Estimation of inflammation by Doppler ultrasound: quantitative changes after intra-articular treatment in rheumatoid arthritis

Abstract

Objective: To evaluate the use of ultrasound, including quantitative Doppler analysis of synovial vascularisation, before and after intra-articular treatment with glucocorticosteroids in patients with rheumatoid arthritis (RA). Methods: 51 patients with RA were followed prospectively after an intra-articular glucocorticosteroid injection. Disease modifying antirheumatic drug treatment was kept unchanged and no further injections given in this observation period. At baseline, disease activity was estimated clinically by target join pain on a 100 mm visual analogue scale, on which the target joint was scored 0-3 for swelling and tenderness, and by ultrasound measurements of grey scale pixels, colour Doppler pixels, and the spectral Doppler resistive index (RI) as indicators of synovial swelling and inflammation. After four weeks, the measurements were repeated on the same joint. An observer unaware of the sequence and patient number evaluated the ultrasound images. Results: At one month follow up after the glucocorticosteroid injection, a marked decrease in the fraction of colour pixels was seen in 41/51 patients (Student's t test p,0.001). Correspondingly, the RI increased indicating a diminished flow to the synovium (Student's t test p,0.01). Both the fraction of colour pixels and the RI values corresponded with the clinical evaluation and with the subjective effect of the treatment. The synovial membrane volume estimated by total amount of pixels showed a significant decrease by 31% after treatment. Conclusion: Ultrasound-Doppler seems to be a promising tool for the estimation of synovial activity in arthritis. After intra-articular glucocorticosteroid, changes in RI and fraction of colour pixels may both be used as quantitative measurements of the blood flow.

Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: Predictive value in disease activity and radiologic progression

“…In keeping with our results, other studies have found changes in color Doppler or PDUS to be associated with clinical and laboratory response to intraarticular corticosteroid injections (22,33,36), systemic corticosteroid therapy (30,32), and biologic agents (15,31,34,37) in chronic inflammatory arthritis. However, the sensitivity to change of any method should be demonstrated by calculating the intraobserver variation and the SDD between repeated measurements (50).…”

“…Some different methods have been used for assessing color Doppler or power Doppler findings such as semiquantitative signal scoring (15,22,30,36,37), color pixel counting (31)(32)(33)(34)(35), and resistive index calculating (33,34). We considered semiquantitative signal grading as the most suitable for clinical practice.…”

Ultrasonography: A valid method for assessing rheumatoid arthritis?

“…Doppler US, in which moving blood cells generate the signal, can be used to detect (8,19,20) and potentially quantify (17,21) the increased synovial blood flow that occurs during joint inflammation. In knee and hip joints, the power Doppler signal has been found to correlate well with the histologic assessment of synovial membrane microvascular density (7,9).…”

A Preliminary Study of Diagnostic Color Doppler Ultrasonography in Equine Superficial Digital Flexor Tendonitis

“…All images of tendons were obtained under weight-bearing conditions. After completely clipping and then removing the hair on the palmar aspect of the mid-metacarpal region on 10 injured forelimbs using depilatory cream, 7 different regions from the proximal end (bottom of accessory carpal bone) to the distal end (top of the proximal sesamoid bone) of the SDFT (1A-B, 2A-B and 3A-C) were scanned as previously described [6,8], with some modifications using a mobile ultrasound system (iU22, Philips Medical Systems Corporation, Tokyo, Japan). Transverse GS images were recorded at 70 regions in the 10 tendons to determine cross-sectional area (CSA) of the outlined SDFT and cross-sectional hypoechogenic area (CSHA) of the outlined lesion (Table 1).…”