Detection of vascularity in wrist tenosynovitis: power doppler ultrasound compared with contrast-enhanced grey-scale ultrasound

Abstract

IntroductionWe sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS).MethodsTwenty-six tendons of 24 patients (nine men, 15 women; mean age ± SD, 54.4 ± 11.8 years) with a clinical diagnosis of tenosynovitis were examined with B-mode ultrasonography, PDUS, and CEUS by using a second-generation contrast agent, SonoVue (Bracco Diagnostics, Milan, Italy) and a low-mechanical-index ultrasound technique. Thickness of synovitis, extent of vascularized pannus, intensity of peritendinous vascularisation, and detection of intratendinous vessels was incorporated in a 3-score grading system (grade 0 to 2). Interobserver variability was calculated.ResultsWith CEUS, a significantly greater extent of vascularity could be detected than by using PDUS (P < 0.001). In terms of peri- and intratendinous vessels, CEUS was significantly more sensitive in the detection of vascularization compared with PDUS (P < 0.001). No significant correlation between synovial thickening and extent of vascularity could be found (P = 0.089 to 0.097). Interobserver reliability was calculated to be excellent when evaluating the grading score (κ = 0.811 to 1.00).ConclusionsCEUS is a promising tool to detect tendon vascularity with higher sensitivity than PDUS by improved detection of intra- and peritendinous vascularity.

Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis

“…Some previous studies on inflammatory tenosynovitis have used semiquantitative US scoring for B-mode21 26–34 and/or Doppler mode 21 27–32 34 35. These scores were purely subjective or based on the measurement of tenosynovial thickness on B-mode and percentage of tenosynovial widening showing PD or colour Doppler flow.…”

The Microvascular Volume of the Achilles Tendon Is Increased in Patients With Tendinopathy at Rest and After a 1-Hour Treadmill Run

“…Previous studies have mainly investigated the MV of tendons at rest in both healthy patients and in patients with tendon injuries. 17,32 One study has shown that 1 to 2 sets of 20 repetitions of forward shoulder elevations increase blood flow to the rotator cuff tendons, as measured using CEU. 8 However, the present study is the first to measure the MV in the Achilles tendon of patients with AT before and after a 1-hour treadmill run.…”

Concepts in diagnosing, scoring, and monitoring tenosynovitis and other tendon abnormalities in patients with rheumatoid arthritis- the role of musculoskeletal ultrasound.

“…Moreover, MSUS has been considered by some authors as the "goldstandard" method for the evaluation of superficial tendons [45]. In comparison to MRI it permits not only multi-planar evaluation but also real time dynamic assessment and vasculariza-Overall, MSUS showed a fair to moderate sensitivity but a high specificity [28,29,31,33,37,46,[60][61][62][63][64][65][66][67][68][69][70][71][72].…”

“…A variety of scoring systems were developed in time for the tenosynovitis assessment -binary scoring systion detection [42,[46][47][48][49][50][51][52][53][54]. MSUS evaluation can be repeated anytime during the disease course, offering a key to a better understanding and monitoring in early stages and longstanding disease.…”