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Triantafyllias K, Alhaddad M, Baraliakos X, Muthuraman M, Schwarting A. Optical spectral transmission to monitor disease activity in arthritis patients: longitudinal follow-up comparison with clinical parameters. Rheumatology (Oxford) 2025; 64:3319-3327. [PMID: 39752326 DOI: 10.1093/rheumatology/keaf007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 01/01/2025] [Indexed: 05/29/2025] Open
Abstract
OBJECTIVE To examine the longitudinal associations of optical spectral transmission (OST) with clinical inflammatory arthritis activity markers in order to investigate its potential in monitoring disease activity. METHODS OST measurements were performed in 1312 wrist and finger joints of 60 patients with clinical suspicion of inflammatory activity, within the context of known rheumatic inflammatory diseases at two separate time intervals. In each time point, patients underwent additional clinical and laboratory examinations. The change of OST values was statistically compared with changes in clinical activity parameters like DAS28 and swollen joint counts (SJC). Additionally, the diagnostic performance of OST was assessed in comparison to a historic control group (2508 joints of 114 healthy subjects) using receiver operating characteristics (ROC). The relationships between OST values, clinical and laboratory parameters, as well as patient characteristics, were evaluated through correlation analyses. RESULTS Mean OST scores were significantly higher in the inflammatory arthritis group compared with the control group (P < 0.001). OST correlated significantly with clinical activity markers like DAS28, SJC and TJC in both time points (all; P < 0.05). Longitudinal changes of OST values (ΔOST) were significantly associated with changes in DAS28 (ΔDAS28) (r = 0.377; P = 0.004) and ΔSJC (r = 0.488; P < 0.001) over the same time period. The area under the curve of the baseline receiver operating characteristic curve was 0.781 (95%CI 0.82-0.94). CONCLUSION OST was able to reliably assess disease activity and correlated longitudinally with arthritis activity markers, showing promising potential during monitoring of inflammatory arthritis.
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Affiliation(s)
- Konstantinos Triantafyllias
- Department of Rheumatology, Acute Rheumatology Centre Rhineland-Palatinate, Bad Kreuznach, Germany
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, Johannes Gutenberg University Medical Centre, Mainz, Germany
| | - Mohammed Alhaddad
- Department of Rheumatology, Acute Rheumatology Centre Rhineland-Palatinate, Bad Kreuznach, Germany
| | | | - Muthuraman Muthuraman
- Department of Neurology, Neural Engineering with Signal Analytics and Artificial Intelligence (NESA-AI), University Hospital of Würzburg, Würzburg, Germany
- Informatics for Medical Technology, University Augsburg, Augsburg, Germany
| | - Andreas Schwarting
- Department of Rheumatology, Acute Rheumatology Centre Rhineland-Palatinate, Bad Kreuznach, Germany
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, Johannes Gutenberg University Medical Centre, Mainz, Germany
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Sahr ME, Grünebaum A, Positano RC, Nwawka OK, Chervenak FA, Positano RG. Common foot and ankle disorders in pregnancy: the role of diagnostic ultrasound. J Perinat Med 2024; 52:674-687. [PMID: 39213647 DOI: 10.1515/jpm-2024-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
Foot and ankle disorders are common during pregnancy, driven by significant physiological changes including weight distribution, hormonal fluctuations, and fluid balance. These changes often result in conditions such as varicose veins, thrombophlebitis, deep vein thrombosis (DVT), edema, overpronation, ankle sprains, metatarsalgia, stress fractures, ligament tears, synovitis, tendon tears, tenosynovitis, paratenonitis, plantar fasciitis, and Morton's neuroma. This paper emphasizes the diagnostic utility of ultrasound for these conditions, given its safety, non-invasiveness, and real-time imaging capabilities without ionizing radiation. Ultrasound is particularly effective for diagnosing venous disorders like varicose veins and thrombophlebitis, leveraging Doppler ultrasound to assess vein structure and function. It is also instrumental in identifying DVT, detecting vein dilation, reflux, and thrombosis. For conditions such as edema, ultrasound helps differentiate physiological from pathological causes, ensuring accurate diagnosis and management. In cases of musculoskeletal issues like overpronation, ankle sprains, ligament tears, and tendon pathologies, ultrasound provides detailed images of soft tissues, allowing for precise diagnosis and effective treatment planning. It is equally useful for detecting metatarsalgia, plantar fasciitis, and Morton's neuroma, offering insights into soft tissue abnormalities and guiding therapeutic interventions. Ultrasound's role extends to diagnosing foreign bodies in the foot and ankle, where it demonstrates high sensitivity and specificity. The accessibility and cost-effectiveness of ultrasound make it an invaluable tool in various healthcare settings, ensuring timely and accurate diagnosis and management of foot and ankle disorders during pregnancy, ultimately enhancing patient outcomes and quality of life.
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Affiliation(s)
- Meghan E Sahr
- Radiology & Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021
| | - Amos Grünebaum
- Zucker School of Medicine, Northwell, 2000 Marcus Ave., Suite 300, New Hyde Park, 11042-1069, NY, USA
| | - Rock C Positano
- Non-Surgical Foot and Ankle Center, Hospital for Special Surgery, New York, USA
| | - Ogonna K Nwawka
- Radiology & Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021
| | - Frank A Chervenak
- Zucker School of Medicine, Northwell, 2000 Marcus Ave., Suite 300, New Hyde Park, 11042-1069, NY, USA
| | - Rock G Positano
- Non-Surgical Foot and Ankle Center, Hospital for Special Surgery, New York, USA
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Triantafyllias K, Altamimi KK, Schederecker F, Schwarting A. Increased predictive value of optical spectral transmission in early rheumatoid arthritis through use of patient-adjusted cut-off scores. Arthritis Res Ther 2024; 26:165. [PMID: 39304933 DOI: 10.1186/s13075-024-03400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 09/06/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVES The aims of this study were to suggest patient-adjusted optical spectral transmission (OST) cut-off values for the first time and to develop clinical models that predict the probability of an early rheumatoid arthritis (RA) diagnosis based on OST findings and the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria as a reference standard. METHODS OST examinations were performed in newly diagnosed RA patients and healthy controls by the HandScan device. Moreover, RA patients underwent a full clinical [tender/swollen joint counts (TJC/SJC), disease activity score-28 (DAS28)] and laboratory evaluation. OST confounding factors were examined via logistic multivariate regression analyses and patient-adjusted OST-cut-offs were subsequently determined. Furthermore, statistical models to calculate the probability of an RA diagnosis, based on the measured OST values and the presence of OST influencing factors, were developed. Finally, correlations of OST with RA activity parameters were assessed. RESULTS 1.584 joints of 72 early RA patients were examined via OST and compared to 2.200 joints of 100 healthy controls and 1.166 joints of 53 patients with non-inflammatory arthralgia (NIA), respectively. Overall OST diagnostic performance was excellent in the whole cohort between RA- and healthy control-group [Area-Under-the-Curve (AUC): 0.810 (95%CI: 0.746-0.873); p < 0.0001], and further improved in RA-patients with ≥ 1 swollen wrist/finger joint(s) [AUC: 0.841 (95%CI: 0.773-0.908); p < 0.0001]. Comparison between RA patients and patients with non-inflammatory arthralgia showed similar results by an AUC of 0.788 (95%-CI: 0.709-0.867; p < 0.0001), and further improved in RA patients with ≥ 1 swollen wrist/finger joint(s) [AUC: 0.822 (95%CI: 0.74-0.90); p < 0.0001]. For the assessment of an adjusted RA diagnosis probability, two gender-specific statistical models were developed, based on OST values and patient age. OST cut-off values of 11.2 and 18.21 were calculated for female and male patients with active disease (sensitivity 93% and 67%; specificity 71.2% and 90%), respectively. Among RA patients, OST was associated moderately/significantly with DAS28 (r = 0.42,p < 0.001) and swollen joint count (rho = 0.355,p = 0.002). CONCLUSION The development of patient-adjusted OST cut-off values and the suggested statistical models significantly enhance OST's diagnostic performance, supporting its utility in differentiating between RA and non-inflammatory conditions. Future research should include a broader spectrum of arthritis types to validate OST's comprehensive diagnostic utility also across various inflammatory arthritides. TRIAL REGISTRATION DRKS00016752 (German Registry of Clinical Trials).
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Affiliation(s)
- Konstantinos Triantafyllias
- Department of Rheumatology, Acute Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany.
