Doppler sonography in rheumatology

doi:10.1016/j.berh.2004.05.003

Best Practice & Research Clinical Rheumatology

Volume 18, Issue 6, December 2004, Pages 827-846

https://doi.org/10.1016/j.berh.2004.05.003 Get rights and content

Abstract

The importance of ultrasonography in rheumatology has increased dramatically within the last few years both with regard to clinical practice and to research. High-resolution colour Doppler ultrasound equipment is, to date, widely available. Colour and power Doppler studies of intra-articular and peritendinous blood flow allow an estimation of the inflammatory activity and aid in distinguishing anatomical structures. Contrast agent increases the ability of ultrasonography to detect even minor perfusion. These findings have a practical clinical impact on the management of inflammatory rheumatic diseases.

The resolution of ultrasonography is superior to that of magnetic resonance imaging (MRI) and computed tomography (CT) with regard to superficial anatomical structures. Furthermore, ultrasonography can depict the artery wall in contrast to angiography. In temporal arteritis and Takayasu's arteritis, ultrasonography depicts characteristic, homogenous wall thickening, stenoses and acute occlusions. These pathologies resolve quickly with treatment in the temporal arteries and much more slowly in larger arteries.

Section snippets

Definitions

Doppler US relies technologically on the Doppler effect. It detects the movement of red blood cells in the vessels by the analysis of the change in frequency of the returning echoes. This information is transformed into sound. Furthermore, it is possible to delineate flow curves and to determinate the direction of the blood flow. Continuous-wave Doppler (CW-Doppler) assesses only flow without providing anatomical images. Pulsed-wave Doppler (PW-Doppler: Figure 1(c)) detects the information in a

Musculoskeletal colour-Doppler and power-Doppler US

Inflammation coincides with increased perfusion of the involved tissues. US technology has improved considerably within the last few years enabling investigators to delineate very small intra-articular and periarticular vessels. In addition, to date, US can assess very small vessels in muscles, in tendons and in inflamed tendon sheaths.

The first studies focused on periarticular flow (Figure 2(a)). Perfusion increased both around symptomatic joints² and around effusions in inflammatory rheumatic

Temporal arteritis

Temporal arteritis is the most frequent primary vasculitis. In addition, 40–50% of patients with temporal arteritis

Summary

Two main applications for colour and power Doppler ultrasonography (US) exist in rheumatology: examination of small intra- and periarticular and peritendinous vessels in inflammatory rheumatic diseases and the assessment of large arteries for the diagnosis of vasculitis.

Musculoskeletal US can aid in the description of inflammatory activity in arthritis and tenosynovitis. It helps to distinguish intra-articular structures. US contrast agent increases the sensitivity for detecting blood flow.

