid arthritis. Acta Radiol 2016; 44:645-52. [PMID: 14616209 DOI: 10.1080/02841850312331287759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the use of spectral Doppler in the longitudinal follow-up of inflammatory joint involvement in rheumatoid arthritis (RA) by comparing resistive index (RI) findings with color fraction and pain on a visual analog scale (VAS). Material and Methods: Five patients on unchanged disease modifying anti-rheumatic drugs (DMARD) treatment were followed after an intra-articular corticosteroids injection and received no further injections in the observation period. They were followed clinically and by ultrasound using color Doppler pixels and the spectral Doppler RI as indicators of inflammation. At 1, 6 and 12 months the measurements were repeated on the same joint. Results: At 1-month follow-up after the corticosteroids injection, a marked decrease in the color fraction was seen in 4 out of 5 patients, while the fifth patient had a moderate decrease (Wilcoxon p < 0.05). The changes in RI showed correspondingly a marked increase in 4 out of 5 patients indicating a diminished flow to the synovium (Wilcoxon p < 0.05). The effect of the corticosteroid injection could still be seen after 1 year in 4 out of 5 patients. In RI, pixel fraction and VAS there was improvement compared with the baseline values; however, only the pixel fraction was statistically significant (Wilcoxon p < 0.05). Conclusion: RI seems to be an objective alternative to pixel estimation of the degree of inflammation and treatment response in RA.
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Affiliation(s)
- L Terslev
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Frederiksberg, Denmark.
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Karstrup S, Glenthøj A, Torp-Pedersen S, Hegedüs L, Holm HH. Ultrasonically Guided Fine Needle Aspiration of Suggested Enlarged Parathyroid Glands. Acta Radiol 2016. [DOI: 10.1177/028418518802900215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ultrasonically guided fine needle aspiration from 22 ultrasonically suspect enlarged parathyroid glands was performed in 21 consecutive patients with biochemically confirmed hyperparathyroidism. Histologic examination revealed parathyroid tissue in 20 and thyroid tissue in 2 of the 22 ultrasonically suspect parathyroid glands. The aspirated material (21 patients) was analysed for PTH content and compared with the PTH content in aspirates from corresponding thyroid tissue. In all but one, a higher PTH content was found in aspirates from parathyroid glands. Further, the aspirated material (16 patients) was cytologically examined for parathyroid cells. In 10 of 14 histologically confirmed parathyroid glands cells of parathyroid origin were found, but in 4 cases only cells of endocrine origin were seen. The results and the use of fine needle aspiration in relation to the ultrasonic findings are discussed.
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Abstract
Two patients with disseminated prostatic cancer underwent transrectal ultrasonographic examination. In the rectal wall, at the prostatic level, tumor infiltration was seen without obvious communication to the prostate. Biopsy demonstrated adenocarcinoma, and immunohistochemic staining for prostatic specific antigen (PSA) was positive. We recommend the application of PSA staining in biopsy specimens of unclear rectal masses.
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Affiliation(s)
- T. Lorentzen
- Departments of Urology and Ultrasound, Herlev Hospital, University of Copenhagen, Denmark
| | - S. Torp-Pedersen
- Departments of Urology and Ultrasound, Herlev Hospital, University of Copenhagen, Denmark
| | - C. Nolsøe
- Departments of Urology and Ultrasound, Herlev Hospital, University of Copenhagen, Denmark
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15
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Ellegaard K, Christensen R, Rosager S, Bartholdy C, Torp-Pedersen S, Bandholm T, Danneskiold-Samsøe B, Bliddal H, Henriksen M. Exercise therapy after ultrasound-guided corticosteroid injections in patients with subacromial pain syndrome: a randomized controlled trial. Arthritis Res Ther 2016; 18:129. [PMID: 27262892 PMCID: PMC4893247 DOI: 10.1186/s13075-016-1002-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Subacromial pain syndrome (SAPS) accounts for around 50 % of all cases of shoulder pain. The most commonly used treatments are glucocorticosteroid (steroid) injections and exercise therapy; however, despite treatment SAPS patients often experience relapse of their symptoms. Therefore the clinical effect of combining steroid and exercise therapy is highly relevant to clarify. The aim of this randomized controlled trial was to investigate if exercise therapy added to steroid injection in patients with SAPS will improve the effect of the injection therapy on shoulder pain. Methods In this two-arm randomized trial running over 26 weeks, patients with unilateral shoulder pain (> 4 weeks) and thickened subacromial bursa (> 2 mm on US) were included. At baseline all participants received two steroid injections into the painful shoulder with an interval of one week. Subsequently they were randomized (1:1) to either 10 weeks exercise of the involved shoulder (intervention group) or exercise of the uninvolved shoulder (control group). The patients were re-examined after the exercise program (at week 13) and again at week 26. The primary outcome assessed after 26 weeks was change in shoulder pain analyzed using the intention-to-treat principle (non-responder imputation). Results Ninety-nine SAPS patients (58 female) participated (49 intervention/50 control). At both follow up visits (week 13 and 26) no statistically significant between-group differences in pain changes on a visual analog scale (mm) were seen (13 weeks: pain at rest 1.7 (95 % CI –3.6 to 7.0; P = 0.53); pain in activity 2.2 (95 % CI –6.5 to 10.9; P = 0.61), 26 weeks: rest 5.6 (95 % CI –0.9 to 12.1; P = 0.09); activity 2.2 (95 % CI –6.8 to 11.2; P = 0.62). The reduction in pain was most evident in the control group at all four pain measurements. The only difference between groups was seen by US examination at week 13, where fewer participants with impingement were observed in the intervention group compared with the controls (9 vs. 19 participants; P = 0.03). Conclusion Exercise therapy in the painful shoulder in SAPS patients did not improve the effectiveness of steroid injections for shoulder pain in patients with unilateral SAPS and enlarged subacromial bursa on US examination. Trial registration ClinicalTrials.gov (NCT01506804). Registration date 5 May 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1002-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Ellegaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark
| | - Sara Rosager
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark