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany.
| | - Khalid K Altamimi
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | - Andreas Schwarting
- Department of Rheumatology, Acute Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
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Watt FT, Mackle EC, Zhang EZ, Beard PC, Alles EJ. Towards clinical application of freehand optical ultrasound imaging. Sci Rep 2024; 14:18779. [PMID: 39138339 PMCID: PMC11322517 DOI: 10.1038/s41598-024-69826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/09/2024] [Indexed: 08/15/2024] Open
Abstract
Freehand optical ultrasound (OpUS) imaging is an emerging ultrasound imaging paradigm that uses an array of fibre-optic, photoacoustic ultrasound sources and a single fibre-optic ultrasound detector to perform ultrasound imaging without the need for electrical components in the probe head. Previous freehand OpUS devices have demonstrated capability for real-time, video-rate imaging of clinically relevant targets, but have been hampered by poor ultrasound penetration, significant imaging artefacts and low frame rates, and their designs limited their clinical applicability. In this work we present a novel freehand OpUS imaging platform, including a fully mobile and compact acquisition console and an improved probe design. The novel freehand OpUS probe presented utilises optical waveguides to shape the generated ultrasound fields for improved ultrasound penetration depths, an extended fibre-optic bundle to improve system versatility and an overall ruggedised design with protective elements to improve probe handling and protect the internal optical components. This probe is demonstrated with phantoms and the first multi-participant in vivo imaging study conducted with freehand OpUS imaging probes, this represents several significant steps towards the clinical translation of freehand OpUS imaging.
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Affiliation(s)
- Fraser T Watt
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK.
| | - Eleanor C Mackle
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Edward Z Zhang
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Paul C Beard
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Erwin J Alles
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
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Zou Q, Huang Y, Gao J, Zhang B, Wang D, Wan M. Three-dimensional ultrasound image reconstruction based on 3D-ResNet in the musculoskeletal system using a 1D probe: ex vivoand in vivofeasibility studies. Phys Med Biol 2023; 68:165003. [PMID: 37419124 DOI: 10.1088/1361-6560/ace58b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/07/2023] [Indexed: 07/09/2023]
Abstract
Objective. Three-dimensional (3D) ultrasound (US) is needed to provide sonographers with a more intuitive panoramic view of the complex anatomical structure, especially the musculoskeletal system. In actual scanning, sonographers may perform fast scanning using a one-dimensional (1D) array probe .at random angles to gain rapid feedback, which leads to a large US image interval and missing regions in the reconstructed volume.Approach.In this study, a 3D residual network (3D-ResNet) modified by a 3D global residual branch (3D-GRB) and two 3D local residual branches (3D-LRBs) was proposed to retain detail and reconstruct high-quality 3D US volumes with high efficiency using only sparse two-dimensional (2D) US images. The feasibility and performance of the proposed algorithm were evaluated onex vivoandin vivosets.Main results. High-quality 3D US volumes in the fingers, radial and ulnar bones, and metacarpophalangeal joints were obtained by the 3D-ResNet, respectively. Their axial, coronal, and sagittal slices exhibited rich texture and speckle details. Compared with kernel regression, voxel nearest-neighborhood, squared distance weighted methods, and a 3D convolution neural network in the ablation study, the mean peak-signal-to-noise ratio and mean structure similarity of the 3D-ResNet were up to 28.53 ± 1.29 dB and 0.98 ± 0.01, respectively, and the corresponding mean absolute error dropped to 0.023 ± 0.003 with a better resolution gain of 1.22 ± 0.19 and shorter reconstruction time.Significance.These results illustrate that the proposed algorithm can rapidly reconstruct high-quality 3D US volumes in the musculoskeletal system in cases of a large amount of data loss. This suggests that the proposed algorithm has the potential to provide rapid feedback and precise analysis of stereoscopic details in complex and meticulous musculoskeletal system scanning with a less limited scanning speed and pose variations for the 1D array probe.
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Affiliation(s)
- Qin Zou
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yuqing Huang
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Junling Gao
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Bo Zhang
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Diya Wang
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Mingxi Wan
- Department of Biomedical Engineering, the Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China
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Triantafyllias K, Marinoska T, Heller C, de Blasi M, Muthuraman M, Schwarting A. Optical spectral transmission to assess glucocorticoid therapy response in patients with arthritis: a longitudinal follow-up comparison with joint ultrasound. Arthritis Res Ther 2023; 25:47. [PMID: 36964628 PMCID: PMC10039502 DOI: 10.1186/s13075-023-03023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Optical spectral transmission (OST) is a modern diagnostic modality, able to assess the blood-specific absorption of light transmitted through a tissue, promising quantification of inflammation in the finger and wrist joints of patients with arthritis. To date, there are no adequate data regarding the diagnostic value of OST in the evaluation of inflammatory activity changes, during arthritis follow-up. Objectives of this study were therefore to examine the performance of OST in assessing response to anti-inflammatory therapy in patients with active arthritis and to explore OST associations with clinical, laboratory, and ultrasonographic (US) activity markers. METHODS 1173 joints of 54 patients with arthritides of the wrist and finger joints were examined by OST before and after oral administration of glucocorticoids (GC), during a disease flare. For the same time-points patients underwent clinical, laboratory, and joint US [grayscale (GSUS), power-Doppler (PDUS)] examinations. The distribution of ΔOST-values between the two time-points was compared with the respective distributions of ΔPDUS and ΔGSUS by Bayesian statistical analyses. Moreover, the diagnostic performance of OST compared to a control group (2508 joints of 114 subjects) was examined by receiver operating characteristics and associations of OST values with clinical, laboratory, and arthrosonographic parameters were evaluated by correlation analyses. RESULTS OST and US performed similarly in the assessment of inflammatory changes caused by GC (same value-change tendency in 83.2% of the cases). Bayesian statistics revealed no significant differences between ΔOST and ΔPDUS for all 3 examined joint categories (accuracy: metacarpophalangeal (MCP): 68.1%; proximal interphalangeal (PIP): 60.4%; wrists: 50.4%) and between ΔOST and ΔGSUS for MCP and PIP joints (accuracy: 51.1% and 78.7%, respectively). OST diagnostic performance (patients vs. controls) was excellent in both time-points [area under the curve (AUC) before GC=0.883(95%CI=0.83-0.94) and after GC=0.811(95%CI=0.74-0.881); p<0.001]. Furthermore, OST correlated significantly with all examined sonographic activity scores (all; p<0.001) and with swollen joint counts (p<0.01). CONCLUSIONS OST was able to assess response to therapy in a similar way to joint US and correlated significantly with arthritis activity markers. Therefore, OST has proved to be a valuable tool to assist disease activity monitoring in the examined cohort. TRIAL REGISTRATION German Registry of Clinical Trials, DRKS00016752.
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Affiliation(s)
- Konstantinos Triantafyllias
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany.
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Tatjana Marinoska
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
| | - Caroline Heller
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michele de Blasi
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
| | - Muthuraman Muthuraman
- Department of Biomedical Statistics and Multimodal Signal Processing, Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Schwarting
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543, Bad Kreuznach, Germany
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Bethina NK, Torralba KD, Choi KS, Fairchild RM, Cannella AC, Salto L, Kissin EY, Yinh J, Aggarwal M, Thiele R, Nishio MJ. North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study. Clin Rheumatol 2022; 41:3825-3835. [PMID: 36008579 DOI: 10.1007/s10067-022-06337-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/24/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America. METHOD Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar's chi-square test. RESULTS Consensus was achieved for 70% of scan views of the upper extremity joints. Two views-ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand-were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation. CONCLUSIONS This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound. Key Points • Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely. • A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present. • The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.
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Affiliation(s)
- Narandra K Bethina
- Division of Rheumatology and Clinical Immunology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kristal S Choi
- Division of Rheumatology, University of CA-Los Angeles, Los Angeles, CA, USA
| | - Robert M Fairchild
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Amy C Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorena Salto
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Harvard Medical School, Boston, MA, USA
| | - Manushi Aggarwal
- Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Ralf Thiele
- Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA
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Jana M, Mittal D, Bagri N, Yadav R, Parihar V, Bagri NK. Role of Imaging in Childhood Arthritis. J Clin Rheumatol 2022; 28:e539-e544. [PMID: 33843776 DOI: 10.1097/rhu.0000000000001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Imaging plays a pivotal role in the management of various childhood arthritis. Conventional radiography is the most commonly ordered imaging modality for the evaluation of arthritis. Owing to their higher sensitivity for detecting synovitis, magnetic resonance imaging and ultrasonography are increasingly being used to guide clinical management of various forms of arthritis, especially juvenile idiopathic arthritis. Magnetic resonance imaging is a preferred modality for evaluating more complex sites such as the sacroiliac joint. In this review, we have discussed the rational use and the characteristic imaging features of common childhood arthritis.
