Doppler US in rheumatic diseases with special emphasis on rheumatoid arthritis and spondyloarthritis

Abstract

Developments in digital ultrasonography (US) technology and the use of high-frequency broadband transducers have increased the quality of US imaging, particularly of superficial tissues. Thus, US, particularly color US or power Doppler US, in which high-resolution transducers are used, has become an important imaging modality in the assessment of rheumatic diseases. Furthermore, therapeutic interventions and biopsies can be performed under US guidance during the assessment of lesions. In this era of effective treatments, such as biologics, improvements in synovial inflammation in rheumatoid arthritis as well as changes in enthesitis in spondyloarthropathies, including ankylosing spondylitis and psoriatic arthritis, can be monitored effectively using gray-scale and/ or power Doppler US. US is also a good imaging modality for crystal arthropathies, including gout and pseudogout, in which synovitis, erosions, tophi, and crystal deposition within or around the joint can be visualized readily. Vascular and tenosynovial structures, as well as the salivary glands, can be assessed with US in vasculitis and connective tissue disorders, including systemic lupus erythematosus and Sjögren's syndrome. Current research is focused on improving the sensitivity, specificity, validity, and reproducibility of US findings. In this review, we summarized the role of US, particularly power Doppler US, in rheumatic diseases and inflammation in superficial tissues.

Presence of enthesopathy demonstrated with ultrasonography in systemic sclerosis

“…All patients with SSc and healthy controls underwent an ultrasonographic examination by an experienced rheumatologist (SO, certified in musculoskeletal ultrasonography and spending weekly at least 5 hours to the ultrasonographic examination) on a Logiq P5 (GE Medical Systems, Buckinghamshire, United Kingdom) ultrasound machine with a linear transducer (7)(8)(9)(10)(11)(12). Patients and controls were evaluated in the morning between 9:00 to 12:00 A.M. and the examiner was blind to the patients' or controls' laboratory details.…”

“…Ultrasonography (US) is non-invasive, widely available, low cost and repeatable imaging method which also does not have ionizing radiation risk and could be used in the diagnosis, follow-up and prognostic stratification of enthesitis. Enthesitis can be demonstrated with US, even the physical examination was normal [8][9][10][11][12].…”

Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions

“…[ 1 2 3 4 ] Excessive pressure during examination can decrease power Doppler signal. [ 5 ] Error in image interpretation can be reduced by adequately training radiologists. During examination, low-wall filters and low PRF should be used for detection of low-velocity flows.…”

Feasibility of US-CT image fusion to identify the sources of abnormal vascularization in posterior sacroiliac joints of ankylosing spondylitis patients

“…Within the past decade, ultrasound (US), particularly color Doppler US (CDUS), has become an established imaging technique for rheumatic diseases that is currently indispensable clinically 1 2 3 4 . For ankylosing spondylitis (AS), a chronic inflammatory rheumatic disease that represents the most common spondyloarthropathy, CDUS displays definite value for assessing the inflammatory activity of the sacroiliac joint (SIJ) 5 6 7 8 .…”