Shear‐wave elastographic ultrasound of metacarpophalangeal synovium in rheumatoid arthritis – A pilot study

Abstract

Introduction: Shear-wave elastographic ultrasound (SW-EUS) assesses the stiffness of human tissues. It is used in liver, thyroid and breast imaging but has not been studied in synovium. Soft tissues have a slower shear-wave velocity (SWV) than stiff tissues. We hypothesised that rheumatoid arthritis (RA) patients would have softer synovium than controls and this could be quantified with a slower SWV. We also assessed whether SWV varied with disease activity. Methods: Nine patients with RA were consecutively recruited and matched with five controls. Participants underwent clinical assessment, blood sampling, grey scale ultrasound (GSUS), power Doppler ultrasound and SW-EUS of MCP joints 2-5 on the dominant hand. Results: Average age was 60. Mean RA disease activity (DAS28-ESR) was moderate at 3.65. Patients with RA had lower maximum synovial SWV than controls (6.38 m/s vs. 6.99 m/s P = 0.042). Negative Pearson's correlation coefficients (PCC) were observed between maximum SWV and disease activity markers including GSUS graded synovial thickness (PCC = À0.57, P = 0.03) and ESR (PCC = À0.46, P = 0.095). Intra-and interobserver reliability was good with intraclass correlation coefficients (ICC) of 0.66 and 0.58, respectively, for quantitative maximum SWV and ICC > 0.80 for colour scale rated SWV. Conclusion: This is the first pilot study of SW-EUS in synovium. Maximum synovial SWV was significantly lower in RA than controls. There was a negative correlation between maximum SWV and GSUS synovial thickening. Further study is warranted to confirm the role of SW-EUS in diagnosing and assessing disease activity in RA.

Study of Role of Shear- Wave Elastography and Musculoskeletal Ultrasound in Assessment of Hand and Wrist in Rheumatoid Arthritis Patients

“…It's possible that this means that RA patients' synovium is softer than that of age-and sex-matched individuals without inflammatory arthritis. We agree with Sammel et al (5) in assessment of RA patients by shear wave velocity measurement that our average was 2.16 ± 0.94 (m/sec) in comparison with 2.62 ± 5 (m/sec). We disagree with Prakash et al (19) whose study was about role of shear wave elastography of synovium to differentiate rheumatoid and tubercular arthritis.…”

“…Power Doppler grading decreased from 25% of moderate grade at start to be 0% of patients after followup with no statistically significant difference. Table (5) showed that there was highly statistically significant difference in SWE parameters between RA patients and healthy control where the mean of Elastic Modulus (KPa) was statistically lower (16.77 ± 15.0) among RA patient than (101.2 ± 27.9) among healthy control. Also, mean of mean velocity (m/sec) was statistically lower among RA patients (2.16 ± 0.94 (m/sec) vs 5.53 ± 1.14 (m/sec) respectively).…”

“…Patients with RA may have softer synovium compared to age-and sex-matched individuals without inflammatory arthritis, according to recent research. In addition, a number of disease activity markers were found to have a negative Pearson association with SWV, suggesting that a softer synovium may be indicative of increased disease activity (5) .…”