| | - Søren Torp-Pedersen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,Department of Radiology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen [PMR-C], Department of Physical Therapy, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.,Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bente Danneskiold-Samsøe
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen F, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Copenhagen, Denmark
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16
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Ammitzbøll-Danielsen M, Glinatsi D, Østergaard M, Torp-Pedersen S, Terslev L. AB0961 Comparison between Ultrasound B-Flow, Colour Doppler and Magnetic Resonance Imaging for Assessment of Tenosynovitis in The Hand of Rheumatoid Arthritis Patients - A Pilot Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Møller Døhn U, Torp-Pedersen S, Hammer H, Koski J, Luosujarvi R, Terslev L. SAT0563 Optimized Doppler Setting Increase Scores of Synovitis and Colour Fraction in Rheumatoid Arthritis Wrist Joints - Experience from A Targeted Ultrasound Initiative Workshop. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ammitzbøll-Danielsen M, Janta I, Torp-Pedersen S, Naredo E, Østergaard M, Terslev L. Three-dimensional Doppler ultrasound findings in healthy wrist and finger tendon sheaths - can feeding vessels lead to misinterpretation in Doppler-detected tenosynovitis? Arthritis Res Ther 2016; 18:70. [PMID: 26993979 PMCID: PMC4797218 DOI: 10.1186/s13075-016-0968-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/04/2016] [Indexed: 01/08/2023] Open
Abstract
Background The aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct interpretation of Doppler signals when diagnosing tenosynovitis. Method Forty healthy participants (20 women and 20 men age 23-67 years) without prior history of arthritis, tendon diseases or present pain in their hands were included. Twenty participants had 3D Doppler US of the second and third finger and twenty of the right wrist. US was carried out using a GE Logiq E9 unit with a 3D US probe. The colour Doppler settings were to published recommendation. Results The feeding vessels in or in close proximity to the tendon sheaths were found in the flexor and extensor tendons sheaths at least once in each participant. No significant difference in feeding vessels was seen between the radial and carpal level in the wrist (p = 0.06) or between the second and third flexor tendon sheath (p = 0.84). Conclusion Doppler findings in or in close proximity to the tendon sheaths were common in wrists and fingers in healthy participants. These feeding vessels can be a source of error, not only due to their presence but also because they may be interpreted as being inside the tendon sheath due to blooming and reverberations artefacts. These vessels should be taken into consideration when diagnosing Doppler tenosynovitis.
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Affiliation(s)
- Mads Ammitzbøll-Danielsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Iustina Janta
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Søren Torp-Pedersen
- Department of Radiology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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19
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Torp-Pedersen S, Christensen R, Ellegaard K, Torp-Pedersen A, Szkudlarek M, D'Agostino MA, Iagnocco A, Naredo E, Balint P, Wakefield RJ, Terslev L, Jensen JA. Reply. Arthritis Rheumatol 2015; 67:1681-3. [DOI: 10.1002/art.39057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/27/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Søren Torp-Pedersen
- Copenhagen University Hospital, Frederiksberg, Denmark and Copenhagen University Hospital at Glostrup; Glostrup Denmark
| | | | | | | | | | | | | | | | - Peter Balint
- National Institute of Rheumatology and Physiotherapy; Budapest Hungary
| | | | - Lene Terslev
- Copenhagen University Hospital at Glostrup; Glostrup Denmark
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20
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Andersen M, Boesen M, Ellegaard K, Söderström K, Søe N, Spee P, Mørch U, Torp-Pedersen S, Bartels E, Danneskiold-Samsøe B, Karlsson L, Bliddal H. OP0016 The Effects of Biologics on Imaging Pathology Reflects Changes in Ex Vivo Mediator Release from Rheumatoid Arthritis Synovial Explants: A Cohort Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Torp-Pedersen S, Christensen R, Szkudlarek M, Ellegaard K, D'Agostino MA, Iagnocco A, Naredo E, Balint P, Wakefield RJ, Torp-Pedersen A, Terslev L. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheumatol 2015; 67:386-95. [PMID: 25370843 DOI: 10.1002/art.38940] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 10/28/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints. METHODS Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity. RESULTS Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2. CONCLUSION The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation by ultrasound in RA patients, and this must be taken into account in multicenter studies.
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Affiliation(s)
- Søren Torp-Pedersen
- Copenhagen University Hospital, Frederiksberg, Denmark, and Copenhagen University Hospital at Glostrup, Glostrup, Denmark
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22
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Rezaei H, Torp-Pedersen S, af Klint E, Backheden M, Kisten Y, Györi N, van Vollenhoven RF. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach. Arthritis Res Ther 2014; 16:448. [PMID: 25270355 PMCID: PMC4209056 DOI: 10.1186/s13075-014-0448-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/01/2014] [Indexed: 01/19/2023] Open
Abstract
Introduction This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach. Methods One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis were included. Patients were assessed clinically including joint examination, laboratory testing including acute-phase reactants, rheumatoid factor (RF) and anti citrulinated protein antibody (ACPA), and radiographs of hands and feet if clinically indicated. A diagnostic assessment was then performed by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist. The latter then assessed the diagnostic probabilities again, using the same scale. Results The rheumatologists’ certainty for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P <0.001). With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001). MSUS findings agreed with the final diagnosis in 95% of patients. Conclusion Musculoskeletal ultrasound, when added to routine rheumatologic investigation, greatly increases the diagnostic certainty in patients referred for the evaluation of inflammatory arthritis. The changes from pre-test to post-test probability quantify the diagnostic utility of musculoskeletal ultrasound in probabilistic terms.
