Ultraschall Med 2011; 32: E38-E44
DOI: 10.1055/s-0031-1281770
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Contrast-Enhanced Ultrasonography is More Sensitive Than Grayscale and Power Doppler Ultrasonography Compared to MRI in Therapy Monitoring of Rheumatoid Arthritis Patients

Kontrastmittelgestützter Gelenkultraschall ist sensitiver als B-Bild- und Power-Doppler-Ultraschall – im Vergleich zur MRI als Referenzmethode – im Therapiemonitoring von Patienten mit rheumatoider ArthritisS. Ohrndorf1 , A. Hensch1 , L. Naumann1 , K.-G. A. Hermann2 , C. Scheurig-Münkler2 , S. Meier2 , G. R. Burmester1 , M. Backhaus1
  • 1Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin
  • 2Department of Radiology, Charité-University Medicine Berlin
Further Information

Publication History

received: 13.12.2010

accepted: 19.8.2011

Publication Date:
03 November 2011 (online)

Zusammenfassung

Ziel: Untersuchung der Hand- und Fingergelenke von Patienten mit rheumatoider Arthritis (RA) mittels B-Bild-, Power-Doppler- und kontrastmittelgestütztem Ultraschall (US) und Vergleich dieser Befunde mit MRT-, klinischen (DAS28) und Labordaten (BSG; CRP). Material und Methoden: Die US-Verfahren wurden vor Therapieumstellung (t0) sowie nach 3, 6 und 12 Monaten (t12) angewendet; MRT-Bilder zum t0- und t12-Zeitpunkt erhoben und dessen Ergebnisse als Referenzstandard betrachtet. Mittels kontrastmittelgestütztem US ist die klinisch am stärksten betroffene Gelenkregion untersucht worden. Synovialitis-Summenscores wurden mittels B-Bild- und Power-Doppler-US gebildet. Ergebnisse: Der kontrastmittelgestützte US wurde mittels dreier Methoden angewendet: Kontrastanreicherung, Slope und semiquantitativ (0 – 3), welche untereinander, zum B-Bild-Ultraschall, zum CRP als auch zur MRT mit den höchsten Korrelationskoeffizienten (r = 0,56, r = 0,55, r = 0,57; jeweils p < 0,05) signifikant korrelierten. Die per B-Bild erhobenen Summenscores konnten zeigen, dass die palmare Fingergelenksregion signifikant häufiger von Synovialitis betroffen war als die dorsale Seite (p = 0,001). Die untersuchten Handgelenksregionen waren im Power-Doppler-Ultraschall häufiger von dorsal entzündlich verändert (p = 0,0004). Im Verlauf korrelierten die Ergebnisse des B-Bild- und Power-Doppler-Ultraschalls signifikant. Schlussfolgerung: B-Bild-, Power-Doppler- und kontrastmittelgestützter US sind gute Methoden zur Aufdeckung und Verlaufsuntersuchung von Synovialitis an den Hand- und Fingergelenken von Patienten mit RA, von denen der kontrastmittelgestützte US, im Vergleich zur MRT, am sensitivsten war. Die bildgebenden Methoden spiegelten die Antwort auf eine TNFα-Inhibitor-Therapie adäquat wider.

Abstract

Purpose: To evaluate wrist and finger joints in patients with rheumatoid arthritis (RA) by grayscale, power Doppler (PD) and contrast-enhanced musculoskeletal ultrasonography (US) and to compare these findings with MRI, clinical (DAS28) and laboratory (ESR; CRP) data. Materials and Methods: US was performed at baseline (t0) and after three, six and twelve (t12) months before and after a change of medical treatment. MRI was carried out at t0 and t12 and used as the reference method. Contrast-enhanced US was used to assess one clinically most affected joint region. Different semiquantitative synovitis scores were calculated by grayscale and PD US. Results: Contrast-enhanced US results evaluated by enhancement, slope and semi-quantitative assessment significantly correlated to each other, to grayscale US, CRP, as well as to MRI with the highest correlation coefficients for the used contrast-enhanced US modes (r = 0.56, r = 0.55, r = 0.57; each p < 0.05). Sum scores evaluated by grayscale US showed that synovial inflammation in finger joints was detected significantly more frequently in the palmar aspect than on the dorsal side (p = 0.001). Using power Doppler US, the wrists were significantly more inflamed from dorsal than on the palmar side (p = 0.0004). Significant longitudinal correlations between grayscale and power Doppler US scores were detected. Conclusion: Grayscale, power Doppler and contrast-enhanced US are accurate tools for the detection and follow-up of synovitis in RA wrist and finger joints, with contrast-enhanced US being most sensitive compared to MRI. All imaging methods reflected a good response to TNFα blocking therapy.

