Role of Contrast-enhanced Ultrasound in the Evaluation of Inflammatory Arthritis

Abstract

Objective:Contrast-enhanced ultrasound (CEUS) is a well-established imaging modality which has been put into clinical use in recent years with the development of second-generation contrast agent and imaging devices, and its applications in the assessment of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, have provoked abundant discussion and researches among radiologists and rheumatologists. To summarize the achievements of clinical studies on CEUS in the application of arthritis, and to keep up with the latest progresses of the imaging technique, we reviewed the literature in recent years, hoping to establish the role of CEUS in joint diseases.Data Sources:PubMed and EMBASE.Study Selection:We searched the database with the conditions “contrast-enhanced ultrasound AND arthritis” with the time limitation of recent 10 years. Clinical studies applying CEUS in inflammatory arthritis and review articles about development of CEUS in joint diseases in English were selected.Results:As it is proved by most studies in recent years, by delineating microvasculature within the inflamed joints, CEUS can indicate early arthritis with high sensitivity and specificity. Moreover, the imaging of CEUS has been proved to be consistent with histopathological changes of inflammatory arthritis. Quantitative analysis of CEUS permits further evaluation of disease activity. CEUS also plays a significant role in the therapeutic monitoring of the disease, which has been backed up by a number of studies.Conclusions:CEUS may be a new choice for the rheumatologists to evaluate inflammatory arthritis, because of its low price, ability to provide dynamic pictures, and high sensitivity to angiogenesis. It can also be applied in disease classification and therapeutic monitoring. More studies about CEUS need to be done to set up the diagnostic standards.

Role of imaging in evaluation and management of juvenile idiopathic arthritis: a prospective cohort study

“…7 Previous studies were proved that Ultrasound contrast media can help in early detection and follow up of disease activity in Rheumatoid arthritis. [8][9][10][11] In present study ESR and CRP values assessed in the first visit was compared with the synovial thickness score (by addition of measured thickness of inflamed synovium in affected joints) and power doppler signal score (by addition of power doppler grades obtained in each joints). The mean ESR for 70 patients was 41.9±23.6 and the mean CRP was 43.7±16.9.…”

“…[11][12][13][14][15] years of age (42.9%), with slight (20%) female preponderance. This female predilection is distributed across all age groups.…”

The value of contrast-enhanced musculoskeletal ultrasound for early diagnosis, monitoring of disease activity and assessment of treatment efficacy in patients with rheumatoid arthritis and psoriatic arthritis

“…Интензитетът на сигнала в малките съдове е по-малък от този на шума, предизвикан от движенията в околните тъкани, който от своя страна може да бъде филтриран от настройките на апарата. Този бавен кръвоток е характерен за процеса на неоангиогенеза във възпалената синовия [13]. Приложението на ехоконтрастни вещества, съставени от микромехурчета, може да подобри установяването му чрез увеличаване на съотношението сигнал/шум.…”

“…Signal intensity in the small vessels is lower than that of the noise created by movements in the adjacent tissue, which in turn can be filtered by the settings of the ultrasound scanner. This slow blood flow is characteristic of the process of neoangiogenesis in the inflamed synovium [13]. The use of contrast agents made up of microbubbles may improve its detection by increasing the signal/noise ration.…”

Value of Contrast-Enhanced Ultrasonography in Evaluating Rheumatoid Arthritis: Preliminary Research Based on an Animal Model

“…To estimate the degree of RA remission, ultrasound can be considered a semiquantitative assessment, mainly through the grayscale ultrasound (GSUS) presentation of the soft tissue around the joints and the detected blood flow signal. Based on the harmonic effect of the ultrasound contrast (contrast-enhanced ultrasonography, CEUS) agent, microbubbles, and their resolution on peripheral microcirculation, some scholars have applied CEUS in the diagnosis and evaluation of the remission of RA [ 9 , 10 ]. As with MRI and other techniques, these studies have often been based on serological tests [ 7 , 11 ], in which the clinical pathology of the diseased RA joints is often overlooked.…”