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Affiliation(s)
- Manisha Jana
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Disha Mittal
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Neha Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Richa Yadav
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Vivek Parihar
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Narendra Kumar Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
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Diagnostic performance of high-resolution ultrasound in pre- and postoperative evaluation of the hand tendons injuries. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00375-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Hand tendon injuries are recognized clinical entities that are frequently seen. Clinical examinations usually warrant radiological correlative studies for confirmation and as a postoperative screening test. Here is a prospective observational cohort study enrolling 30 patients who were diagnosed clinically to have hand tendon injuries either pre- or postoperative; their ages were ranging from 5 to 64 years with a mean ± SD of 31.43 ± 12.19 years; 23 male patients (76.7%) and 7 female patients (23.3%) were evaluated by high-resolution ultrasound examination and a correlative evaluation was done by either intra-operative assessment or MRI study as gold standards.
Results
High-resolution ultrasound (HRUS) findings were binned into seventeen cases (56%) that had tendon tears, of which 10 cases (33.3%) had a complete tear and 7 cases (23.3%) had a partial tear. Postoperative tendon integrity was present in 13 cases (43.3%), a tendon callus was found in 2 cases (6.66%), and a postoperative abnormal motion on the dynamic study was present in 15 cases (50%). Intra-tendinous foreign bodies were detected in two cases (6.66%), a gap between the torn ends was found in 10 cases (33.3%), and re-tear (rupture) of the repaired tendons was present in four cases (13.3%). Coexistent nerve injuries were seen in two cases (6.66%); for the forementioned findings, HRUS had gained high accuracy measures as correlated to the gold standards (100% sensitivity and 100% specificity).
Conclusion
High-resolution ultrasound serves as a highly accurate potential diagnostic modality for preoperative evaluation of hand tendon injuries and the postoperative follow-up.
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Kim SK, Jung UH, Choe JY. Functional index for hand osteoarthritis (FIHOA) is associated with pain, muscle strength, and EQ-5D in hand osteoarthritis. Adv Rheumatol 2021; 61:19. [PMID: 33741081 DOI: 10.1186/s42358-021-00177-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study identified whether Functional Index for Hand Osteoarthritis (FIHOA) is associated with pain, hand muscle strength, health-related quality of life, and radiographic severity in hand osteoarthritis (OA). METHODS We consecutively recruited 95 patients with hand OA. The FIHOA was used to assess questionnaire-based physical function in hand OA. Health-related quality of life was evaluated using EuroQol-5 dimension (EQ-5D). Radiographic changes of hand joints were measured by Kellgren-Lawrence (K-L) grade, which was determined based on total radiographic severity score and number of affected joints. Other measures included patient's visual analogue scale (VAS) score for pain and performance-based function indexes such as grip and pinch strength. Statistical analysis was performed using Mann-Whitney U test, Spearman's correlation analysis, and multivariate logistic regression analysis. RESULTS FIHOA score was negatively associated with grip and pinch hand strength and EQ-5D and positively correlated to VAS pain (p < 0.05 for all). There were significant differences of grip and pinch strength, VAS pain, EQ-5D index, and EQ-VAS between two FIHOA groups (≤ 4 vs. > 4) (p < 0.05 for all). Multivariate logistic regression analysis showed that higher FIHOA score (FIHOA > 4) was related with increased VAS pain and with lower EQ-5D index (p = 0.008 and p = 0.013, respectively). There was no association between FIHOA score and measures of total radiographic severity score and number of affected joints. CONCLUSION This study observes that FIHOA score is associated with patient-reported VAS pain, hand muscle strength indexes, and EQ-5D but not radiographic severity in hand OA.
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Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea.
| | - Ui Hong Jung
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
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Jindal G, Bansal S, Gupta N, Singh SK, Gahukar S, Kumar A. Comparison of Ultrasonography and X-Rays for the Diagnosis of Synovitis and Bony Erosions in Small Joints of Hands in Early Rheumatoid Arthritis: a Prospective Study. MAEDICA 2021; 16:22-28. [PMID: 34221152 PMCID: PMC8224727 DOI: 10.26574/maedica.2020.16.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: Rheumatoid arthritis (RA) is the most common inflammatory joint disease. Many studies have shown that erosions and synovitis can be picked up at an early stage on ultrasonography (US) when X-rays appear normal. Ultrasonography exams in inflammatory arthritis helps in determining objective evidence of inflammatory arthritis- synovitis, erosions, effusions and also help in monitoring therapy in established RA patients. Materials and methods: Ninety patients aged over 18 years, who were diagnosed with RA (according to 2010 ACR criteria) of less than two years duration, were included in the study prospectively. Baseline data, disease activity score of 28 joints (DAS 28 score), complete clinical evaluation and laboratory investigations were registered. Conventional radiographs of both hands were taken in posteroanterior views. A power Doppler US was performed on all metacarpophalangeal (MCP) joints and proximal interphalangeal (PIP) joints of both hands. Results: Out of the 90 patients, 84 had positive findings on US and only 13 subjects had positive radiographic findings. The second MCP was the most common joint involved on US. The mean cumulative flow signal (CFS) score was 4.15±5.12. The relation between CFS and DAS 28 scores was highly significant, with p value <0.01. Conclusion: Ultrasonography can detect changes in joints at an earlier stage than radiographs. Both grey scale and power Doppler US have a role in detecting synovitis and erosions.
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Affiliation(s)
- Gunjan Jindal
- Department of Radiodiagnosis, MMIMSR, Mullana, India
| | - Saloni Bansal
- Department of Biochemistry, PGIMER Outreach Center, Sangrur, Punjab, India
| | - Nishu Gupta
- Department of Pediatrics, PGIMER Outreach Center, Sangrur, Punjab, India
| | | | - Shailesh Gahukar
- Department of Hospital Administration; PGIMER Outreach Center, Sangrur, India
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER Chandigarh; PGIMER Satellite Centre, Sangrur, Punjab, India
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12
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Kim SK, Jung UH, Kim JW, Choe JY. Ultrasound Findings were Associated With Radiographic Changes, But Not Clinical and Functional Outcomes in Hand Osteoarthritis. JOURNAL OF RHEUMATIC DISEASES 2021; 28:17-24. [PMID: 37476391 PMCID: PMC10324955 DOI: 10.4078/jrd.2021.28.1.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 07/22/2023]
Abstract
Objective There is a debate over the relevance of ultrasound abnormalities to the pain, functional impairment, and radiologic severity in hand osteoarthritis (OA) This study aims to determine the association between ultrasound abnormalities and clinical, functional, and radiographic measures in hand OA. Methods A total of 66 patients was consecutively enrolled All patients with gray-scale synovitis, joint effusion, and osteophytes were examined by ultrasound for 20 hand joints Radiographic changes in both hands were evaluated by the Kellgren-Lawrence (K-L) grading system and were described as total radiographic severity score and number of affected joints Other measures were also assessed, including each patient's visual analogue scale for pain, the Functional Index for Hand Osteoarthritis for functional disability, and grip and pinch strength for hand muscle strength. Results In total, 10 patients with gray-scale synovitis, 35 with joint effusion, and 66 with osteophytes were detected in hand OA scans on ultrasound Osteophytes on ultrasound were significantly associated with total radiographic severity score and number of affected joint (r=0293, p=0003 and r=0336, p<0001, respectively) In addition, there were weak associations of synovitis and joint effusion with radiographic changes Patients with higher total radiographic severity score showed larger number of ultrasound-detected abnormalities, such as synovitis, joint effusion, and osteophytes (p=0011, p=0002, and p<0001, respectively). Conclusion This study shows that ultrasound findings, especially osteophytes, were associated with radiographic changes based on K-L grade, but not clinical and functional status in hand OA.
