shu-508 and Synovitis

The purpose of this study was to first evaluate Levovist (Schering, Berlin, Germany), an echo-contrast agent, during power Doppler sonography (PDS) in patients with synovitis using asymptomatic joints as controls. Then we evaluated the accuracy of this technique against contrast-enhanced MRI. Forty patients (19 men and 21 women; mean age 40 years) were enrolled on the basis of clinical signs, laboratory tests, and radiographic findings positive for articular inflammatory disease. They were examined with conventional ultrasonography (US) and PDS techniques before and after intravenous contrast medium injection. Fourteen patients then underwent MRI with and without contrast medium 8-14 days after PDS studies. Three expert readers independently evaluated each examination. After contrast medium, synovium in inflammatory arthritis enhanced on PDS compared with normal joints in the same patient. Power Doppler sonography after contrast medium and MRI were concordant in all cases. Power Doppler sonography with contrast medium showed a qualitative increase in signal from synovial vessels, the first sign of synovial changes in inflammatory diseases.

Topics: Adolescent; Adult; Aged; Child; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Synovitis; Ultrasonography, Doppler

The aim of this study was to evaluate the ability of power Doppler sonography (PDS) with ultrasound contrast agent to assess the synovial perfusion changes induced by intra-articular steroid injection therapy in the knee joints of patients with rheumatoid arthritis (RA). Eighteen RA patients (16 women, 2 men) with a history and signs of active knee synovitis were studied. Tenderness was evaluated using Thompson's modified index of synovitis activity. All patients underwent joint aspiration followed by intra-articular injection of 40 mg of triamcinolone hexacetonide. Gray-scale ultrasonography and PDS with an intravenous ultrasound contrast agent (Levovist) examinations were carried out before and 3 weeks after the intra-articular steroid injection. The calculation of the time--intensity curves provided a quantitative estimation of the synovial perfusion. The median values of the index of synovitis activity decreased significantly from 7.0 (95% confidence interval (CI) 6.0-8.0) to 3.0 (95% CI 2.0-4.0) ( p<0.01) 3 weeks after the intra-articular steroid injection. All patients showed a reduction of PDS signal after intra-articular steroid therapy and the baseline and follow up median values of the area underlying time-intensity curves were 7.48 (95% CI 5.79-8.73) and 2.45 (95% CI 1.92-3.61), respectively. The comparison between baseline and follow-up median values of the area under the curves showed a statistically significant reduction of PDS findings ( p<0.01). At follow-up examinations the changes in the index score of the synovitis activity were significantly correlated to the changes in the values of the area underlying time-intensity curves ( r=0.785; p<0.01). A significant correlation was also observed between baseline values of the area underlying time-intensity curves and C-reactive protein (CRP) ( r=0.548; p=0.023). In conclusion, PDS with an intravenous ultrasound contrast agent has been shown to be able to detect changes in synovial perfusion after intra-articular steroid injection and may be an additional useful method in the evaluation of synovial inflammation and in the assessment of the therapeutic response.

Topics: Adult; Aged; Anti-Inflammatory Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Contrast Media; Female; Humans; Image Enhancement; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Polysaccharides; Regional Blood Flow; Synovial Membrane; Synovitis; Treatment Outcome; Triamcinolone Acetonide; Ultrasonography, Doppler

To evaluate patients with clinically active rheumatoid arthritis (RA) of the shoulder for joint effusion and synovitis using conventional sonography, power Doppler (PD) sonography with and without echo-enhancing contrast agent, and contrast-enhanced MRI.. Twenty-four patients (mean age 64 years) with known RA had one symptomatic shoulder evaluated by conventional gray-scale sonography and PD sonography before and after intravenous administration of the echo-enhancing contrast agent Levovist (300 mg/ml, 2.5 g). The degree and extent of the altered echo pattern in the subacromial bursa, axillary recess and glenohumeral joint seen by conventional gray-scale sonography and the intensity of vascular signals of PD sonography were compared with the findings of MRI obtained with T2-weighted turbo spin-echo sequences and contrast-enhanced T1-weighted fat-saturated spin-echo sequences. MRI was evaluated by two readers in consensus without knowledge of the sonographic findings.. MRI, which was used as the reference examination, detected joint effusion in 71% (17/24) and synovitis in 92% (22/24) of the patients. Conventional sonography revealed an abnormal articular echo pattern in 96% (23/24) of the patients, especially in the axillary recess and subacromial bursa, but failed to attribute the altered echo pattern to either fluid or specific synovitis. PD sonography allowed a specific diagnosis of synovitis in 33% (8 patients), which increased to 50% (12 patients) after administration of an echo-enhancing contrast agent. In 42% (10/24) of the patients, the findings of synovitis demonstrated by MRI corresponded to an altered echo pattern by conventional sonography, but vascular signals were absent by PD sonography with or without echo-enhancing contrast agent.. Using MRI as the "gold standard," PD sonography with and without echo-enhancing contrast agent cannot reliably identify synovitis or distinguish synovial inflammation from effusion in the shoulder joint.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Contrast Media; Diagnosis, Differential; Exudates and Transudates; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Reproducibility of Results; Sensitivity and Specificity; Shoulder Joint; Synovitis; Ultrasonography, Doppler, Pulsed

