Power and Color Doppler Ultrasound Settings for Inflammatory Flow: Impact on Scoring of Disease Activity in Patients With Rheumatoid Arthritis

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

Concepts in diagnosing, scoring, and monitoring tenosynovitis and other tendon abnormalities in patients with rheumatoid arthritis- the role of musculoskeletal ultrasound.

“…A variety of scoring systems were developed in time for the tenosynovitis assessment -binary scoring systion detection [42,[46][47][48][49][50][51][52][53][54]. MSUS evaluation can be repeated anytime during the disease course, offering a key to a better understanding and monitoring in early stages and longstanding disease.…”

Imaging in Psoriatic Arthritis

“…28 The Doppler choice depends on the most sensitive modality, which may vary from model to model. 29 In situations where the Doppler modality is less sensitive, US contrast agents in the form of microbubbles may be used to enhance the scattering reflection of erythrocytes by amplifying the Doppler signal, thereby increasing the sensitivity of the Doppler examination to low velocity flow. US has limited access in some areas and for some pathologies because it cannot penetrate bone.…”

Concepts in monitoring the treatment in rheumatoid arthritis – the role of musculoskeletal ultrasound. Part I: synovitis.

“…These parameter settings should be adjusted in accordance with the target region and from patient to patient, if needed. For longitudinal, correct, assessments and multicenter studies it is advisable to keep the same set-up and the same ultrasound machine [56]. Qualitative, semi-quantitative and quantitative scoring systems have been used for assessing synovitis by GS and/or PD in a different number of joints [57].…”

“…In clinical practice, it is advisable to follow the EULAR guidelines for MSUS evaluation in GS and PD [55], to be familiarized with Doppler techniques [56,102], and with actual scoring systems and composites instruments for disease activity assessment [103].…”