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What does power Doppler signal indicate in rheumatoid synovitis? A point of view from synovial histopathology
2018, Journal of the Chinese Medical Association
Citation Excerpt :
Ultrasound (US) is a useful tool for assessment of rheumatoid arthritis (RA) and has been widely applied in clinical practice. Power Doppler (PD) US detects the vascularity of synovium, which, if it presents, is presumed to result from active inflammation.1 However, there is a lack of direct evidence supporting the connection between PD signals and active inflammation.
To clarify the nature of power Doppler (PD) signals in rheumatoid synovium and to establish the connection between PD signals and active inflammation using synovial histopathology. Ten adult patients (median age 57.0 years, 9 women and one man) with rheumatoid arthritis (RA) were enrolled and received ultrasound (US) examinations. US-guided synovial biopsies using core needle were performed in 7 knees, 2 wrists and one elbow. Each patient had one joint biopsied. In total, 11 synovial specimens were obtained for hematoxylin and eosin staining and histopathologic examinations. The US examinations revealed prominent synovial hypertrophy in all biopsied joints. Six synovial specimens were PD-positive (from 3 knees, 2 wrists and 1 elbow) while 5 synovial specimens were PD-negative (from 5 knees). In comparison with the PD-negative synovial specimens, the PD-positive synovial specimens had significantly more lymphocyte infiltration, vessel proliferation and lining hyperplasia on histologic examination. There was no significant difference in fibrin exudate and stromal fibrosis between the PD-positive and the PD-negative synovial specimens. PD signals in rheumatoid synovium indicate active inflammation and vascularization supported by synovial histopathology. Our study establishes the connection between synovial PD signals and active synovitis in RA.
The role of ultrasound in the diagnosis of temporal arteritis
2015, Neurologia i Neurochirurgia Polska
Temporal arteritis (TA), also known as giant cell arteritis, is a chronic vasculitis of medium and large-sized blood vessels, in particular the main cervical branches of the aorta, with particular affinity to the temporal arteries and eye-supplying arteries. Temporal artery biopsy is still a gold standard for diagnosis, however in recent years colour duplex ultrasound examination has been proposed as a useful diagnostic screening tool in cases of TA suspicion. We report three cases of TA in which the ultrasonographical examination of the temporal arteries had a decisive role in the diagnosis.
Sonographic criteria for therapy follow-up in the course of ultrasound-guided intra-articular injections of hyaluronic acid in hand osteoarthritis
2012, European Journal of Radiology
Citation Excerpt :
Although OA is diagnosed in older people more frequently, under certain circumstances younger people can also develop this disease, e.g. secondary to joint injuries, chronic overuse, joint malformation, or genetic defects in joint cartilage metabolism. The most characteristic early features of OA are, besides marked irregularities of the bone margin with bony spur formation, increased synovial fluid, mucous cysts, synovial thickening, and synovial hypervascularity [4–6]. Symptomatic joint involvement is frequently associated with a variable degree of capsular distension due to effusion and/or synovial hypertrophy [7].
To assess the value of sonographic criteria, based on measurements of joint capsule distension and synovial hyperemia, during the course of repeated ultrasound (US)-guided intra-articular injections of hyaluronic acid (HA) in hand osteoarthritis (OA).
Thirty-three patients (28 females/5 males), with hand OA in 78 joints, were included in this study. Patients underwent sonographic evaluation at baseline and consecutively for 4 weeks at weekly US-guided intra-articular injections of HA (Hyalgan^®). Measurements of joint thickening and joint inflammation were performed with Grey-scale and semi-quantitative Power-Doppler US (PDUS). Sonographic values were correlated with weekly patients self-assessment of pain for each treated joint.
The mean (SD) patients self-assessment of pain statistically significantly (p < 0.0001) decreased from the first [68.3(22.3)] to the last week [37.3(30.34)]. A steady pain relief could be noticed in 67 (86%) of all treated joints. Over the whole observation period, the mean (SD) joint thickening of all joints markedly decreased from 15.6 mm (5.3) to 13.1 mm (6.4) (p < 0.0001). The PDUS-score before initiation of HA treatment was statistically significantly higher than at the end of therapy (p < 0.0001). The decrease in pain statistically significantly correlated with the decrease of joint thickening and PDUS-score between baseline and the end of therapy (p < 0.001).
In this study, we demonstrate the meaningfulness of sonographic evaluation criteria including measurements of joint capsule distension and PDUS vascularization, both significantly correlating with the decrease of pain, during the therapy follow-up of US-guided intra-articular HA-injections in patients with hand OA.
Comparison of Clinical and Ultrasonographic Evaluations for Peripheral Synovitis in Juvenile Idiopathic Arthritis
2011, Seminars in Arthritis and Rheumatism
The characteristics of synovitis in juvenile idiopathic arthritis (JIA) are important to evaluate, as they define several clinical categories. The metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints are frequently involved. Few studies have investigated peripheral joint evaluation using ultrasonography, a sensitive tool for detecting subclinical synovitis. Our objectives here were to compare clinical and ultrasound evaluations of MCP and MTP joint synovitis and to determine the prevalence of predefined ultrasound abnormalities in JIA patients and healthy controls.
Standardized physical and ultrasound assessments of the same joints were done in 31 consecutive patients with JIA and 41 healthy volunteers. Joint pain, motion limitation, and swelling were recorded. Ultrasonography was performed on the same joints by 2 trained sonographers who recorded synovial fluid, synovial hypertrophy, erosion, and power Doppler signal. Intraobserver reproducibility of ultrasonography was assessed.
Of 558 peripheral joints examined in JIA patients, 69 (12.5%) had ultrasonographic synovitis and 83 (15%) had abnormal physical findings. All the physical abnormalities were significantly associated with ultrasonographic synovitis (P < 0.0001) but agreement was low between ultrasonographic and physical findings. Ultrasonographic synovitis was most common at the feet (59.4%), where it was detected clinically in only 25% of cases. Ultrasonographic synovitis was associated with the presence of synovial fluid. Cartilage vascularization was found in 2 (4.2%) healthy controls.
Ultrasonography is useful for monitoring synovitis in JIA. Subclinical involvement of the MTP joints is common. Clinicians should be aware of the specific ultrasonographic findings in children.
Temporal arteritis: An approach to suspected vasculitides
2010, Primary Care - Clinics in Office Practice
Citation Excerpt :
If this technique is used, it should only be done by ultrasonographers who are trained to assess the temporal artery using specific protocols. In patients with temporal arteritis, the sensitivity and specificity of the diagnosis when confirmed by histology has been reported as 95% and 76%, respectively, when the characteristic abnormalities were observed.13 In some centers, color duplex ultrasonography is being investigated as a diagnostic tool for temporal arteritis in patients with typical clinical and laboratory findings.
Ultrasound
2009, Imaging of Arthritis and Metabolic Bone Disease: Expert Consult - Online and Print

