Ultrasound transmission velocity of the proximal phalanxes of the non-dominant hand in the study of osteoporosis

Periarticular osteopenia is the earliest radiographic sign of rheumatoid arthritis (RA). Recent studies using dual-energy X-ray absorptiometry (DXA) have indicated that the loss of periarticular BMD can be quantified by whole-hand bone mineral density (BMD) measurements. The aim of this study was to analyze periarticular BMD in more detail by DXA and quantitative ultrasound (QUS). In a cross-sectional study 23 women aged 30-76 years with early RA, mean disease duration 26 +/- 19 months, and 18 men aged 42-69 years, mean disease duration 24 +/- 25 months, were examined. All patients received antirheumatic therapy. The reference population consisted of 103 age-matched controls (68 females, 35 males) and young healthy controls. BMD measurements were performed using a DXA Expert XL densitometer (Lunar). BMD of the whole-hand and two subregions was determined: two subchondral regions of interest (S.CH.) were set within the trabecular bone, distal to the proximal interphalangeal joints of digits II and III excluding the dense subchondral bone of the metacarpophalangeal (MCP) joint and two metacarpal regions of interest (MCP) were set including the entire MCP joint of these fingers. QUS measurements at the proximal phalanges of digits II-V were performed using a DBM Sonic (Igea); amplitude-dependent speed of sound (Ad-SoS) was determined. In comparison with whole-hand BMD measurements, bone loss was pronounced in patients with a disease duration of 18-72 months at the subchondral regions of interest in both genders compared with age-matched controls (women: mean BMD loss S.CH. -23%, p<0.001, whole-hand -16%, p<0.001; men: mean BMD loss S.CH. -19%, p < 0.05, whole-hand -12%, p<0.05). The bone changes were also shown by QUS (women: Ad-SOS values of 1950 +/- 90 m/s in RA vs 2137 +/- 35 m/s in young healthy controls (p <0.005); men AD-SOS 1956 +/- 87 m/s in RA vs 2146 +/- 41 m/s in young healthy controls (p <0.05)). These results show that BMD and Ad-SOS values are significantly lowered in patients with early RA and indicate that periarticular osteoporosis in early RA might possibly be better detected using detailed hand scan analyses.

Section: Quantitative Ultrasound At the Proximal Phalanges Of The Handsupporting

confidence: 86%

Detailed Analyses of Periarticular Osteoporosis in Rheumatoid Arthritis

Alenfeld

Dießel

Brezger

et al. 2000

“…Our short-term precision of the technique in healthy subjects was similar to other reports of our research group and others [10,29,30]. This CV value was slightly increased when calculated in patients with synovitis.…”

Section: Discussionsupporting

confidence: 90%

“…The aim of this study was to assess the bone status in male PA patients evaluating the ultrasound transmission velocity through the proximal phalanges, which positively correlates with BMD of the lumbar spine [10], as well as the morphologic and energetic parameters of the trace score, which depend on the integrity of the bone structures traversed [11]. We also compared these findings with those of RA patients, whose peripheral osteoporosis is a well-known feature of the disease [12][13][14][15], and with those of ankylosing spondylitis (AS) patients, in whom there are conflicting data concerning the appendicular bone mass measurements [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Measurements at the Proximal Phalanges in Male Patients with Psoriatic Arthritis

Taccari

Sensi

Spadaro

et al. 2001

Self Cite

Bone ultrasound parameters at the proximal phalanges of the hands were measured in 55 male patients with psoriatic arthritis (PA) (39 with peripheral radiologic involvement and 16 with axial involvement), comparing the findings with those in 16 rheumatoid arthritis (RA) patients, 20 ankylosing spondylitis (AS) patients and 55 age- and sex-matched normal controls. Mean values of amplitude-dependent speed of sound (Ad-SoS) and ultrasound bone profile score (UBPS) were significantly lower in RA (p < 0.001 and p < 1 x 10(-5)) and PA (p < 0.03 and p < 1 x 10(-6)) patients than in controls, while there was no statistically significant difference between AS patients and healthy subjects. Ultrasound parameters showed a significant negative correlation with age in all groups. In each patient group ultrasound values were unrelated either to disease duration or to inflammatory indices such as erythrocyte sedimentation rate and C-reactive protein. Moreover no significant differences were observed between ultrasound parameters of the dominant and the nondominant hand. PA patients with and without axial radiologic changes did not show any differences in ultrasound parameters. However, PA subjects with peripheral involvement only had significantly higher Ad-SoS (p < 0.04) and UBPS (p < 0.04) values than RA patients. PA patients with axial lesions had significantly lower (p < 0.04 and p < 0.01) ultrasound values than AS patients. These findings suggest that PA ultrasound techniques performed at the peripheral level are of value to speculate on bone involvement, although we think that ultrasound measurements cannot yet be recommended for monitoring bone involvement in these patients.

“…Initial results also indicate the usefulness of phalangeal SOS in the assessment of rheumatoid arthritis [26,27] and disorders of growth and puberty in children [28]. It has been shown that AD-SoS allows the discrimination of osteoporotic from normal subjects [10,17,23].…”

Section: Introductionmentioning

confidence: 97%

“…With aging and osteoporosis the phalanges undergo morphologic changes such as widening of the medullary canal and increased tunneling in the cortex, which should be detectable by ultrasound. Using the DBMSonic 1200 (IGEA, Carpi, Italy) a signi®cant decrease in`Amplitude-Dependent Speed of Sound' (AD-SoS) due to aging [17,23,24], strongest in early postmenopausal women, and an increase in AD-SoS during hormone replacement therapy [25] have been observed. AD-SoS is the standard speed of sound parameter of the device, calculated as the ratio between transducer distance and time-of-¯ight (TOF) between the transducers.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Geometry of Human Finger Phalanges Using Quantitative Ultrasound In Vivo

Barkmann¹,

Lüsse²,

Stampa³

et al. 2000

106

Quantitative Ultrasound (QUS) methods have been shown to be useful in the assessment of bone status. Nevertheless, ultrasound transmission depends on a variety of skeletal parameters, and a detailed understanding of ultrasound propagation through bone is important for the accurate interpretation of QUS results. In this study we wanted to elucidate the pathways of an ultrasound wave through finger phalanges and determine correlations between geometric and QUS parameters. Phalanges of a subject group were measured using QUS and magnetic resonance imaging (MRI). MRI was used for the derivation of the geometric parameters. Similar assessments were performed on cylindrical tubes and with a simulation program. New parameters related to speed of sound (SOS) and amplitude of the wave (A2P) were calculated. Strong correlations between QUS parameters and morphologic cross-sectional areas were observed in vivo and in phantoms. Similar correlations could be found in the calculations using the simulation software. Cross-sectional cortical area, medullary canal area and relative cortical area could be calculated from the QUS parameters (subjects: R2 = 0.71 for cortical area, R2 = 0.45 for medullary canal area and R2 = 0.61 for relative cortical area; phantoms: R2 = 0.98 for cortical area, R2 = 0.78 for medullary canal area and R2 = 0.77 for relative cortical area). In vivo, phantom and simulation results consistently showed that SOS was correlated with cortical area but not with medullary canal area while the opposite was found for A2P. Pathways of the ultrasound wave through solid cortical bone and the medullary canal could be identified and the propagation of the wave could be depicted. These results help to interpret QUS findings and provide information that may be helpful in improving the performance of QUS.