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Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ui Hong Jung
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji-Won Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Romero-Morales C, Bravo-Aguilar M, Ruiz-Ruiz B, Almazán-Polo J, López-López D, Blanco-Morales M, Téllez-González P, Calvo-Lobo C. Current advances and research in ultrasound imaging to the assessment and management of musculoskeletal disorders. Dis Mon 2020; 67:101050. [PMID: 32711897 DOI: 10.1016/j.disamonth.2020.101050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Currently evidence-based practice has given scientific weight to the physical therapist profession; it is essential that all medical professional and physical therapists know the usefulness of new tools that optimize the effectiveness of their interventions and allow the growing of the scientific knowledge base. The use of ultrasound imaging (USI) by physiotherapists has evolved in recent years, consolidating as an increasingly standardized technique, low cost compared to other imaging techniques, quickly of execution, feasible and reliable tool. USI offers a wide range of opportunities in clinical practice as well as in different research areas. Therefore, ultrasound has been currently used as a diagnostic tool by physicians and in recent years there has been an expansion of the use of ultrasound equipment by non-physicians professionals such as physical therapist or physical trainers, who incorporates USI as a means of assessing musculoskeletal system architecture and composition, musculoskeletal changes in dysfunction, pain or injury conditions, as an interventional technique assisting echo-guided procedures or using the visual real-time information as a biofeedback in control motor approaches, as guiding tool in clinical decisions as well as to improve the understanding of tissue adaptations to exercise or movement. The purpose of this article is to review and provide an overview about the currently research of the USI applications and their benefits for the diagnosis and management in individuals with musculoskeletal conditions.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Beatriz Ruiz-Ruiz
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403, Ferrol, Spain
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403, Ferrol, Spain.
| | - María Blanco-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Patricia Téllez-González
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040, Madrid, Spain
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De Maeseneer M, Meng J, Marcelis S, Jager T, Provyn S, Shahabpour M. Ultrasound anatomy of the fingers: flexor and extensor system with emphasis on variations and anatomical detail. J Ultrason 2020; 20:e122-e128. [PMID: 32609968 PMCID: PMC7418857 DOI: 10.15557/jou.2020.0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/07/2020] [Indexed: 12/04/2022] Open
Abstract
Many anatomical details and variants occur in the finger tendons and soft tissue structures. These may lead to misdiagnosis if the radiologist is not well aware of them. We discuss the midhand extensor tendons, dorsal hood, junctura tendinea, conjoint tendons, transverse retinacular ligament, triangular ligament as well as central and distal slip anatomy and ultrasound correlation. The dorsal hood is an important structure to center the tendons at the midportion of the MCP heads, and the sagittal bands are its main components. Two tendons are present at the second digit, and two or more at the fifth digit. The extensor mechanism is anatomically interrelated with the palmar lumbricals and interosseous tendons. At the palmar side, the flexor superficialis and profundus tendons show varying relationships along the finger. The flexor profundus passes through an opening in the flexor superficialis. We also discuss the chiasma crurale, ridges at the flexor superficialis insertions and bifid flexor profundus tendon. Although a typical distribution of annular pulleys can be observed, many variants may be present of which we address some. The volar plate is a midline fibro-cartilaginous meniscus attached proximally to the well-identifiable checkrein ligaments and distally to the base of the phalanges. Knowledge of these details and variations allows for better understanding of the finger and hand ultrasound.
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Affiliation(s)
- Michel De Maeseneer
- Vrije Universiteit Brussel , Brussels , Belgium ; Department of Radiology, Radiologie Buggenhout , Buggenhout , Belgium
| | - Jie Meng
- Department of Ultrasound, Jilin University , Changchun Jilin , China
| | - Stefaan Marcelis
- Department of Radiology, Sint Andries Ziekenhuis SAT , Tielt , Belgium
| | | | - Steven Provyn
- Department of Anatomical Research and Clinical Studies, Vrije Universiteit Brussel , Brussel , Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
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Rossi F, Zaottini F, Picasso R, Martinoli C, Tagliafico AS. Ankle and Foot Ultrasound: Reliability of Side-to-Side Comparison of Small Anatomic Structures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2143-2153. [PMID: 30592321 DOI: 10.1002/jum.14911] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In sonography of clinically relevant small structures of the ankle and foot, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intrasubject side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side sonographic evaluation of small structures of the ankle and foot. METHODS Thirty healthy volunteers were prospectively studied. Small structures of the ankle and foot were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The deep peroneal nerve, superior extensor retinacula, calcaneofibular ligament, superior peroneal retinacula, tibialis posterior tendon, tibial nerve, Achilles tendon, plantaris tendon, plantar fascia, and sural nerve were considered. To assess intra- and interreader agreements, 30 (100%) examinations were repeated. A nonparametric statistic was used. RESULTS Data were not normally distributed (P > .001). Intrareader agreement was k = 0.67 (95% confidence interval, 0.57-0.78) and interreader agreement was k = 0.73 (95% confidence interval, 0.68-0.77). The mean values and standard deviation for all the structures were 0.36 ± 1.85 mm. The overall coefficient of variation was 18.5%. The intraclass correlation coefficient was 0.93 (95% confidence interval, 0.92-0.94). CONCLUSIONS In ankle and foot sonography, the healthy contralateral side can be used as a reference during a real-time musculoskeletal ultrasound evaluation of small structures.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Federico Zaottini
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Riccardo Picasso
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
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16
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Man With Finger Pain and Swelling. Ann Emerg Med 2019; 73:e79-e80. [PMID: 31133193 DOI: 10.1016/j.annemergmed.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Indexed: 11/20/2022]
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Baffour FI, McKenzie GA, Bekele DI, Glazebrook KN. Sonography of active rheumatoid arthritis during pregnancy: a case report and literature review. Radiol Case Rep 2018; 13:1233-1237. [PMID: 30258513 PMCID: PMC6148827 DOI: 10.1016/j.radcr.2018.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/18/2018] [Accepted: 08/26/2018] [Indexed: 11/16/2022] Open
Abstract
Disease activity in rheumatoid arthritis usually subsides in pregnancy, however a subset of patients have worsened symptoms with joint pain and swelling. Monitoring and mitigating disease activity in pregnancy is important for preventing deforming structural changes which can affect the ability of the patient to care for themselves and the newborn. Ultrasound is a safe and low-cost imaging modality for detecting active changes from an inflammatory arthritis, which can help guide management. We describe a case of an acute disease flare during pregnancy, readily detected with ultrasound, and present a review of sonographic evaluation of rheumatoid arthritis in pregnancy.
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Affiliation(s)
- Francis I. Baffour
- Division of Musculoskeletal Radiology, Department of Radiology, 200 1st Street SW, Rochester, MN 55905
- Corresponding author.
| | - Gavin A. McKenzie
- Division of Musculoskeletal Radiology, Department of Radiology, 200 1st Street SW, Rochester, MN 55905
| | | | - Katrina N. Glazebrook
- Division of Musculoskeletal Radiology, Department of Radiology, 200 1st Street SW, Rochester, MN 55905
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18
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Rossi F, Romano N, Muda A, Martinoli C, Tagliafico A. Wrist and Hand Ultrasound: Reliability of Side-to-Side Comparisons of Very Small (<2-mm) Clinically Relevant Anatomic Structures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2785-2795. [PMID: 29689624 DOI: 10.1002/jum.14635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In ultrasound (US) examinations of clinically relevant very small structures of the wrist and hand, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intraindividual side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side US evaluations of very small structures of the wrist and hand. METHODS Forty-one healthy volunteers were prospectively studied. Small structures of the wrist and hand were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The first annular pulleys of the second finger and the thumb, sagittal band of the third finger, extensor and flexor retinacula, ulnar collateral ligament of the thumb, radial collateral ligament of the second finger, and palmar cutaneous branches of the median and ulnar nerves were considered. To assess intra- and inter-reader agreement, 10 of 41 (24%) examinations were repeated. Nonparametric statistics were used. RESULTS Data were not normally distributed (P > .001). Intra-reader agreement was κ = 0.674 (95% confidence interval [CI], 0.57-0.78), and inter-reader agreement was κ = 0.935 (95% CI, 0.92-0.95). The mean value ± SD for all of the structures was 0.78 ± 0.44 mm. The overall coefficient of variation was 9.8% ± 0.07%. The intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98). CONCLUSIONS In clinical practice, the healthy contralateral side can be used as a reference during a real-time musculoskeletal US evaluation of small (<2-mm) structures.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicola Romano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessandro Muda
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
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19
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Ibrahim SE, Morshedy NA, Farouk N, Louka AL. Anti-carbamylated protein antibodies in psoriatic arthritis patients: Relation to disease activity, severity and ultrasonographic scores. EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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21
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Automated assessment of joint synovitis activity from medical ultrasound and power doppler examinations using image processing and machine learning methods. Reumatologia 2016; 54:239-242. [PMID: 27994268 PMCID: PMC5149571 DOI: 10.5114/reum.2016.63664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives Rheumatoid arthritis is the most common rheumatic disease with arthritis, and causes substantial functional disability in approximately 50% patients after 10 years. Accurate measurement of the disease activity is crucial to provide an adequate treatment and care to the patients. The aim of this study is focused on a computer aided diagnostic system that supports an assessment of synovitis severity. Material and methods This paper focus on a computer aided diagnostic system that was developed within joint Polish–Norwegian research project related to the automated assessment of the severity of synovitis. Semiquantitative ultrasound with power Doppler is a reliable and widely used method of assessing synovitis. Synovitis is estimated by ultrasound examiner using the scoring system graded from 0 to 3. Activity score is estimated on the basis of the examiner’s experience or standardized ultrasound atlases. The method needs trained medical personnel and the result can be affected by a human error. Results The porotype of a computer-aided diagnostic system and algorithms essential for an analysis of ultrasonic images of finger joints are main scientific output of the MEDUSA project. Medusa Evaluation System prototype uses bone, skin, joint and synovitis area detectors for mutual structural model based evaluation of synovitis. Finally, several algorithms that support the semi-automatic or automatic detection of the bone region were prepared as well as a system that uses the statistical data processing approach in order to automatically localize the regions of interest. Conclusions Semiquantitative ultrasound with power Doppler is a reliable and widely used method of assessing synovitis. Activity score is estimated on the basis of the examiner’s experience and the result can be affected by a human error. In this paper we presented the MEDUSA project which is focused on a computer aided diagnostic system that supports an assessment of synovitis severity.
