Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis

Abstract

Objective To examine the significance of power Doppler sonography (PDS) in the diagnosis of synovial hypertrophy of the knee joint by verifying and comparing the PDS findings with histopathologic findings of synovial membrane vascularity. Methods The knee joints of 23 patients who were undergoing arthroplasty of the knee joint because of osteoarthritis or rheumatoid arthritis were examined with ultrasound before arthroplasty. The vascularity of the synovial membrane was classified semiquantitatively using PDS. A sample of synovial tissue was obtained during the arthroplasty, and the vascularity of the synovial tissue was evaluated by immunohistochemistry (factor VIII) and was graded qualitatively by a pathologist who was unaware of the PDS findings. The visual qualitative grading by the examiner was controlled by analyzing PDS images and histologic samples using a digital image evaluation system. Results The correlation between the qualitative PDS results and the qualitative grading of the vascularity by the pathologist was 0.89 by Spearman's ρ (P < 0.01). The Pearson correlation coefficient between the digital analysis of the PDS images and the digital analysis of the tissue sections was 0.81 (P < 0.01). Digital image analysis and qualitative grading by the examiner had a correlation of 0.89 by Spearman's ρ (P < 0.01) for the PDS images. The correlation between the qualitative estimation of vascularity by the pathologist and the digital image analysis was 0.88 by Spearman's ρ (P < 0.01). Conclusion In the present study, PDS proved to be a reliable diagnostic method for qualitative grading of the vascularity of the synovial tissue. In clinical practice, PDS allows further differentiation of the hypertrophic synovium.

Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

“…Transcatheter arterial embolization might act by stopping the influx of inflammatory cells in synovial tissues and thus have a beneficial effect against inflammation and pain. Joint hypervascularization is included indirectly in current scoring systems for osteoarthritis by assessing the degree of synovitis using Doppler ultrasound and/or MRI [18][19][20]. Direct evaluation of neohypervascularization is not included in the current scoring systems, and its assessment in osteoarthritic patients by arteriography does not appear to be a reasonable option as a result of its relative invasiveness compared to other diagnostic imaging modalities.…”

Relationship between power Doppler grade and the pathological blood vessel features in long-standing rheumatoid arthritis

“…However, there are few studies to elucidate the relationship between PD signal positivity and the blood vessel features on pathological specimen. Walther M, et al showed, by analyzing the biopsy specimen, that PD signal is related to the blood vessel area but not influenced by the number of the blood vessels in the knee joint of the early RA patients [2]. Here, we determined to examine this using surgical specimen from joints with long standing RA.…”

Definitions for the Sonographic Features of Joints in Healthy Children

“…An abundant number of studies have emerged in the literature over the past 2 decades for adult rheumatology, which included validation of the US detection of synovitis with histology and magnetic resonance imaging (MRI), standardization of the scanning technique, normative data acquisition, as well as documenting the responsiveness to change (11)(12)(13)(14)(15). These aspects have nevertheless only been partially addressed for pediatric patients (2,10,16); very few publications have started to collect information (16,17).…”