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4Doppler sonography in rheumatology

Abstract

Section snippets

Definitions

Musculoskeletal colour-Doppler and power-Doppler US

Temporal arteritis

Summary

Lancet

Lancet

Lancet

Journal of Vascular Surgery

Ultrasound in Medicine and Biology

Musculoskeletal ultrasound

Best Practice and Research Clinical Rheumatology

Detection of soft-tissue hyperemia: value of power Doppler sonography

American Journal of Roentgenology

Power Doppler sonography in the assessment of musculoskeletal fluid collections

American Journal of Roentgenology

Power Doppler sonography in tenosynovitis: significance of the peritendinous hypoechoic rim

Journal of Ultrasound in Medicine

Colour Doppler ultrasonography to detect pannus in knee-joint synovitis

Clinical and Experimental Rheumatology

Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis

Arthritis and Rheumatism

Evaluation of pannus and vascularization of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthitis by high-resolution ultrasound (multidimensional linear array)

Arthritis and Rheumatism

Quantitative ultrasonography in rheumatoid arthritis: evaluation of inflammation by Doppler technique

Annals of the Rheumatic Diseases

Juvenile rheumatoid arthritis of the knee: evaluation with contrast-enhanced color Doppler ultrasound

Pediatric Radiology

Power Doppler sonography of synovitis: assessment of therapeutic response - preliminary observations

Radiology

Power Doppler ultrasound assessment of rheumatoid hand synovitis

Journal of Rheumatology

High resolution ultrasound detects a decrease in pannus vascularisation of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor alpha receptor (etanercept)

Annals of the Rheumatic Diseases

Standard reference values for musculoskeletal ultrasonography

Annals of the Rheumatic Diseases

Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging

Arthritis and Rheumatism

Power Doppler sonography in the assessment of synovial tissue of the knee joint in rheumatoid arthritis: a preliminary experience

Annals of the Rheumatic Diseases

The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis

Arthritis and Rheumatism

Contrast-enhanced power Doppler ultrasonography in the metacarpophalangeal joints in rheumatoid arthritis

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Power Doppler sonography with and without echo-enhancing contrast agent and contrast-enhanced MRI for the evaluation of rheumatoid arthritis of the shoulder joint: differentiation between synovitis and joint effusion

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Contrast medium in power Doppler ultrasound for assessment of synovial vascularity: comparison with arthroscopy

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Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study

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Doppler sonography in rheumatology