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Taljanovic MS, Melville DM, Gimber LH, Scalcione LR, Miller MD, Kwoh CK, Klauser AS. High-Resolution US of Rheumatologic Diseases. Radiographics 2016; 35:2026-48. [PMID: 26562235 DOI: 10.1148/rg.2015140250] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema. Crystal deposition diseases including gouty arthropathy and calcium pyrophosphate deposition disease (CPPD) have characteristic appearances at US, enabling differentiation between these two diseases and from inflammatory arthropathies. Enthesopathy, which frequently accompanies psoriatic and reactive arthritis, also has a characteristic appearance at high-resolution US, distinguishing these two entities from other inflammatory and metabolic arthropathies. The presence of Doppler signal in examined joints, bursae, and tendon sheaths indicates active synovitis. Microbubble echo contrast agents augment detection of tissue vascularity and may act in the future as a drug delivery vehicle. Frequently, joint, tendon sheath, and bursal fluid aspirations and therapeutic injections are performed under US guidance. The authors describe the high-resolution US technique including gray-scale, color or power Doppler, and contrast agent-enhanced US that is used in evaluation of rheumatologic diseases of the wrist and hand and the ankle and foot in their routine clinical practice. This article demonstrates imaging findings of normal joints, rheumatoid arthritis, gouty arthritis, CPPD, psoriatic and reactive arthritis, and osteoarthritis.
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Affiliation(s)
- Mihra S Taljanovic
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - David M Melville
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Lana H Gimber
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Luke R Scalcione
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Margaret D Miller
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - C Kent Kwoh
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Andrea S Klauser
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
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Ventura-Ríos L, Hernández-Díaz C, Sanchez-Bringas G, Madrigal-Santillán E, Morales-González JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol 2016; 35:2269-2276. [PMID: 27393079 DOI: 10.1007/s10067-016-3338-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 02/07/2023]
Abstract
The aim of this study is to characterize bone erosions in metatarsal heads (MTH) in rheumatoid arthritis (RA) and gout by grayscale ultrasound. In a descriptive, cross-sectional study, we evaluated 40 patients with RA and 40 with gout, both diagnosed according to the American College of Rheumatology/European League Against Rheumatism criteria, respectively. All patients had bone erosion demonstrated by ultrasound, which was used, following OMERACT criteria, to describe the shape, size, number, border definition, overhanging margin, topography (intra- or extra-articular), and distribution (over dorsal, medial, lateral, or plantar aspect) of the lesions in the MTH. Descriptive statistics were used and a concordance exercise between two ultrasonographers blinded to the diagnosis was performed. Bone erosions in RA were observed most frequently at the plantar and lateral aspect of the fifth MTH, round in 96 %, small-sized (2.43 ± 0.9 mm), intra-articular (100 %), and single (75 %). Few bone erosions had a well-defined border an overhanging margin while in gout were found most frequently in the medial and dorsal aspect of the first MTH, single in 71 %, intra-articular in 100 %, and of median size (4.0 ± 2.3). For shape, 51 % was round and 49 % was oval. A well-defined border was present in 39 %, and an overhanging margin in 62 %. Inter-rater reliability kappa was excellent (0.81, 95 % CI 0.56-1.00). Some characteristics of bone erosions in RA, including shape, size, ill-defined border, and localization in the fifth MTH could distinguish the lesions from gout. Grayscale US has excellent reliability to describe bone erosions in RA and gout.
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Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México.
| | - Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México
| | - Guadalupe Sanchez-Bringas
- Servicio de Cirugía de Columna. Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México
| | - Eduardo Madrigal-Santillán
- Laboratorio de Medicina de Conservación. Escuela Superior de Medicina. Instituto Politécnico Nacional, México City, México
| | - José Antonio Morales-González
- Laboratorio de Medicina de Conservación. Escuela Superior de Medicina. Instituto Politécnico Nacional, México City, México
| | - Carlos Pineda
- Dirección de Investigación, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México
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Soldatos T, Pezeshk P, Ezzati F, Karp DR, Taurog JD, Chhabra A. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol 2016; 45:1173-91. [PMID: 27209200 DOI: 10.1007/s00256-016-2402-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains images and data, which were collected from patients as a part of a retrospective IRB from the institutional teaching files and informed consent was waived.
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Affiliation(s)
| | - Parham Pezeshk
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - Fatemeh Ezzati
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David R Karp
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joel D Taurog
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Musculoskeletal Radiology, Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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25
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Mainz ER, Serafin DS, Nguyen TT, Tarrant TK, Sims CE, Allbritton NL. Single Cell Chemical Cytometry of Akt Activity in Rheumatoid Arthritis and Normal Fibroblast-like Synoviocytes in Response to Tumor Necrosis Factor α. Anal Chem 2016; 88:7786-92. [PMID: 27391352 PMCID: PMC6040665 DOI: 10.1021/acs.analchem.6b01801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The etiology of rheumatoid arthritis (RA) is poorly understood, and 30% of patients are unresponsive to established treatments targeting tumor necrosis factor α (TNFα). Akt kinase is implicated in TNFα signaling and may act as a barometer of patient responses to biologic therapies. Fluorescent peptide sensors and chemical cytometry were employed to directly measure Akt activity as well as proteolytic activity in individual fibroblast-like synoviocytes (FLS) from RA and normal subjects. The specificity of the peptide reporter was evaluated and shown to be a valid measure of Akt activity in single cells. The effect of TNFα treatment on Akt activity was highly heterogeneous between normal and RA subjects, which was not observable in bulk analyses. In 2 RA subjects, a bimodal distribution of Akt activity was observed, primarily due to a subpopulation (21.7%: RA Subject 5; 23.8%: RA Subject 6) of cells in which >60% of the reporter was phosphorylated. These subjects also possessed statistically elevated proteolytic cleavage of the reporter relative to normal subjects, suggesting heterogeneity in Akt and protease activity that may play a role in the RA-affected joint. We expect that chemical cytometry studies pairing peptide reporters with capillary electrophoresis will provide valuable data regarding aberrant kinase activity from small samples of clinical interest.
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Affiliation(s)
- Emilie R. Mainz
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - D. Stephen Serafin
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27599, USA
| | - Tuong T. Nguyen
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Teresa K. Tarrant
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27599, USA
- Department of Medicine, Division of Rheumatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Christopher E. Sims
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Department of Medicine, Division of Rheumatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nancy L. Allbritton
- Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina 27599, USA and North Carolina State University, Raleigh, North Carolina 27695, US
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Ultrasound Color Doppler Image Segmentation and Feature Extraction in MCP and Wrist Region in Evaluation of Rheumatoid Arthritis. J Med Syst 2016; 40:197. [PMID: 27449351 DOI: 10.1007/s10916-016-0552-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
The present study focuses on automatically to segment the blood flow pattern of color Doppler ultrasound in hand region of rheumatoid arthritis patients and to correlate the extracted the statistical features and color Doppler parameters with standard parameters. Thirty patients with rheumatoid arthritis (RA) and their total of 300 joints of both the hands, i.e., 240 MCP and 60 wrists were examined in this study. Ultrasound color Doppler of both the hands of all the patients was obtained. Automated segmentation of color Doppler image was performed using color enhancement scaling based segmentation algorithm. The region of interest is fixed in the MCP joints and wrist of the hand. Features were extracted from the defined ROI of the segmented output image. The color fraction was measured using Mimics software. The standard parameters such as HAQ score, DAS 28 score, and ESR was obtained for all the patients. The color fraction tends to be increased in wrist and MCP3 joints which indicate the increased blood flow pattern and color Doppler activity as part of inflammation in hand joints of RA. The ESR correlated significantly with the feature extracted parameters such as mean, standard deviation and entropy in MCP3, MCP4 joint and the wrist region. The developed automated color image segmentation algorithm provides a quantitative analysis for diagnosis and assessment of RA. The correlation study between the color Doppler parameters with the standard parameters provides moral significance in quantitative analysis of RA in MCP3 joint and the wrist region.
