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

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.

Key words

ultrasound - MR imaging - biological effects

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