To evaluate the reliability of contrast-unenhanced power Doppler (CUPD) and contrast-enhanced power Doppler (CEPD) ultrasound (US) assessment of synovial vascularity of knee joint synovitis by prospective comparison with the "gold standard," arthroscopy.. A total of 18 knees of 17 patients with refractory rheumatoid and psoriatic knee joint synovitis were examined by US. Recognition of PD synovial vessel flow and its spatial arrangement in relation to the pannus/cartilage interface (P/CI) or fluid/synovium interface (F/SI) were studied by CUPD- and CEPD-US after a single intravenous bolus of galactosel palmitic acid (Levovist). Arthroscopy video recordings were reanalyzed by computer image analysis to assess synovial vascular marking. CUPD and CEPD flow signal scores were compared with each other and with corresponding vascular marking scores. Using villous vascular marking as reference, CUPD and CEPD sensitivity and specificity were measured. Interobserver variability was evaluated.. Compared with the unenhanced PD method, contrast administration increased the PD flow signal score in 13/18 knees (72.2%), allowing increased detection of F/SI PD flow signal configuration (p < 0.018) and of the coexistence of P/CI and F/SI PD imaging (p < 0.0078). With arthroscopy as reference, contrast-enhanced PD was found to be more useful than the unenhanced method, showing more reproducible PD signal scores (p = 0.05 vs p = nonsignificant), as well as higher sensitivity (80% vs 30%), but lower specificity (62% vs 87%), in the recognition of increased vascularity of synovial villi. Interobserver agreement was 100%.. The prospective comparison with arthroscopy showed the reliability of the CEPD method in synovial vessel recognition and its potential clinical usefulness in assessment of knee joint synovitis.

Topics: Adult; Aged; Arthroscopy; Contrast Media; Female; Humans; Knee Joint; Male; Middle Aged; Polysaccharides; Radiography; Reproducibility of Results; Synovial Membrane; Synovitis; Ultrasonography, Doppler, Color

To investigate the intra-articular vascularisation of the synovial pannus in the knee of patients with rheumatoid arthritis (RA) with power Doppler ultrasonography (PDS) and an echo contrast agent and correlate the area under the time-intensity curves with the clinical findings and laboratory measures of disease activity.. Forty two patients with RA (31 women, 11 men) with history and signs of knee arthritis, classified according to a modified index of synovitis activity (active, moderately active, and inactive), were studied. Clinical and functional assessment (number of swollen joints, intensity of pain, general health-visual analogue scale, disability index-Health Assessment Questionnaire, Ritchie articular index) and a laboratory evaluation were made on all patients. Disease activity was evaluated using the disease activity score (DAS) and the chronic arthritis systemic index (CASI) for each patient. All patients were examined with conventional ultrasonography and PDS before injection of intravenous ultrasound contrast agent (Levovist). The quantitative estimation of the vascularisation of the synovial membrane was performed with time-intensity curves and calculation of the area under the curves.. The mean (SD) value of the area underlying time-intensity curves was 216.2 (33.4) in patients with active synovitis, 186.8 (25.8) in patients with moderately active synovitis, and 169.6 (20.6) in those with inactive synovitis. The mean value of the areas differed significantly between the patients with active and those with inactive synovitis (p<0.01). The mean value of the area under the curve of the entire group was weakly correlated with the number of swollen joints (p=0.038), but a strong correlation was found with composite indexes of disease activity such as the DAS (p=0.006) and CASI (p=0.01). No correlation was found with age, disease duration, and other laboratory and clinical variables.. PDS may be a valuable tool to detect fractional vascular volume and to assist clinicians in distinguishing between inflammatory and non-inflammatory pannus. The transit of microbubbles of ultrasound contrast across a tissue can be used to estimate haemodynamic alterations and may have a role in assessing synovial activity and the therapeutic response to treatment of synovitis of the knee joint.

Topics: Adult; Aged; Area Under Curve; Arthritis, Rheumatoid; Contrast Media; Cross-Sectional Studies; Female; Humans; Knee Joint; Male; Middle Aged; Polysaccharides; Regional Blood Flow; Severity of Illness Index; Synovial Membrane; Synovitis; Ultrasonography, Doppler; Ultrasonography, Doppler, Color