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Rheinboldt M, Scher C. Musculoskeletal ultrasonography in the diagnosis of acute crystalline synovitis. Emerg Radiol 2016; 23:623-632. [DOI: 10.1007/s10140-016-1419-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/28/2016] [Indexed: 12/19/2022]
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Hussain Manik Z, George J, Sockalingam S. Ultrasound Assessment of Synovial Thickness of Some of the Metacarpophalangeal Joints of Hand in Rheumatoid Arthritis Patients and the Normal Population. SCIENTIFICA 2016; 2016:5609132. [PMID: 27190682 PMCID: PMC4846766 DOI: 10.1155/2016/5609132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 06/05/2023]
Abstract
Objective. To compare ultrasound synovial thickness of the 2nd, 3rd and 4th metacarpophalangeal joints (MCPJ) in a group of patients with proven rheumatoid arthritis (RA) and a control group of normal individuals. Materials and Methods. This is a cross-sectional study comprising 30 rheumatoid arthritis patients and 30 healthy individuals. Ultrasound scans were performed at the dorsal side of 2nd, 3rd, and 4th MCPJ of both hands in RA patients and the healthy individuals. Synovial thickness was measured according to quantitative method. The synovial thickness of RA patients and healthy individuals was compared and statistical cut-off was identified. Results. Maximum synovial thickness was most often detected at the radial side of the 2nd MCPJ and 3rd MCPJ and ulnar side of the 4th MCPJ of both hands which is significantly higher (p < 0.05) in RA patients compared to healthy individuals. With high specificity (96%) and sensitivity (90%) the optimum cut-off value to distinguish RA patients and healthy individuals' synovial thickness differs for the radial side of the 2nd and 3rd MCPJ and ulnar side of the 4th MCPJ. Conclusion. Patients with early RA appear to exhibit a characteristic pattern of synovitis which shows radial side predominance in the 2nd and 3rd MCPJ and ulnar side in the 4th MCPJ.
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Affiliation(s)
- Zuhudha Hussain Manik
- University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John George
- University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sargunan Sockalingam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ultrasound Findings in Hand Joints Involvement in Patients with Psoriatic Arthritis and Its Correlation with Clinical DAS28 Score. Radiol Res Pract 2015; 2015:353657. [PMID: 26858846 PMCID: PMC4700862 DOI: 10.1155/2015/353657] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 01/08/2023] Open
Abstract
Objective. To determine the frequency of the various ultrasound findings in hand joints in patients with psoriatic arthritis and correlate grayscale and Power Doppler ultrasonography findings with Disease Activity Score 28. Methods. This prospective study was performed in 30 patients. Ultrasound evaluation of 28 joints of both hands was undertaken and various findings were recorded including synovial hypertrophy, Power Doppler abnormality, soft tissue thickening, tendonitis, joint effusion, periosteal reaction, and erosions. Composite ultrasound scores and Disease Activity Score 28 were calculated and compared. Spearman correlation was used to see relationship between the ultrasound and DAS28 scores. Results. Ultrasound detected more abnormalities in the hand joints than did clinical examination. The frequency of various ultrasound abnormalities was as follows: Synovial hypertrophy was seen in 100%, Power Doppler abnormality suggesting hypervascularity was seen in 36.7%, soft tissue thickening was seen in 66.7%, periosteal reaction was seen in 33.3%, erosions were seen in 30% (mostly in DIP and PIP joints), and flexor tendonitis was seen in 6.7% of patients. Significant correlation was found between Disease Activity Score 28 and grayscale joint score (GSJS) (Spearman's ρ: 0.499; P: 0.005), grayscale joint count (GSJC) (ρ: 0.398; P: 0.029), and Power Doppler joint score (PDJS) (ρ: 0.367; P: 0.046). There was a statistically significant difference between remission and low disease activity group and moderate disease activity group in terms of GSJC, GSJS, PDJC, and PDJS (P < 0.05). These ultrasound measures were higher in moderate disease activity zone patients. Conclusion. Ultrasound is a useful modality for the objective assessment of psoriatic arthritis. Ultrasound including Power Doppler can be used as a modality for assessment of severity of psoriatic arthritis as it correlates with the clinical scoring.
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Lee SA, Kim BH, Kim SJ, Kim JN, Park SY, Choi K. Current status of ultrasonography of the finger. Ultrasonography 2015; 35:110-23. [PMID: 26753604 PMCID: PMC4825212 DOI: 10.14366/usg.15051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/03/2022] Open
Abstract
The recent development of advanced high-resolution transducers has enabled the fast, easy, and dynamic ultrasonographic evaluation of small, superficial structures such as the finger. In order to best exploit these advances, it is important to understand the normal anatomy and the basic pathologies of the finger, as exemplified by the following conditions involving the dorsal, volar, and lateral sections of the finger: sagittal band injuries, mallet finger, and Boutonnière deformity (dorsal aspect); flexor tendon tears, trigger finger, and volar plate injuries (volar aspect); gamekeeper's thumb (Stener lesions) and other collateral ligament tears (lateral aspect); and other lesions. This review provides a basis for understanding the ultrasonography of the finger and will therefore be useful for radiologists.
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Affiliation(s)
- Seun Ah Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seon-Jeong Kim
- Department of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Ji Na Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyunghee Choi
- Department of Radiology, Incheon Baek Hospital, Incheon, Korea
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Duftner C, Dejaco C, Kainberger F, Machold K, Mandl P, Nothnagl T, DeZordo T, Husic R, Schüller-Weidekamm C, Schirmer M. Empfehlungen der Österreichische Gesellschaft für Rheumatologie und Rehabilitation/Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound zur Anwendung des Ultraschalls bei rheumatischen Erkrankungen in der klinischen Praxis. Wien Klin Wochenschr 2014; 126:809-14. [DOI: 10.1007/s00508-014-0606-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
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Tripathi D, Agarwal V. Quantifying synovial inflammation: Emerging imaging techniques. World J Rheumatol 2014; 4:72-79. [DOI: 10.5499/wjr.v4.i3.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 07/23/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging techniques to assess synovial inflammation includes radiography, ultrasound, computed tomography, magnetic resonance imaging (MRI) and recently positron emission tomography. The ideal objective of imaging approaches are to quantify synovial inflammation by capturing features such as synovial hyperplasia, neo-angiogenesis and infiltration of immune cells in the synovium. This may enable clinicians to estimate response to therapy by measuring the improvement in the inflammatory signals at the level of synovium. Ultrasound can provide information regarding thickening of the synovial membrane and can reveal increased synovial blood flow using power Doppler technique. Bone marrow edema and synovial membrane thickness on MRI scan may serve as indicators for arthritis progression. Enhancement of the synovium on dynamic contrast MRI may closely mirror the inflammatory activity in the synovium. Diffusion tensor imaging is an advance MRI approach that evaluates the inflammation related to cell infiltration or aggregation in an inflamed synovium. In this review, we summarize the newer imaging techniques and their developments to evaluate synovial inflammation.
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33
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Ten Cate DF, Luime JJ, Hazes JMW, Kleinrensink GJ, Jacobs JWG. Is the frequent sonographic anechoic area distally in metacarpophalangeal joints a sign of arthritis? ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2537-2541. [PMID: 25130453 DOI: 10.1016/j.ultrasmedbio.2014.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
In clinical practice, ultrasonography (US) often reveals, in the dorsal scan, a small anechoic area distally in both inflamed and clinically non-inflamed metacarpophalangeal joints. This "distal anechogenicity in the metacarpophalangeal joint" (DAEM) might thus be scored false positively as arthritis. We aimed to investigate whether the DAEM is a sign of arthritis. We evaluated the prevalence of DAEMs in 24 non-arthritic subjects. We then compared the dimensions of the DAEM in 10 non-arthritic subjects with a DAEM and 7 consecutive rheumatoid arthritis (RA) outpatients, using 2-D and 3-D ultrasound. Furthermore, we dissected two fresh-frozen postmortem hand specimens after US. A DAEM was observed in the metacarpophalangeal 2 (MCP2) joints of 54% of the 24 non-selected non-arthritic individuals; in none of those did the joint exhibit a power Doppler signal. A DAEM was observed in 86% of the 7 RA patients. Dimensions of DAEMs did not statistically significantly differ between these groups. At 3-D imaging and dissection, the DAEM was found to be an extension of the metacarpophalangeal joint capsule. In conclusion, DAEMs occur frequently and are not a sign of arthritis, but are distal joint recesses. This should be taken into account when using current sensitive ultrasonographic scoring systems grading arthritis.