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23
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Riecke BF, Christensen R, Torp-Pedersen S, Boesen M, Gudbergsen H, Bliddal H. An ultrasound score for knee osteoarthritis: a cross-sectional validation study. Osteoarthritis Cartilage 2014; 22:1675-91. [PMID: 25278077 DOI: 10.1016/j.joca.2014.06.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/11/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop standardized musculoskeletal ultrasound (MUS) procedures and scoring for detecting knee osteoarthritis (OA) and test the MUS score's ability to discern various degrees of knee OA, in comparison with plain radiography and the 'Knee injury and Osteoarthritis Outcome Score' (KOOS) domains as comparators. METHOD A cross-sectional study of MUS examinations in 45 patients with knee OA. Validity, reliability, and reproducibility were evaluated. RESULTS MUS examination for knee OA consists of five separate domains assessing (1) predominantly morphological changes in the medial compartment, (2) predominantly inflammation in the medial compartment, (3) predominantly morphological changes in the lateral compartment, (4) predominantly inflammation in the lateral compartment, and (5) effusion. MUS scores displayed substantial reliability and reproducibility, with interclass correlations coefficients ranging from 0.75 to 0.97 for the five domains. Construct validity was confirmed with statistically significant correlation coefficients (0.47-0.81, P < 0.01). CONCLUSION The MUS score suggested in this study was reliable and valid in detecting knee OA. In comparison with standing radiographs of the knees, the score detected all aspects of knee OA with relevant precision.
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Affiliation(s)
- B F Riecke
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - S Torp-Pedersen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - M Boesen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - H Gudbergsen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
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Ellegaard K, Terslev L, Christensen R, Szkudlarek M, Schmidt WA, Jensen PS, Bliddal H, Torp-Pedersen S. Comparison of discrimination and prognostic value of two US Doppler scoring systems in rheumatoid arthritis patients: a prospective cohort study. Clin Exp Rheumatol 2014; 32:495-500. [PMID: 24960526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/23/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this paper is to investigate sensitivity to change (SRM), predictive validity and discriminative ability of a quantitative (QS) and a semi-quantitative (SQS) Doppler ultrasound scoring systems in patients with rheumatoid arthritis (RA) treated with anti-TNF-α therapy. METHODS RA patients with wrist joint affection treated with TNF-α inhibitor were followed for one year. The wrist was examined with Doppler before initiating therapy and after one year. DAS28 was determined at both visits. One person trained in the SQS system and one in the QS system evaluated the anonymised images. The SRM, predictive validity and discriminative ability for both systems were calculated using DAS28 as the measure of disease improvement. RESULTS Fourty-six patients with RA (80% females) were included. The mean Doppler activity at baseline was QS:24.4% (SD=17.7%) and SQS:2.0 (SD=0.6). A decrease in Doppler activity was seen for both systems after anti-TNF-α therapy. Sensitivity to change was seen, SRM=-0.52 (95%CI; -0.83 to -0.21; QS) and -0.24 (-0.53 to -0.05; SQS). Predictive value was poor (QS rs=-0.24; SQS rs=-0.05). Construct validity was; QS: rs=0.29, SQS: rs=0.23. CONCLUSIONS Both systems were to some extent sensitive to change. Predictive validity and discriminate capacity of both systems showed only a weak association to DAS 28 in the study population. The QS was a little superior to the SQS. The results do not necessarily reflect Doppler evaluation as being ineffective, but may be caused by DAS28 not being a perfect marker of inflammation.
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Affiliation(s)
- Karen Ellegaard
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark.
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25
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Andersen M, Boesen M, Ellegaard K, Christensen R, Söderström K, Søe N, Spee P, Mørch U, Torp-Pedersen S, Bartels E, Danneskiold-Samsøe B, Vendel N, Karlsson L, Bliddal H. FRI0021 Synovial Explant Activity is Associated with Disease Activity in Biologically Treated Rheumatoid Arthritis Patients: A Cohort Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Andersen M, Boesen M, Ellegaard K, Christensen R, Söderström K, Søe N, Spee P, Mørch U, Torp-Pedersen S, Bartels E, Danneskiold-Samsøe B, Vendel N, Karlsson L, Bliddal H. AB0079 Synovial Explant Inflammatory Mediator Production is Correlated with Disease Activity in Rheumatoid Arthritis: A Cross Sectional Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Andersen M, Boesen M, Ellegaard K, Christensen R, Söderström K, Søe N, Spee P, Mørch UG, Torp-Pedersen S, Bartels EM, Danneskiold-Samsøe B, Vendel N, Karlsson L, Bliddal H. Synovial explant inflammatory mediator production corresponds to rheumatoid arthritis imaging hallmarks: a cross-sectional study. Arthritis Res Ther 2014; 16:R107. [PMID: 24886513 PMCID: PMC4078218 DOI: 10.1186/ar4557] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 04/04/2014] [Indexed: 12/20/2022] Open
Abstract
Introduction Despite the widespread use of magnetic resonance imaging (MRI) and Doppler ultrasound for the detection of rheumatoid arthritis (RA) disease activity, little is known regarding the association of imaging-detected activity and synovial pathology. The purpose of this study was to compare site-specific release of inflammatory mediators and evaluate the corresponding anatomical sites by examining colour Doppler ultrasound (CDUS) and MRI scans. Methods RA patients were evaluated on the basis of CDUS and 3-T MRI scans and subsequently underwent synovectomy using a needle arthroscopic procedure of the hand joints. The synovial tissue specimens were incubated for 72 hours, and spontaneous release of monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), macrophage inflammatory protein 1β (MIP-1β) and IL-8 was measured by performing multiplex immunoassays. Bone marrow oedema (BME), synovitis and erosion scores were estimated on the basis of the rheumatoid arthritis magnetic resonance imaging score (RAMRIS). Mixed models were used for the statistical analyses. Parsimony was achieved by omitting covariates with P > 0.1 from the statistical model. Results Tissue samples from 58 synovial sites were obtained from 25 patients. MCP-1 was associated with CDUS activity (P = 0.009, approximate Spearman’s ρ = 0.41), RAMRIS BME score (P = 0.01, approximate Spearman’s ρ = 0.42) and RAMRIS erosion score (P = 0.03, approximate Spearman’s ρ = 0.31). IL-6 was associated with RAMRIS synovitis score (P = 0.04, approximate Spearman’s ρ = 0.50), BME score (P = 0.04, approximate Spearman’s ρ = 0.31) and RAMRIS erosion score (P = 0.03, approximate Spearman’s ρ = 0.35). MIP-1β was associated with CDUS activity (P = 0.02, approximate Spearman’s ρ = 0.38) and RAMRIS synovitis scores (P = 0.02, approximate Spearman’s ρ = 0.63). IL-8 associations with imaging outcome measures did not reach statistical significance. Conclusions The association between imaging activity and synovial inflammatory mediators underscores the high sensitivity of CDUS and MRI in the evaluation of RA disease activity. The associations found in our present study have different implications for synovial mediator releases and corresponding imaging signs. For example, MCP-1 and IL-6 were associated with both general inflammation and bone destruction, in contrast to MIP-1β, which was involved solely in general synovitis. The lack of association of IL-8 with synovitis was likely underestimated because of a large proportion of samples above assay detection limits among the patients with the highest synovitis scores.
