Three-dimensional Doppler ultrasound findings in healthy wrist and finger tendon sheaths - can feeding vessels lead to misinterpretation in Doppler-detected tenosynovitis?

Abstract

BackgroundThe aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct interpretation of Doppler signals when diagnosing tenosynovitis.MethodForty healthy participants (20 women and 20 men age 23-67 years) without prior history of arthritis, tendon diseases or present pain in their hands were included. Twenty participants had 3D Doppler US of the second and third finger and twenty of the right wrist. US was carried out using a GE Logiq E9 unit with a 3D US probe. The colour Doppler settings were to published recommendation.ResultsThe feeding vessels in or in close proximity to the tendon sheaths were found in the flexor and extensor tendons sheaths at least once in each participant. No significant difference in feeding vessels was seen between the radial and carpal level in the wrist (p = 0.06) or between the second and third flexor tendon sheath (p = 0.84).ConclusionDoppler findings in or in close proximity to the tendon sheaths were common in wrists and fingers in healthy participants. These feeding vessels can be a source of error, not only due to their presence but also because they may be interpreted as being inside the tendon sheath due to blooming and reverberations artefacts. These vessels should be taken into consideration when diagnosing Doppler tenosynovitis.

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

“…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.…”

Gebelikte Venöz Akımda Blooming Artefaktının Değerlendirilmesi için Üç Farklı Renkli Doppler Tekniğinin Karşılaştırılması

“…The techniques of Doppler ultrasound have been available to clinicians for nearly 40 years [4]. CCD and PWD are used to guide the mapping of the vascular tree in the body, including fetal parts.…”

“…Advanced dynamic flow (ADF) uses a wide-band Doppler technique, while conventional color Doppler (CCD) employs narrow-band frequency transmission [3]. Power Doppler (PWD) is a variation of color flow imaging that displays intensity based on the sum of all Doppler shift frequencies, rather than on the mean Doppler shift as in color flow imaging [4].…”

Vascular supply of the metacarpophalangeal joint

“…One study showed synovial vascularization with Doppler ultrasound corresponding to normal vessels in healthy wrists, first carpometacarpal joints and less frequently in MCP joints ( 20 ). Another study raised attention to possible misinterpretation of Doppler-artifacts outside of healthy tendon sheaths on the wrist, 2nd and 3rd fingers, respectively ( 25 ). Further studies emphasized that synovial hyperplasia and locally altered vascularization are both important parameters to define and score synovitis ( 13 ).…”