Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group

Abstract

The purpose of this study way to assess the value of contrast enhanced gray-scale ultrasound (CEUS) in detection of vascularity in joints of patients with rheumatoid arthritis (RA) in a multicenter study of the International Arthritis Contrast Ultrasound (IACUS) study group. We assessed 113 joints in 113 patients (44 men, 69 women; mean age 51+/-14 years) with clinical diagnosis of RA. Gray-scale ultrasound (US), power Doppler US (PDUS) and CEUS, using a low mechanical index US technique, was performed. CEUS was done by bolus administration of the contrast agent SonoVue (Bracco, Milan, Italy) with a dosage of 4.8-ml SonoVue flushed with 10 ml saline. Detection of joint vascularity was performed for differentiation of active synovitis from inactive intra-articular thickening (synovitis/effusion). With the use of US and PDUS, active synovitis could be differentiated from inactive intra-articular thickening in 68/113 joints (60.1%), whereas CEUS enabled differentiation in 110/113 (97.3%) joints (p<0.0001). Thickness measurement of active synovitis was significantly improved after contrast administration (p=0.008). In conclusion, CEUS improves the differentiation of active synovitis from inactive intra-articular thickening. Since CEUS has shown an ability to improve assessment of vascularized synovial proliferation in RA affected joints, this technique may have further potential in monitoring therapy.

Application of a second-generation US contrast agent in infants and children—a European questionnaire-based survey

“…These reports demonstrate not only a high diagnostic potential and reliability of CE-US, but also a high safety profile of US-CAs; in adults, anaphylactoid reactions have been reported at a low rate of less than 0.002% [53,54]. The established indications are oncological, traumatic or inflammatory lesions, assessment of vascular patency or pathology, tissue perfusion, echocardiography, intraoperative guidance and transplant queries [32,[55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70].…”

Assessment of tissue perfusion by contrast-enhanced ultrasound

“…The identification of small renal perfusion defects in the sub-capsular renal region is penalised by the limited spatial resolution of CEUS which cannot identify renal perfusion defects smaller than 5 mm. Other fields of application of CEUS in tissue perfusion quantitation are the liver [78,79], skeletal muscle [80,81], free skin flaps [82], joints [83], testis [84,85] and prostate [86]. Moreover, CEUS is capable of quantifying tumor tissue perfusion via their neoangiogenesis [87][88][89][90][91][92][93][94], also by the use of microbubbles targeting the tumor antigens [95].…”

The evolution of time-intensity curves of contrast enhanced ultrasonography in early arthritis patients with wrist involvement.

“…Moreover, Weidekamm et al [23] demonstrated that the decrease of AUC was observed also in cases with persistent PD. Due to the increased sensitivity of CEUS in detecting slow flow and flow in small vessels compared with PD [14,17,37], it is possible that TIC parameters detect the minimal changes in the synovial vascularisation and correlate less with PD [23].…”

“…Contrast enhanced ultrasonography (CEUS) allows a better visualization of blood flow in small vessels with low velocity, providing more information on synovial inflammation comparing to PDUS [13][14][15][16][17]. Objective CEUS measurements using time-intensity curves (TIC) parameters calculated by dedicated software may provide information about the disease activity in RA [18].…”