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Ellegaard K, Bliddal H, Møller Døhn U, Henriksen M, Boesen M, Bouert R, Danneskiold-Samsøe B, Torp-Pedersen S. Validity and reliability of 3D US for the detection of erosions in patients with rheumatoid arthritis using MRI as the gold standard. Ultraschall Med 2014; 35:137-141. [PMID: 23696060 DOI: 10.1055/s-0032-1330348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To test the reliability and validity of a 3D US erosion score in RA using MRI as the gold standard. MATERIALS AND METHODS RA patients were examined with 3D US and 3 T MRI over the 2nd and 3rd metacarpophalangeal joints. 3D blocks were evaluated by two investigators. The erosions were estimated according to a semi-quantitative score (SQS) (0 - 3) and a quantitative score (QS) (mm²). MRI was evaluated according to the RAMRIS score. For the estimation of reliability, intra-class correlation coefficients (ICC) were used. Validity was tested using Spearman's rho (rs). The sensitivity and specificity were also calculated. RESULTS 28 patients with RA were included. The ICC for the inter-observer reliability in the QS was 0.41 and 0.13 for the metacarpal bone and phalangeal bone, respectively, and 0.86 and 0.16, respectively, in the SQS. The ICC for the intra-observer reliability in the QS was 0.75 and 0.48 for the metacarpal bone and phalangeal bone, respectively, and 0.83 and 0.60, respectively, in the SQS. The correlation with MRI for the metacarpal bone was significant, with values of 0.73 (p = 0.0001) (SQ) and 0.74 (p = 0.0001) (SQS). For the phalangeal bone, bad correlation was found: 0.28 (p = 0.145) (SQ) and 0.26 (p = 0.57) (SQS). The sensitivity and specificity for the metacarpal bone were 86 % and 85 % respectively. For the phalangeal bone they were 60 % and 97 %, respectively. CONCLUSION Good inter- and intra-observer reliability and correlation with MRI were seen in the assessment of erosions with 3D US in the metacarpal bone, while the results were low and insignificant for the phalangeal bone, indicating that 3D US still has room for improvement.
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Affiliation(s)
- K Ellegaard
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
| | - H Bliddal
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
| | - U Møller Døhn
- Department of Rheumatology, Slagelse Hospital, Slagelse
| | - M Henriksen
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
| | - M Boesen
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
| | - R Bouert
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
| | - B Danneskiold-Samsøe
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
| | - S Torp-Pedersen
- Department of Rheumatology, Frederiksberg Hospital, The Parker Institute, Frederiksberg
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29
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Christensen AW, Rifbjerg-Madsen S, Christensen R, Amris K, Taylor PC, Locht H, Ellegaard K, Torp-Pedersen S, Jespersen A, Bartels EM, Danneskiold-Samsøe B, Bliddal H. Temporal summation of pain and ultrasound Doppler activity as predictors of treatment response in patients with rheumatoid arthritis: protocol for the Frederiksberg hospitals Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study. BMJ Open 2014; 4:e004313. [PMID: 24390385 PMCID: PMC3902530 DOI: 10.1136/bmjopen-2013-004313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Chronic pain is common in rheumatoid arthritis (RA) and may still persist despite regression of objective signs of inflammation. This has led researchers to hypothesise that central pain sensitisation may play a role in the generation of chronic pain in RA. Application of the disease activity score DAS28 can classify some patients with active RA solely based on a high tender joint count and poor patient global health score. In such cases, intensified treatment with anti-inflammatory drugs would be expected to yield poorer results than in cases with DAS28 elevation due to a high score for swollen joints and C reactive protein (CRP). Evaluation of central pain sensitisation in patients with few inflammatory indices may be a predictive tool regarding the effect of anti-inflammatory treatment. Computerised pneumatic cuff pressure algometry (CPA) is a method for assessing temporal summation (ie, degree of central sensitisation). The main objective of this study was to examine the prognostic values of pressure pain-induced temporal summation, ultrasound Doppler activity and the interaction between them in relation to treatment response (DAS28-CRP change) in patients with RA initiating any anti-inflammatory therapy. METHOD AND ANALYSIS 120 participants ≥18 years of age will be recruited. Furthermore, they must be either (1) diagnosed with RA, untreated with disease-modifying antirheumatic drugs for at least 6 months and about to initiate disease-modifying antirheumatic drug treatment or (2) about to begin or switch treatment with any biological drug for their RA. Data (clinical, imaging, blood samples, patient reported outcomes and CPA measurements) will be collected from each participant at baseline and after 4 months of anti-inflammatory treatment. ETHICS AND DISSEMINATION This study has been approved by the ethics committee for the Copenhagen region (H-4-2013-007). Dissemination will occur through presentations and publication in international peer-reviewed journals.