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Affiliation(s)
- David Folkert Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Jolanda Jacoba Luime
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Taniguchi D, Tokunaga D, Oda R, Fujiwara H, Ikeda T, Ikoma K, Kishida A, Yamasaki T, Kawahito Y, Seno T, Ito H, Kubo T. Maximum intensity projection with magnetic resonance imaging for evaluating synovitis of the hand in rheumatoid arthritis: comparison with clinical and ultrasound findings. Clin Rheumatol 2014; 33:911-7. [PMID: 24599675 DOI: 10.1007/s10067-014-2526-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/27/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI) with maximum intensity projection (MIP) is used to evaluate the hand in rheumatoid arthritis (RA). MIP yields clear visualization of synovitis over the entirety of the bilateral hands with a single image. In this study, we assessed synovitis with MIP images, clinical findings, and power Doppler (PD) findings to examine the clinical usefulness of MIP images for RA in the hand. Thirty RA patients were assessed for swelling and tenderness in the joints included in the DAS28, and both contrast-enhanced MRI for bilateral hands and ultrasonography for bilateral wrist and metacarpophalangeal (MCP) joints were performed. Articular synovitis was scored in MIP images, and the scores were compared with those for PD. The agreement on synovitis between MIP and conventional MR images was excellent. Palpation showed low sensitivity and high specificity compared with both MIP and PD images. There were joints that were positive in MIP images only, but there were no joints that were positive in PD images only. A statistically significant correlation between the scores of MIP and PD images was found. Furthermore, the agreement between grade 2 on MIP images and positive on PD images was 0.87 (κ = 0.73) for the wrist and 0.92 (κ = 0.57) for MCP joints. Using MIP images together with palpation makes detailed evaluation of synovitis of the hand in RA easy. MIP images may predict further joint damage, since they allow semiquantitative estimation of the degree of thickening of the synovial membrane.
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Affiliation(s)
- Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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McMurrich W, Thomson C, McKay ND, McRorie E, Salter D, McKinley J. Soft tissue swellings in the foot: rheumatoid nodulosis. Foot (Edinb) 2014; 24:37-41. [PMID: 24534374 DOI: 10.1016/j.foot.2013.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 10/16/2013] [Accepted: 11/20/2013] [Indexed: 02/04/2023]
Abstract
Background rheumatoid nodulosis is a rare disease characterised by multiple subcutaneous nodules, a high titre of rheumatoid factor, radiologically detectable cystic bone lesions, but with none or few of the systemic manifestations or joint activity of rheumatoid disease. Histopathologically, nodulosis is the same as the nodules found in rheumatoid arthritis. It is considered to be a benign variant of rheumatoid arthritis. A 69 year old male presents with multiple subcutaneous nodules on the feet. This case study highlights the benefits of ultrasound in establishing a correct diagnosis and management. Although rare, rheumatoid nodulosis is a consideration in the differential diagnoses of soft tissue swellings in the feet.
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Affiliation(s)
- William McMurrich
- The Foot and Ankle Service, Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SU, United Kingdom.
| | - Colin Thomson
- The Foot and Ankle Service, Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SU, United Kingdom.
| | - Neil D McKay
- Rheumatic Disease Unit, Department, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, United Kingdom.
| | - Euan McRorie
- Rheumatic Disease Unit, Department, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, United Kingdom.
| | - Donald Salter
- Department of Pathology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SU, United Kingdom.
| | - John McKinley
- The Foot and Ankle Service, Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 5SU, United Kingdom.
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Tuijthof GJM, Kok AC, Terra MP, Aaftink JFA, Streekstra GJ, van Dijk CN, Kerkhoffs GMMJ. Sensitivity and specificity of ultrasound in detecting (osteo)chondral defects: a cadaveric study. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1368-1375. [PMID: 23711501 DOI: 10.1016/j.ultrasmedbio.2013.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/31/2013] [Accepted: 02/19/2013] [Indexed: 06/02/2023]
Abstract
The long-term prognosis of cartilage lesions evolving into an eroding subchondral bone defect is not known. Longitudinal monitoring using ultrasound could assist in overall understanding. The aim of the work described in this article was to determine the feasibility of using ultrasound to detect small (osteo)chondral defects. On the anterior talar surface of 10 human cadaveric ankles, at most four defects were arthroscopically created: two pure chondral defects 3 and 1.5 mm in diameter and two osteochondral defects 3 and 1.5 mm in diameter. All ankles were examined by two observers, and their ultrasound observations were validated using computed tomography scans and photographs. Overall sensitivity was 96% for observer 1 and 92% for observer 2, and specificity for both observers was 100%. Sixty-eight percent and 79% of defect sizes were within relevant limits of agreement (-0.2 ± 1.0 mm), respectively. Ultrasound imaging has the potential to detect small (osteo)chondral defects located within visible areas.
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Affiliation(s)
- G J M Tuijthof
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands.
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In vivo ultrasonic detection of polyurea crosslinked silica aerogel implants. PLoS One 2013; 8:e66348. [PMID: 23799093 PMCID: PMC3683029 DOI: 10.1371/journal.pone.0066348] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/07/2013] [Indexed: 11/30/2022] Open
Abstract
Background Polyurea crosslinked silica aerogels are highly porous, lightweight, and mechanically strong materials with great potential for in vivo applications. Recent in vivo and in vitro studies have demonstrated the biocompatibility of this type of aerogel. The highly porous nature of aerogels allows for exceptional thermal, electric, and acoustic insulating capabilities that can be taken advantage of for non-invasive external imaging techniques. Sound-based detection of implants is a low cost, non-invasive, portable, and rapid technique that is routinely used and readily available in major clinics and hospitals. Methodology In this study the first in vivo ultrasound response of polyurea crosslinked silica aerogel implants was investigated by means of a GE Medical Systems LogiQe diagnostic ultrasound machine with a linear array probe. Aerogel samples were inserted subcutaneously and sub-muscularly in a) fresh animal model and b) cadaveric human model for analysis. For comparison, samples of polydimethylsiloxane (PDMS) were also imaged under similar conditions as the aerogel samples. Conclusion/significance Polyurea crosslinked silica aerogel (X-Si aerogel) implants were easily identified when inserted in either of the regions in both fresh animal model and cadaveric model. The implant dimensions inferred from the images matched the actual size of the implants and no apparent damage was sustained by the X-Si aerogel implants as a result of the ultrasonic imaging process. The aerogel implants demonstrated hyperechoic behavior and significant posterior shadowing. Results obtained were compared with images acquired from the PDMS implants inserted at the same location.
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Olubaniyi BO, Bhatnagar G, Vardhanabhuti V, Brown SE, Gafoor A, Suresh PS. Comprehensive musculoskeletal sonographic evaluation of the hand and wrist. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:901-914. [PMID: 23716510 DOI: 10.7863/ultra.32.6.901] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sonography is widely used for evaluation of hand and wrist lesions. The easy accessibility, cost-effectiveness, and good diagnostic accuracy of sonography coupled with the numerous benefits of real-time imaging make it desirable. The aim of this article is to describe the typical sonographic appearances of lesions in the hand and wrist that are encountered frequently in routine clinical practice, such as inflammatory arthropathies, tumors, traumatic injuries, foreign bodies, and nerve entrapment syndromes. Relevant anatomy, scanning methods, and recent developments in musculoskeletal sonography are also discussed.
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Affiliation(s)
- Babajide O Olubaniyi
- Department of Radiology, Plymouth Hospitals National Health Service Trust, Derriford Hospital, Plymouth, Devon, England.