References

  • 1 Ostergaard M, Hansen M, Stoltenberg M et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis.  Arthritis Rheum. 1999;  42 918-929
  • 2 Conaghan P G, O’Connor P, McGonagle D et al. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis.  Arthritis Rheum. 2003;  48 64-71
  • 3 Haavardsholm E A, Boyesen P, Ostergaard M et al. Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression.  Ann Rheum Dis. 2008;  67 794-800
  • 4 Backhaus M, Kamradt T, Sandrock D et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging.  Arthritis Rheum. 1999;  42 1232-1245
  • 5 Backhaus M, Burmester G R, Sandrock D et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints.  Ann Rheum Dis. 2002;  61 895-904
  • 6 Scheel A K, Hermann K G, Ohrndorf S et al. Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints.  Ann Rheum Dis. 2006;  65 595-600
  • 7 Walther M, Harms H, Krenn V et al. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis.  Arthritis Rheum. 2001;  44 331-338
  • 8 Klauser A, Demharter J, De Marchi A et al. Contrast-enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group.  Eur Radiol. 2005;  15 2404-2410
  • 9 De Zordo T, Mlekusch S P, Feuchtner G M et al. Review: Value of contrast-enhanced ultrasound in rheumatoid arthritis.  Eur J Radiol. 2007;  64 222-230
  • 10 Terslev L, Torp-Pedersen S, Bang N et al. Doppler ultrasound findings in healthy wrists and finger joints before and after use of different contrast agents.  Ann Rheum Dis. 2005;  64 824-827
  • 11 Koch A E. Review: angiogenesis: implications for rheumatoid arthritis.  Arthritis Rheum. 1998;  41 951-962
  • 12 Bodolay E, Koch A E, Kim J et al. Angiogenesis and chemokines in rheumatoid arthritis and other systemic inflammatory rheumatic diseases.  J Cell Mol Med. 2002;  6 357-367
  • 13 Szkudlarek M, Klarlund M, Narvestad E et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination.  Arthritis Res Ther. 2006;  8 R52
  • 14 Wakefield R J, Gibbon W W, Conaghan P G et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography.  Arthritis Rheum. 2000;  43 2762-2770
  • 15 Scheel A K, Hermann K G, Kahler E et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis.  Arthritis Rheum. 2005;  52 681-686
  • 16 Drossaers-Bakker K W, Kroon H M, Zwinderman A H et al. Radiographic damage of large joints in long-term rheumatoid arthritis and its relation to function.  Rheumatology. 2000;  39 998-1003
  • 17 Arnett F C, Edworthy S M, Bloch D A et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.  Arthritis Rheum. 1988;  31 315-324
  • 18 Szkudlarek M, Court-Payen M, Strandberg C et al. Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis.  Eur Radiol. 2003;  13 163-168
  • 19 Schneider M, Arditi M, Barrau M B et al. BR 1: a new ultrasonographic contrast agent based on sulfur hexafluoride-filled microbubbles.  Invest Radiol. 1995;  30 451-457
  • 20 Song I H, Althoff C E, Hermann K G et al. Knee osteoarthritis efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging.  Ann Rheum Dis. 2008;  67 19-25
  • 21 Ejbjerg B J, Vestergaard A, Jacobsen S et al. The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist and toe joints. A comparison of the OMERACT rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the Sharp/van der Heijde radiographic score.  Arthritis Rheum. 2005;  52 2300-2306
  • 22 Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films.  Acta Radiol. 1977;  18 481-491
  • 23 Song I, Althoff C E, Hermann K G et al. Contrast-enhanced ultrasound in monitoring the efficacy of a bradykinin receptor-2 antagonist in painful knee osteoarthritis compared to magnetic resonance imaging.  Ann Rheum Dis. 2009;  68 75-83
  • 24 Klauser A S, Zordo de T, Bellmann-Weiler R et al. Feasibility of second-generation ultrasound contrast media in the detection of active sacroiliitis.  Arthritis Rheum. 2009;  61 909-916
  • 25 Backhaus M, Ohrndorf S, Kellner H et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project.  Arthritis Rheum. 2009;  61 1194-1201
  • 26 Ejbjerg B J, Narvestad E, Jacobsen S et al. Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for Synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography.  Ann Rheum Dis. 2005;  64 1280-1287

Dr. Sarah Ohrndorf

Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin

Charitéplatz 1

10117 Berlin

Germany

Phone: ++ 49/30/4 50 51 30 60

Fax: ++ 49/30/45 05 13  9 39

Email: sarah.ohrndorf@charite.de