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Affiliation(s)
- Anton Wulf Christensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Signe Rifbjerg-Madsen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Robin Christensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kirstine Amris
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, University of Oxford, Botnar Research Centre, Headington, Oxford, UK
| | - Henning Locht
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Karen Ellegaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Søren Torp-Pedersen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anders Jespersen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Else Marie Bartels
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bente Danneskiold-Samsøe
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Terslev L, Hammer HB, Torp-Pedersen S, Szkudlarek M, Iagnocco A, D'Agostino MA, Schmidt WA, Uson J, Bruyn GA, Filippucci E, Möller I, Balint P, Wakefield R, Naredo E. EFSUMB minimum training requirements for rheumatologists performing musculoskeletal ultrasound. Ultraschall Med 2013; 34:475-477. [PMID: 23696065 DOI: 10.1055/s-0033-1335143] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In order to optimize and standardize musculoskeletal ultrasonography education for rheumatologists, there is a need for competency assessments addressing the required training and practical and theoretical skills. This paper describes how these competency assessments for rheumatologists were developed and what they contain.
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Affiliation(s)
- L Terslev
- Center of Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Glostrup University Hospital, Glostrup
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Ellegaard K, Bliddal H, Døhn Møller U, Henriksen M, Boesen M, Bouert R, Danneskiold-Samsøe B, Torp-Pedersen S. THU0428 Validity and reliability of 3D us for detection of erosions in patients with rheumatoid arthritis using MRI as gold standard. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Terslev L, Hammer HB, Torp-Pedersen S, Szkudlarek M, Iagnocco A, D'Agostino MA, Schmidt WA, Uson J, Bruyn GA, Filippucci E, Möller I, Balint P, Wakefield R, Naredo E. EFSUMB Minimum Training Requirements for Rheumatologists Performing Musculoskeletal Ultrasound. Ultraschall Med 2013; 34:e11. [PMID: 23775447 DOI: 10.1055/s-0033-1335890] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- L Terslev
- Center of Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Glostrup University Hospital, Glostrup
| | - H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | | | - M Szkudlarek
- Department of Rheumatology, University of Copenhagen Hospital at Koege
| | - A Iagnocco
- Department of Rheumatology, Sapienza Università di Roma, Rome
| | - M A D'Agostino
- Rheumatology Department, Paris Ouest-Versailles-Saint Quentin en Yvelines University, Paris
| | - W A Schmidt
- Medical Centre for Rheumatology, Immanuel Krankenhaus, Berlin
| | - J Uson
- Department of Rheumatology, Hospital Universitario de Móstoles, Madrid
| | - G A Bruyn
- Department of Rheumatology, MC Groep, Lelystad
| | - E Filippucci
- Department of Rheumatology, Clinica Reumatologica, Università Politecnica delle Marche, Jesi
| | - I Möller
- Rheumatology Department, Instituto Poal, Barcelona
| | - P Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest
| | - R Wakefield
- LIMM Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds
| | - E Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid
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Rosager S, Torp-Pedersen S, Christensen R, Bartholdy C, Danneskiold-Samsøe B, Bliddal H, Ellegaard K. FRI0481-HPR Assessment of validity of clinical impingement tests in patients with thickened subacromial bursa using dynamic us examination as gold standard:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Torp-Pedersen S, Szkudlarek M, Ellegaard K, D’Agostino MA, Iagnocco A, Naredo E, Balint P, Wakefield R, Torp-Pedersen A, Christensen R, Terslev L. SAT0389 Color or power doppler - which is more sensitive and do machine settings matter? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andersen M, Ellegaard K, Hebsgaard JB, Christensen R, Torp-Pedersen S, Kvist PH, Søe N, Rømer J, Vendel N, Bartels EM, Danneskiold-Samsøe B, Bliddal H. Ultrasound colour Doppler is associated with synovial pathology in biopsies from hand joints in rheumatoid arthritis patients: a cross-sectional study. Ann Rheum Dis 2013; 73:678-83. [PMID: 23475981 DOI: 10.1136/annrheumdis-2012-202669] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Little is known regarding the association between ultrasound-determined pathological synovial blood flow and synovial pathology in rheumatoid arthritis (RA). We therefore examined the association between colour Doppler ultrasound imaging and synovitis assessed by histopathology and specific cell markers by immunohistochemistry in patients with RA. METHODS 81 synovial sites from wrist and finger joints from 29 RA patients were evaluated by ultrasound colour Doppler and subsequently biopsied by needle arthroscopy. The association between ultrasound colour fraction and an overall synovitis score and immunohistochemical staining for CD3, CD68, Ki67 and von Willebrand factor was investigated, including repeated samples from the same patients. The overall synovitis score (total 0-9) assessed synovial lining hyperplasia (0-3), stromal activation (0-3) and inflammatory infiltration (0-3). Data were clustered within patients, thus a linear mixed model was applied for the statistical tests. Parsimony in the statistical models was achieved omitting covariates from the model in the case of what was judged no statistical significance (p>0.1). RESULTS Doppler colour fraction showed an association with the overall synovitis score (approximated Spearman, approximately r=0.43, p=0.003). The density of all immunohistochemical stainings showed a significant association with Doppler colour fraction: von Willebrand factor (approximately r=0.44, p=0.01), CD68 (approximately r=0.53, p=0.02), Ki67 (approximately r=0.57, p=0.05) and CD3 (approximately r=0.57, p=0.0003). CONCLUSIONS Colour Doppler activity is associated with the extent of inflammation present in the synovial biopsies from RA patients. However, synovial pathology was also seen in biopsies taken from Doppler negative sites.