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Vlychou M, Koutroumpas A, Alexiou I, Fezoulidis I, Sakkas LI. High-resolution ultrasonography and 3.0 T magnetic resonance imaging in erosive and nodal hand osteoarthritis: high frequency of erosions in nodal osteoarthritis. Clin Rheumatol 2013; 32:755-762. [DOI: 10.1007/s10067-013-2166-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/26/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
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41
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El Sawy N, Suliman I, Nouh M, Naguib A. Hand function in systemic sclerosis: A clinical and ultrasonographic study. EGYPTIAN RHEUMATOLOGIST 2012. [DOI: 10.1016/j.ejr.2012.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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McNally EG. The development and clinical applications of musculoskeletal ultrasound. Skeletal Radiol 2011; 40:1223-31. [PMID: 21847751 DOI: 10.1007/s00256-011-1220-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 05/27/2011] [Accepted: 05/29/2011] [Indexed: 02/02/2023]
Abstract
Musculoskeletal ultrasound has come a long way in 40 years. Reflecting changes in computer technology, ultrasound equipment has developed from machines that have filled examination rooms with mechanical probes linked by hinged arms for spatial localisation, to high-resolution machines that are the size of laptops using compact hand-held probes designed for both external and internal imaging.
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Wells AF, Haddad RH. Emerging role of ultrasonography in rheumatoid arthritis: optimizing diagnosis, measuring disease activity and identifying prognostic factors. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1173-1184. [PMID: 21645962 DOI: 10.1016/j.ultrasmedbio.2011.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/06/2011] [Accepted: 04/17/2011] [Indexed: 05/30/2023]
Abstract
Ultrasonography is a sensitive imaging modality that provides valuable information regarding early inflammatory changes that are not detected by clinical examination or X-rays, such as subclinical synovitis and erosions. This information may improve the management of rheumatoid arthritis by providing a more timely and accurate diagnosis, identifying poor prognostic factors, more accurately monitoring response to therapeutic intervention, improving treatment decisions and more accurately assessing remission. Ultrasonography could play a critical role in minimizing disease activity through strict monitoring and aggressive therapeutic adjustment, which has emerged as an approach to improve long-term outcomes for patients with rheumatoid arthritis.
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Affiliation(s)
- Alvin F Wells
- Rheumatology and Immunotherapy Center, Oak Creek, WI 53154, USA.
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Bowen CJ, Edwards CJ, Hooper L, Dewbury K, Sampson M, Sawyer S, Burridge J, Arden NK. Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy. J Foot Ankle Res 2010; 3:10. [PMID: 20565792 PMCID: PMC2901324 DOI: 10.1186/1757-1146-3-10] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 06/17/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Inhibition of tumour necrosis factor (TNF) is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA), yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability. METHODS Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab) were assessed for presence of synovial hypertrophy and synovitis in the 2nd and 5th metatarso-phalangeal (MTP) joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy. Tender MTP joints and swollen bursae were established clinically by an experienced podiatrist and ultrasound (US) images were acquired and interpreted by a radiologist. Assessment of patient reported disease impact on the foot was performed using the Manchester Foot Pain and Disability Index (MFPDI). RESULTS 31 patients (24 female, 7 male) with RA (12 seronegative, 19 seropositive) completed the study: mean age 59.6 (SD 10.1) years, disease duration 11.1 (SD 10.5) years, and previous number of Disease Modifying Anti Rheumatic Drugs 3.0 (1.6). Significant differences after therapy were found for Erythrocyte Sedimentation Rate (t = 4.014, p < 0.001), C-reactive protein (t = 3.889, p = 0.001), 28 joint Disease Activity Score (t = 3.712, p = 0.0001), Visual Analog Scale (t = 2.735, p = 0.011) and Manchester Foot Pain and Disability Index (t = 3.712, p = 0.001).Presence of MTP joint synovial hypertrophy on US was noted in 67.5% of joints at baseline and 54.8% of joints at twelve weeks. Presence of plantar forefoot bursal hypertrophy on US was noted in 83.3% of feet at baseline and 75% at twelve weeks. Although there was a trend for reduction in observed presence of person specific forefoot pathology, when the frequencies were analysed (McNemar) this was not significant. CONCLUSIONS Significant improvements were seen in patient reported foot pain and disability 12 weeks after commencing TNF inhibition in RA, but this may not be enough time to detect changes in forefoot pathology.
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Affiliation(s)
- Catherine J Bowen
- School of Health Sciences, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Christopher J Edwards
- Research Development and Support Unit, University of Southampton, Southampton, UK
- Department of Rheumatology, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK
- Wellcome Trust Clinical Research Facility, Southampton University Hospitals Trust, Southampton General Hospital, Southampton, UK
- MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK
| | - Lindsey Hooper
- School of Health Sciences, University of Southampton, Southampton, UK
- Wellcome Trust Clinical Research Facility, Southampton University Hospitals Trust, Southampton General Hospital, Southampton, UK
| | - Keith Dewbury
- Ultrasound Department, Department of Radiology, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK
| | - Madeleine Sampson
- Ultrasound Department, Department of Radiology, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK
| | - Sally Sawyer
- Department of Rheumatology, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK
| | - Jane Burridge
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Nigel K Arden
- Department of Rheumatology, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton, UK
- MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
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Ultrasound in American Rheumatology Practice: Report of the American College of Rheumatology Musculoskeletal Ultrasound Task Force. Arthritis Care Res (Hoboken) 2010; 62:1206-19. [DOI: 10.1002/acr.20241] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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[The usefulness of ultrasonography in synovial disease]. RADIOLOGIA 2010; 52:301-10; quiz 377-8. [PMID: 20378135 DOI: 10.1016/j.rx.2010.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 01/21/2010] [Accepted: 02/02/2010] [Indexed: 11/22/2022]
Abstract
Synovial disease is common in clinical practice and can have different causes. The development of high resolution ultrasonography (US) has led to greater use of US in the study of synovial disease. In this context, US is useful because (1) it can detect not only synovial disease, but also its consequences as tissue damage (erosions); (2) it can guide arthrocentesis when clinical attempts to obtain joint fluid have been unsuccessful, especially in joints that are difficult to access (hips), or sometimes when joint infections are clinically suspected; (3) it enables the efficacy of treatment for synovitis to be evaluated; and (4) it makes it possible to distinguish benign cystic lesions from other tumors. The overall evaluation of synovial disease is based on semiologic criteria that enables these alterations to be classified into four main groups: (a) joint effusion, (b) cystic synovial lesions, (c) intra-articular free bodies, and (d) synovial thickening.
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Miquel A, Pradel C, Jomaah N, Bienvenot P, Menu Y. [Cross-sectional imaging of peripheral involvement in ankylosing spondylitis]. ACTA ACUST UNITED AC 2010; 91:151-61. [PMID: 20212391 DOI: 10.1016/s0221-0363(10)70020-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ankylosing spondylitis is the most common spondyloarthropathy. It is characterized by enthesopathy (inflammation at the insertion of ligaments, tendons or fascia to bone). The os calcis is most frequently involved. Additional peripheral manifestations include synovitis and dactylitis. Unlike radiographs that demonstrate late manifestations of the disease, ultrasound and MRI demonstrate early inflammatory changes of bones and soft tissues. Multiple sites of involvement may also be detected on a single examination. Both imaging modalities facilitate early diagnosis, a crucial element for patient management. Both modalities may also monitor lesion regression during treatment.
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Affiliation(s)
- A Miquel
- Hôpital Saint Antoine, 75012 Paris, France.
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Koutroumpas AC, Alexiou IS, Vlychou M, Sakkas LI. Comparison between clinical and ultrasonographic assessment in patients with erosive osteoarthritis of the hands. Clin Rheumatol 2010; 29:511-6. [PMID: 20084443 DOI: 10.1007/s10067-009-1348-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 12/08/2009] [Accepted: 12/16/2009] [Indexed: 11/30/2022]
Abstract
The objective of this study is to assess the reliability of clinical examination in patients with erosive osteoarthritis (EOA). Eighteen patients with EOA underwent clinical examination for joint tenderness, bony swelling, and inflammation by two independent, blinded assessors. All patients were also examined by ultrasound (US) by an independent radiologist. The inter-observer agreement was moderate for bony swelling and joint tenderness and fair for joint inflammation (kappa = 0.513, 0.448, and 0.402, respectively). US detected significantly more inflamed joints than clinical examination. The sensitivity and specificity of clinical examination for joint inflammation were 0.12 and 0.95, respectively. Clinical joint counts for bony swelling, tenderness, and inflammation all correlated with functional status, assessed by the functional index for hand osteoarthritis (FIHOA), whereas US joint counts for joint inflammation did not correlate with the FIHOA. No correlation was found between any clinical or US joint count and visual analog scale for pain. US detects more joints with inflammation than clinical examination in patients with EOA. US can supplement the clinical examination of patients with EOA, as US-detected subclinical joint inflammation might accelerate joint damage and thus functional impairment.
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