Color duplex Doppler ultrasound in rheumatoid arthritis

Transcription

1 Color duplex Doppler ultrasound in rheumatoid arthritis Poster No.: C-1505 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific Paper G. Ivanac, J. Morovic Vergles, M. Cavka, N. Radovic, B. Brkljacic; Zagreb/HR Musculoskeletal joint, Ultrasound-Colour Doppler, Diagnostic procedure, Arthritides /ecr2012/C-1505 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Purpose Rheumatoid arthritis is systemic inflammatory disease that has dominant manifestations on joints synovia, as persistent synovitis. Hand joints are affected in almost all patients. Over the last years ultrasound has become important imaging modality for diagnosis and follow-up of patients suffering from rheumatic diseases. Ultrasound enables demonstration of pannus, inflammatory changes of synovia, joint effusions, paraarticular changes and tendons. Doppler enables demonstration of vascularization of pathologically altered joint. Evaluation of the degree of inflammatory changes and their follow-up during the treatment is of the particular interest. Aim of the study are to determine Doppler changes (degree of vascularization (Fig 1-3), the value of peak systolic velocity-psv, enddiastolic velocity-edv) and resistance index- RI) of ulnocarpal (UC) and metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA) before and after therapy and to compare morphologic and Doppler findings with the clinical disease activity score (DAS 28), Health assessment questionnaire (HAQ), and values of serum inflammatory parameters (RF, ESR, CRP). Methods and Materials Color Doppler (CDI) features were analyzed of 360 UC and MCP joints in 30 patients with RA (21 women, 9 men) before and after six-months therapy. Rheumatoid factor (RF), serum erythrocyte ratio (ESR) and C-reactive protein (CRP) values were determined. Disease activity score (DAS 28) was determined and Health assessment questionnaire (HAQ) filled. On CDI degree of joint vascularization was evaluated, and resistance index (RI), PSVs and EDVs were measured. Results Values of DAS-28 and ESR decreased after therapy (p<0.001, p=0.01), as well as RF (p=0.015), and HAQ (P=0.03). Significant correlation was determined between HAQ/DAS and RI before and after therapy in MCP-I and MCP-II joints (p=0.004-p=0.03), and in RI and EDV in both UC joints (p<0.001-<0.05). Analysis of cut-off values of RI in the group before therapy has shown that cut-off RI < 0.40 has sensitivity and specificity of 100%. In the group after therapy for the cut-off value of RI # 0.55 the sensitivity of 100%, specificity of 87%, PPV of 94%, and NPV of 100% was observed; in the time of initial diagnosis RI < 0.40 indicates the disease, while after therapy RI # 0.55 indicates good therapeutic response (Fig. 4). Page 2 of 8

3 Images for this section: Fig. 1: Degree 1 - Doppler signal in only one vessel. Page 3 of 8

4 Fig. 2: Degree 2 - more Doppler signals in vessels, but on a surface smaller than 50% of the whole synovia. Page 4 of 8

5 Fig. 3: Degree 3 - more Doppler signals, on a surface bigger than 50% of the whole synovia. Page 5 of 8

6 Fig. 4: Ulnocarpal joint after treatment with resistance index values of 0.64 what means good response. Page 6 of 8

7 Conclusion Doppler parameters indicate the efficacy of therapy of RA. CDI of UC and MCP joints should be routinely used in diagnosis and evaluation of therapeutic response of patients with RA. References 1. Terslev L, Torp-Pedersen S, Qvistgaard E, Bliddal H. Spectral Doppler and resistive index - a promissing tool in ultrasonographic evaluation of inflammation in rheumatoid arthritis. Acta Radiologica 2003;44: van der Heijde DMFM. Radiographic imaging: the "gold standard" for assessment of disease progression in rheumatoid arthritis. Rheumatology 2000;39: D#hn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, et al. Are bone erosions detected by MRI and US true erosions? A comparison with CT in rheumatoid arthritis metacarpophalangeal joints. Arthritis Research & Therapy 2006;8:R Sommer OJ, Kladosek A, Weiler V, Czembierek H, Boeck M, Stiskal M. Rheumatoid arthritis: A practical guide to state-of-the-art imaging, image interpretation, and clinical implications. RadioGraphics 2005;25: Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, #stergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis. Arthritis & Rheumatism 2004;50(7): Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, #stergaard M. Power-doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints in patients with rheumatoid arthritis. Arthritis & Rheumatism 2001;44(9): Personal Information Gordana Ivanac, MD, PhD University Hospital Dubrava, Department of Radiology A. G. Suska 6 Page 7 of 8

8 10000 Zagreb Croatia Page 8 of 8