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Affiliation(s)
- Martin Andersen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, , Copenhagen, Denmark
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Jespersen A, Amris K, Graven-Nielsen T, Arendt-Nielsen L, Bartels EM, Torp-Pedersen S, Bliddal H, Danneskiold-Samsoe B. Assessment of Pressure-Pain Thresholds and Central Sensitization of Pain in Lateral Epicondylalgia. Pain Med 2013; 14:297-304. [DOI: 10.1111/pme.12021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Boesen M, Ellegaard K, Boesen L, Cimmino MA, Jensen PS, Terslev L, Torp-Pedersen S, Danneskiold-Samsøe B, Bliddal H. Ultrasound Doppler score correlates with OMERACT RAMRIS bone marrow oedema and synovitis score in the wrist joint of patients with rheumatoid arthritis. Ultraschall Med 2012; 33:E166-E172. [PMID: 21259184 DOI: 10.1055/s-0029-1245922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE MRI is considered the standard of reference for advanced imaging in rheumatoid arthritis (RA). However, in daily clinical practice ultrasound (US) imaging with Doppler information is more versatile and often used for fast and dynamic assessment of joint inflammation. The aim was to compare low-field MRI scores with the US Doppler measurements in the wrist joint of patients with RA. MATERIAL AND METHODS Fifty consecutive patients with RA (46 women & 4 men) completed both low-field dedicated extremity MRI (E-scan®, Esaote) and a high-end US (Sequioa®, Siemens) imaging of the wrist before initiating either biological treatment (n = 26) or intraarticular injection of Depomedrole® (n = 24). Mean age was 56 years (range 21 - 83 years); mean disease duration 87.2 months (range 4 - 349 months), mean DAS 28 4,8 (range 2 - 7). MRI was scored according to the OMERACT RAMRIS recommendations and US Doppler colour-fractions were determined. RESULTS Using Spearman's rho, we found a relatively good to moderate correlation between the US colour-fraction and the total OMERACT bone marrow oedema and synovitis scores on MRI (r = 0.6; p < 0.001 and r = 0.4; p < 0.006 respectively). There was a trend but no significant correlation with the total OMERACT erosion score (r = 0.3; p = 0.06). CONCLUSION Within limits, the OMERACT RAMRIS scores of inflammation in RA patients (bone marrow oedema and synovial enhancement) are comparable to the US colour-fraction measurements using a high-end US scanner. Both imaging modalities detect inflammation although showing different aspects of the inflammatory process in the wrist joint. The higher correlation between US colour-fractions and MRI bone marrow oedema indicates a potential importance of US Doppler in monitoring inflammatory disease changes in RA.
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Affiliation(s)
- M Boesen
- Radiology, Frederiksberg Hospital
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Terslev L, Ellegaard K, Christensen R, Szkudlarek M, Schmidt WA, Jensen PS, Bliddal H, Torp-Pedersen S. Head-to-head comparison of quantitative and semi-quantitative ultrasound scoring systems for rheumatoid arthritis: reliability, agreement and construct validity. Rheumatology (Oxford) 2012; 51:2034-8. [PMID: 22847682 DOI: 10.1093/rheumatology/kes124] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the reliability and agreement of semi-quantitative scoring (SQS) and quantitative scoring (QS) systems. To compare the two types of scoring system and investigate the construct validity for both scoring systems. METHODS A total of 46 RA patients (median disease duration of 6.5 years) were enrolled in the study. They were investigated with colour Doppler ultrasound using the central position of the wrist. Disease activity score based on 28 joints (DAS-28) was determined for all patients using CRP. Two participants trained in the SQS system and two in the QS system evaluated the 46 anonymized images. All images were scored twice by each of the two assessors in order to assess both intra- and inter-reader reliability. RESULTS The reliability for the two systems were 0.964 for the QS, and 0.817 for the SQS, with a comparable inter-reader agreement for both scoring systems; 95% limits of agreement for the QS being between -7.7% and +6.7% on the colour fraction scale (0-100%), whereas SQS was between -0.8 and +0.8 on the ordinal scale from 0 to 3. There was a direct but non-linear relationship between the two modalities (Spearman's r = 0.73) and critical conceptual issues in the agreement between the scoring systems were revealed. The construct validity was poor for both systems with only a weak correlation to CRP. CONCLUSION High reliability and good agreement of both scoring systems were found when applied to the same patient cohort. Different scoring systems appear to be highly correlated.
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Affiliation(s)
- Lene Terslev
- Department of Rheumatology, University Hospital at Glostrup, Copenhagen, Denmark.
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Ellegaard K, Torp-Pedersen S, Christensen R, Stoltenberg M, Hansen A, Lorenzen T, Jensen DV, Lindegaard H, Juul L, Røgind H, Bülow P, Chrysidis S, Kowalski M, Danneskiold-Samsoe B, Bliddal H. Feasibility of a standardized ultrasound examination in patients with rheumatoid arthritis: a quality improvement among rheumatologists cohort. BMC Musculoskelet Disord 2012; 13:35. [PMID: 22410241 PMCID: PMC3414749 DOI: 10.1186/1471-2474-13-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 03/12/2012] [Indexed: 11/15/2022] Open
Abstract
Background Quality improvement is important to facilitate valid patient outcomes. Standardized examination procedures may improve the validity of US. The aim of this study was to investigate the learning progress for rheumatologists during training of US examination of the hand in patients with rheumatoid arthritis (RA). Methods Rheumatologists with varying degrees of experience in US were instructed by skilled tutors. The program consisted of two days with hands-on training followed by personal US examinations performed in their individual clinics. Examinations were sent to the tutors for quality control. The US examinations were evaluated according to a scoring sheet containing 144 items. An acceptable examination was defined as > 80% correct scores. Results Thirteen rheumatologists participated in the study. They included a total of 104 patients with RA. Only few of the initial examinations were scored below 80%, and as experience increased, the scores improved (p = 0.0004). A few participants displayed decreasing scores. The mean time spent performing the standardized examination procedure decreased from 34 min to less than 10 minutes (p = 0.0001). Conclusion With systematic hands-on training, a rheumatologist can achieve a high level of proficiency in the conduction of US examinations of the joints of the hand in patients with RA. With experience, examination time decreases, while the level of correctness is maintained. The results indicate that US may be applied as a valid measurement tool suitable for clinical practice and in both single- and multi-centre trials.
