Objective: To investigate the intra-articular vascularisation of the synovial pannus in the knee of patients with rheumatoid arthritis (RA) with power Doppler ultrasonography (PDS) and an echo contrast agent and correlate the area under the time-intensity curves with the clinical findings and laboratory measures of disease activity. Method: Forty two patients with RA (31 women, 11 men) with history and signs of knee arthritis, classified according to a modified index of synovitis activity (active, moderately active, and inactive), were studied. Clinical and functional assessment (number of swollen joints, intensity of pain, general health-visual analogue scale, disability index-Health Assessment Questionnaire, Ritchie articular index) and a laboratory evaluation were made on all patients. Disease activity was evaluated using the disease activity score (DAS) and the chronic arthritis systemic index (CASI) for each patient. All patients were examined with conventional ultrasonography and PDS before injection of intravenous ultrasound contrast agent (Levovist). The quantitative estimation of the vascularisation of the synovial membrane was performed with time-intensity curves and calculation of the area under the curves. Results: The mean (SD) value of the area underlying time-intensity curves was 216.2 (33.4) in patients with active synovitis, 186.8 (25.8) in patients with moderately active synovitis, and 169.6 (20.6) in those with inactive synovitis. The mean value of the areas differed significantly between the patients with active and those with inactive synovitis (p<0.01). The mean value of the area under the curve of the entire group was weakly correlated with the number of swollen joints (p=0.038), but a strong correlation was found with composite indexes of disease activity such as the DAS (p=0.006) and CASI (p=0.01). No correlation was found with age, disease duration, and other laboratory and clinical variables. Conclusion: PDS may be a valuable tool to detect fractional vascular volume and to assist clinicians in distinguishing between inflammatory and non-inflammatory pannus. The transit of microbubbles of ultrasound contrast across a tissue can be used to estimate haemodynamic alterations and may have a role in assessing synovial activity and the therapeutic response to treatment of synovitis of the knee joint.

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le, ma anche per il fatto che non raramente si presentano con quadri clinici sovrapponibili (1-4). La scialografia è stata la prima tecnica diagnostica ad essere stata introdotta; ad essa si sono aggiunti l'esame radiologico diretto, la teletermografia, la scintigrafia, l'ecografia, la tomografia computerizzata (TC) e più recentemente la risonanza magnetica (RM) e la RM-scialografia, ognuna delle quali ha ormai assunto un ruolo ben definito nell'iter diagnostico (5-14). Tra le diverse metodiche di imaging impiegate per lo studio delle ghiandole salivari l'ecografia rappresenta, per la sua non invasività, l'ampia diffusione, l'ottima accettabilità da parte del paziente, nonché per il basso costo, la metodica di più frequente impiego e di più rapida e facile esecuzione (15-18). Essa consente la dettagliata valutazione morfologica delle ghiandole INTRODUZIONE La molteplicità e le notevoli difficoltà diagnostiche delle diverse affezioni che colpiscono una struttura in esame rendono, spesso, necessaria l'integrazione delle diverse tecniche di imaging. Lo studio delle ghiandole salivari ne rappresenta un esempio, a causa sia del numero e dell'entità delle condizioni patologiche che possono interessar- Reumatismo, 2006; 58(2):138-156 SUMMARY The algorithm for imaging of the salivary glands depends on the clinical scenario with which the patient presents to the clinician. Ultrasound has been increasingly used in recent years and thanks to high performance, easy to use apparatus, it can now be used for exploration of the salivary glands. This non invasive, painless and relatively inexpensive examination provides rapid visualisation of the salivary glands and is a useful adjunct to computed tomography and magnetic risonance imaging examination, particularly in tumour pathology. In recent years, publications have highlighted the potential uselfulness of salivary gland ultrasonography as a simple and non-invasive adjunctive test for the detection of gland involvement in Sjögren's syndrome (SS). SS is a chronic inflammatory disease of the salivary glands characterised by focal lymphocytic infiltrates that cause progressive destruction of the acinar structures. The findings of a previous study lead us to believe, in agreement with

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