Doppler ultrasound findings in healthy wrists and finger joints before and after use of two different contrast agents

Abstract

Objective: To examine the effect of contrast agents on Doppler ultrasound findings in the synovial membrane in the wrist and fingers of healthy volunteers. Material and methods: Eleven healthy subjects were included in the study (5 women and 6 men, mean age 38 years, range (20-60)). They had no clinical signs of inflammatory or degenerative joint diseases. A total of 66 joints were examined-6 joints for each subject: wrist and metacarpophalangeal (MCP) joints 1-5-before contrast injection and after Levovist and SonoVue injection with a 30 minute interval. Results: Colour Doppler activity was detected in 10/55 (18%) MCP joints before contrast injection and in 29/ 55 (53%) and 28/55 (51%) joints after Levovist (p,0.0001) and SonoVue injection (p = 0.0001), respectively. A significant increase in Doppler activity in the radial (p,0.05) and ulnar (p = 0.01) parts of the wrist joint was detected only after SonoVue injections. With spectral Doppler no difference was found in the resistive index (RI) in the vessels measured before as compared with those only detected after contrast injection. Conclusion:The number of joints with colour Doppler activity in healthy volunteers was increased by the use of contrast agents. No changes in RI were detected. The value of contrast agents remains to be demonstrated in inflammatory diagnostics. Doppler ultrasound is used increasingly in the evaluation of joint inflammation and has the advantage of giving an objective analysis of the disease without ionising radiation. It is accessible in many outpatient clinics, has no contraindications, and poses no problems of patient compliance. Colour and power Doppler 1-6 have been used to identify the hyperaemia associated with inflammation 1-4 by visualising the vascularity in the inflamed synovial membrane. With spectral Doppler it is possible to evaluate the type of flow-that is, low resistance versus high resistance, in these vessels expressed by the resistive index (RI). Previous studies have shown that low RI values are associated with inflammation. [3][4][5][6] Ultrasound contrast agents in the form of microbubbles are used to enhance the scattering reflection from blood in order to increase the sensitivity of the Doppler examination. They have within the past few years been used to amplify the colour Doppler signal in patients with inflammatory joint conditions, and one study also used spectral Doppler for the examination of vessels. 3 The results have been divergent. Although some studies have reported Doppler signals from healthy joints without the use of contrast agents, 7 8 Doppler signals in healthy subjects were neither seen before nor after contrast injection in other studies.9-11 The use of contrast agents in rheumatology is still being investigated, and so far the studies have not agreed about the findings and there is no consensus about the recommendations for future use of contrast agents in inflamed joints. Previous studies have shown that it is possible to detect vascularisation in normal joints without the use of contra...

A comparison of clinical vs ultrasound determined synovitis in rheumatoid arthritis utilizing gray-scale, power Doppler and the intravenous microbubble contrast agent 'Sono-Vue'(R)

“…As the addition of contrast improves the detection of low-velocity flow through small vessels, by increasing the power within the Doppler signal, an apparent increase in perfusion, even in normal synovium, would be expected in the post-contrast study. A recent report of colour Doppler activity in normal MCP joints (from healthy volunteers) following the injection of two different contrast agents demonstrates this [29]. However, interestingly in our study, in 10 joints (all of which were either T-only, S-only or S þ T) a change from normal (PD grade 0-1) to abnormally increased perfusion indicative of active inflammation (PD grade 2 or 3) was seen following the contrast.…”

The evolution of time-intensity curves of contrast enhanced ultrasonography in early arthritis patients with wrist involvement.

“…Moreover, Weidekamm et al [23] demonstrated that the decrease of AUC was observed also in cases with persistent PD. Due to the increased sensitivity of CEUS in detecting slow flow and flow in small vessels compared with PD [14,17,37], it is possible that TIC parameters detect the minimal changes in the synovial vascularisation and correlate less with PD [23].…”

Farb-Doppler-Sonographie der Gelenke

“…1) [41]. Beim gesunden, nicht entzündeten Gelenk gelingt es im allgemeinen auch mit sehr hoch auflösenden und sensitiven Geräten nur in Ausnahmefällen, die physiologische synoviale Durchblutung darzustellen, so dass der Nachweis einer Vaskularisierung unter Berücksichtigung einer sicheren intraartikulären Lokalisation derselben prinzipiell als pathologisch zu werten ist [46,50].…”