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Affiliation(s)
- Karen Ellegaard
- The Parker Institute, Copenhagen University Hospital, Denmark.
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Riecke BF, Bartels EM, Torp-Pedersen S, Ribel-Madsen S, Bliddal H, Danneskiold-Samsøe B, Arendt-Nielsen L. A microdialysis study of topically applied diclofenac to healthy humans: Passive versus iontophoretic delivery. Results Pharma Sci 2011; 1:76-9. [PMID: 25755985 DOI: 10.1016/j.rinphs.2011.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 12/16/2022]
Abstract
Topical application of NSAIDs is an alternative route to systemic administration when a local anti-inflammatory effect of the underlying tissue is a treatment option. The aim of the present microdialysis study was to assess and compare plasma and tissue levels of diclofenac when topically applied with or without iontophoresis in healthy adults. Fourteen healthy adults (26±9.4 years) were randomized to diclofenac applied by iontophoresis, or by a gel, in a crossover design. Diclofenac concentrations were measured in plasma and in microdialysis perfusates from the underlying tissues. Iontophoretic application resulted in the highest plasma concentration of 3.4±0.5 ng/ml (SEM given) compared to 0.4 ng/ml (at the detection limit) with gel, whereas no differences were observed between tissue concentrations for the two application methods, both being very low, below or around the detection limit. Iontophoresis caused skin reactions in 25% of the participants. Iontophoresis of diclofenac as compared to traditional topical application was not superior in order to increase the NSAID concentration locally and appears to have a higher frequency of skin reactions.
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Affiliation(s)
- Birgit Falk Riecke
- The Parker Institute, Copenhagen University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Else Marie Bartels
- The Parker Institute, Copenhagen University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Søren Torp-Pedersen
- The Parker Institute, Copenhagen University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Søren Ribel-Madsen
- The Parker Institute, Copenhagen University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark ; Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark ; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Bente Danneskiold-Samsøe
- The Parker Institute, Copenhagen University Hospital, Ndr. Fasanvej 57, 2000 Frederiksberg, Denmark ; Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark ; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Ewertsen C, Henriksen BM, Torp-Pedersen S, Bachmann Nielsen M. Characterization by biopsy or CEUS of liver lesions guided by image fusion between ultrasonography and CT, PET/CT or MRI. Ultraschall Med 2011; 32:191-197. [PMID: 21225564 DOI: 10.1055/s-0029-1245921] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study was to show the number of cases in which the use of fusion-guided ultrasonography (US) provided conclusive diagnosis of lesions in the liver seen on CT or MRI or PET/CT. A lesion is defined as a region that has suffered damage due to injury or disease. MATERIALS AND METHODS Forty patients of whom 34 had confirmed neoplastic disease, referred to US evaluation or US-guided biopsy of liver lesions seen on CT (n = 35), MRI (n = 2) or PET/CT (n = 3), were prospectively included in the study. We used a LOGIQ prototype system with incorporated software for fusion imaging, and a convex-array 4 MHz transducer (GE Healthcare, Chalfont St. Giles, UK). All patients were initially examined with B-mode US, then by fusion-guided US and for some patients also with CEUS. All patients received follow-up after at least one year. RESULTS Twenty-six lesions were initially indistinguishable with US. Of these, 9 became visible with fusion-guided US and another 4 became visible with CEUS, which facilitated a final diagnosis in 11 of these 13 patients. The median tumor size for all lesions included in the study was 1.5 cm (interquartile range: 1.0 - 2.4). There was no statistically significant difference in tumor size between the groups. CONCLUSION We have successfully demonstrated an increase in the characterization of liver lesions by using fusion-guided US compared with conventional B-mode US.
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Affiliation(s)
- C Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark.
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Torp-Pedersen S, Bartels EM, Wilhjelm J, Bliddal H. Articular cartilage thickness measured with US is not as easy as it appears: a systematic review of measurement techniques and image interpretation. Ultraschall Med 2011; 32:54-61. [PMID: 20645223 DOI: 10.1055/s-0029-1245386] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Theoretically, the high spatial resolution of US makes it well suited to monitor the decrease in articular cartilage thickness in osteoarthritis. A requirement is, however, that the borders of the cartilage are correctly identified and that the cartilage is measured under orthogonal insonation. If US measurements are compared to measurements with other techniques, they should be corrected for the higher sound speed in cartilage. PURPOSE To study whether investigators correctly identify the articular cartilage, whether they insonate orthogonally, and whether they correct for sound speed. MATERIALS AND METHODS A literature search limited to the last 10 years of studies applying US to measure cartilage thickness. RESULTS 15 studies were identified and they referred to another 8 studies describing methods of thickness measurement. 11 of the 15 studies identified the superficial cartilage border incorrectly, and 6 applied oblique insonation. 2 of the 15 studies corrected for sound speed. Of the further 8 studies, one might correctly identify the superficial cartilage border, 4 applied oblique insonation, and none corrected for sound speed. CONCLUSION We found that the majority of studies over the last 10 years, evaluating articular cartilage thickness with US, underestimated the cartilage thickness by not including the leading interface as part of the cartilage. Since the cartilage is relatively thin, this error is substantial. Some investigators also overestimated cartilage thickness by using oblique insonation of the cartilage. By not correcting for the high sound speed in cartilage, most investigators underestimated the cartilage thickness.
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Ellegaard K, Christensen R, Torp-Pedersen S, Terslev L, Holm CC, Kønig MJ, Jensen PS, Danneskiold-Samsøe B, Bliddal H. Ultrasound Doppler measurements predict success of treatment with anti-TNF-α drug in patients with rheumatoid arthritis: a prospective cohort study. Rheumatology (Oxford) 2010; 50:506-12. [DOI: 10.1093/rheumatology/keq336] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Ewertsen C, Ellegaard K, Boesen M, Torp-Pedersen S, Bachmann Nielsen M. Comparison of two co-registration methods for real-time ultrasonography fused with MRI: a phantom study. Ultraschall Med 2010; 31:296-301. [PMID: 20517817 DOI: 10.1055/s-0029-1245457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To test the accuracy of spatial registration of real-time ultrasonography (US) fused with MRI in a phantom. MATERIALS AND METHODS An US prototype system (LOGIQ, GE Healthcare) with incorporated software for fusion imaging was used to test two methods of co-registration in a phantom: co-registration from specific points, where common reference points identifiable on both MRI and US images were marked, and plane registration, where common planes identifiable on both MRI and US images were marked. In two series we performed co-registration from points and in one series we performed co-registration from planes. The accuracy of the co-registration was measured at 3 measuring points, defined before initiation of the study, and it was calculated as the root mean square deviation (RMSD), which corresponds to the standard deviation. It was measured in millimeters. Two observers each performed 30 co-registrations for each series, totaling 180 co-registrations. The difference between the methods and the observers was calculated using analysis of variance (two-way ANOVA). RESULTS Co-registration was significantly more accurate when using the measuring points as co-registration points than when using points covering a different area of the phantom (p < 0.0001). The mean calculated RMSD when using the measuring points as co-registration points was 1.3 mm (95 % CI: 1.1 - 1.5 mm), when using points away from the measuring points: 4.0 mm (95 % CI: 3.2 - 4.8 mm), and when using planes for the co-registration: 3.8 mm (95 % CI: 3.2 - 4.4 mm). CONCLUSION Image fusion involving real-time US has high accuracy and is easy to use in a phantom. Working within the area given by the co-registration points optimizes the accuracy. Image fusion is a promising tool for clinical US, since it provides the potential of benefiting from different imaging modalities in one examination.
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Affiliation(s)
- C Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark.
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Boesen MI, Boesen M, Langberg H, Koenig MJ, Boesen A, Bliddal H, Torp-Pedersen S. Musculoskeletal colour/power Doppler in sports medicine: image parameters, artefacts, image interpretation and therapy. Clin Exp Rheumatol 2010; 28:103-113. [PMID: 20346250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This review article discusses the aspects of sports medicine where musculoskeletal Doppler ultrasound has valuable contribution in diagnosis and/or treatment of some of the typical musculoskeletal sports injuries. Also, conditions where the Doppler ultrasound has no value are discussed. Some guidelines and recommendations are based on personal experience since no evidence in literature exists. The basic technical background of Doppler ultrasound and typical artefacts will be discussed, in order to understand and interpret the Doppler result. Recommendations for the Doppler settings are given in relevant sections. Ultrasound guided treatments where the Doppler result is used as a guide are mentioned and discussed.
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Affiliation(s)
- M I Boesen
- The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark.
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Ellegaard K, Torp-Pedersen S, Henriksen M, Lund H, Danneskiold-Samsoe B, Bliddal H. Influence of recent exercise and skin temperature on ultrasound Doppler measurements in patients with rheumatoid arthritis--an intervention study. Rheumatology (Oxford) 2009; 48:1520-3. [DOI: 10.1093/rheumatology/kep294] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marklund M, Christensen R, Torp-Pedersen S, Thomsen C, Nolsøe C. Signal intensity of normal breast tissue at MR mammography midfield: applying a random coefficient model evaluating the effect of doubling the contrast dose. Clin Imaging 2009. [DOI: 10.1016/j.clinimag.2009.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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Ewertsen C, Nielsen KR, Henriksen BM, Torp-Pedersen S, Nielsen MB. [Image fusion with ultrasound]. Ugeskr Laeger 2009; 171:1069. [PMID: 19321064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Caroline Ewertsen
- Radiologisk Klinik X, Sektion for Ultralyd 4123, Rigshospitalet, DK-2100 København Ø.
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Kubassova O, Boesen M, Peloschek P, Langs G, Cimmino MA, Bliddal H, Torp-Pedersen S. Quantifying Disease Activity and Damage by Imaging in Rheumatoid Arthritis and Osteoarthritis. Ann N Y Acad Sci 2009; 1154:207-38. [DOI: 10.1111/j.1749-6632.2009.04392.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Torp-Pedersen S, Amris K, Holm CC, Kønig M, Prip K, Danneskiold-Samsøe B. Vascular response to ischemia in the feet of falanga torture victims and normal controls--color and spectral Doppler findings. Torture 2009; 19:12-18. [PMID: 19491482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate whether signs of chronic compartment syndrome could be found in plantar muscles of falanga torture victims with painful feet and impaired gait. The hypothesis was that the muscular vascular response to two minutes ischemia would be decreased in torture victims compared to controls. On color Doppler this would be seen as less color after ischemia and on spectral Doppler as elevated resistive index (RI). METHODS Ten male torture victims from the Middle East and nine age, sex and ethnically matched controls underwent Doppler examination of the abductor hallucis and flexor digitorum brevis muscles before and after two minutes ischemia induced with a pressure cuff over the malleoli. The color Doppler findings were quantified with the color fraction (CF) before and after ischemia. On spectral Doppler the resistive index was measured once before and three consecutive times after ischemia. RESULTS Both torture victims and controls responded to ischemia with an increased CF. There was no difference between torture victims and controls. With spectral Doppler all subjects had an RI of 1.0 before ischemia. After ischemia, in nearly all subjects and all muscles the first RI was lowest, the second was higher and the third was highest indicating that the response to ischemia was disappearing as measurements were made. There was a trend that the first RI was higher in torture victims than in controls. DISCUSSION The study was not able to confirm the presence of chronic compartment syndrome. However, the trend in RI still supports the hypothesis. The negative findings may be due to inadequate design where the CF and RI were measured in one setting, perhaps resulting in both methods being applied imperfectly. The response to ischemia seems short-lived and we suggest that the Doppler methods may be re-evaluated with separate ischemic phases for CF and RI.
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