Should ultrasound be used routinely in the diagnosis of rheumatoid arthritis?

Sonography of Arthritis: Inflammatory, Infectious, Depositional

Ultrasound (US) is a valuable tool in the evaluation of arthritis both for diagnosis and treatment response. Pertinent findings such as joint effusions, synovitis, bursitis, bone erosions, tenosynovitis, and enthesitis can all be readily evaluated sonographically. In this article, we describe specific considerations in the US evaluation of rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, crystalline arthritis (gout, calcium pyrophosphate deposition disease, and hydroxyapatite deposition disease), septic arthritis, and osteoarthritis with attention to certain differentiating features. The potential role of US in the diagnosis of specific arthritides is discussed, together with an overview of newer technologies and future directions.

Diagnostic Accuracy of Dynamic High-Resolution Ultrasonography in Assessing Anterior Disc Displacement in Temporomandibular Joint Disorders: A Prospective Observational Study

Objective: The objective of this study was to assess the diagnostic efficacy of dynamic high-resolution ultrasonography (HRUS) in detecting anterior disc displacement with reduction (ADDWR) and anterior disc displacement without reduction (ADDWoR) in the temporomandibular joint (TMJ). Methods: A total of 144 TMJs was categorized into three groups according to the magnetic resonance imaging (MRI) findings, which served as the reference standard: the normal disc position (NDP) group, the ADDWR group, and the ADDWoR group. Static images of the TMJ in full opening and maximum intercuspal positions, along with dynamic sequences during jaw opening, were obtained utilizing a 14 MHz L-shaped linear array transducer. The diagnostic efficacy of dynamic HRUS for identifying ADDWR and ADDWoR was evaluated in terms of accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and the Youden index. Results: According to the MRI findings, the NDP, ADDWR, and ADDWoR groups consisted of 42 (29.2%), 47 (32.6%), and 55 (38.2%) TMJs, respectively. HRUS data revealed 54 TMJs (37.5%) in the NDP group, 26 TMJs (18.1%) in the ADDWR group, and 64 TMJs (44.4%) in the ADDWoR group. With MRI as the reference standard, HRUS exhibited a diagnostic accuracy of 71.4%, sensitivity of 51.4%, and specificity of 91.4% for ADDWR. For the ADDWoR, HRUS attained a diagnostic accuracy of 86.5%, sensitivity of 90.0%, and specificity of 82.1%. Conclusions: With MRI serving as the reference standard, dynamic HRUS has high diagnostic value for ADDWoR, with better diagnostic accuracy than ADDWR. Ultrasonography has the potential to be used as a highly effective and non-invasive imaging modality for the early screening of ADD in future clinical practice.

Sclerodermic hand: a retrospective study on the role of ultrasonography in the detection of subclinical joint involvement

INTRODUCTION

The inflammatory involvement of joints and tendons is common in Systemic Sclerosis (SSc). Ultrasonography (US) is a non-invasive tool commonly applied for the assessment of the main inflammatory arthropathies and could be also used in identifying pathological features in SSc patients, even without clinical evidence of joint complaint. So, the aim of this study was to assess the prevalence of US pathological features in a cohort of SSc patients and assessed the role of US in the detection of subclinical joint involvement.

METHODS

In this retrospective study, we collected data about the prevalence of US pathological features at the level of hands and wrists in a cohort of patients with a definite diagnosis of SSc, submitted to an ultrasound examination of hands and wrists according to the clinician's opinion, with or without joint involvement symptoms, in order to assess the US ability in detecting subclinical inflammatory signs in SSc patients.

RESULTS

In total, 47.5% of patients reported at least one US pathological feature. The most common was synovial hypertrophy (62.1%). Other assessed lesions were effusion (48%), tenosynovitis (37.9%), power Doppler (PD) signal (31.0%), and erosions (0.7%). Effusion and PD signal appeared significantly higher in symptomatic patients, with a p<0.01 and p=0.045, respectively.

CONCLUSIONS

In this cohort of SSc subjects, almost the half of the US-positive patients were clinically asymptomatic. Therefore, the application of US could be useful to detect the musculoskeletal involvement of SSc patients, a potential markers of disease severity. Further studies are required to assess the role of US in monitoring SSc patients. Key Points • The inflammatory involvement of joints and/or tendons is common in systemic sclerosis (SSc) but could be partially covered by other disease features. • Among the diagnostic methods able to increase the sensitivity of the musculoskeletal evaluation, Ultrasonography (US) is one of the most promising to reveal subclinical inflammation and predict the joint damage progression. • We retrospectively investigated the prevalence of US pathological features in a cohort of SSc patients, with or without symptoms of joint involvement, assessing the role of US in the detection of subclinical joint involvement. • We found that joint and tendon involvement, a potential marker of disease severity, is common in SSc.

Comparison and correlation study of synovial ultrasound indices and serum VEGF in rheumatoid wrist arthritis before and after treatment

OBJECTIVE

Rheumatoid wrist arthritis is a chronic autoimmune disease, resulting in joint deformity and functional impairment. We aimed to compare the wrist synovial ultrasound indices and serum vascular endothelial growth factor (VEGF) level in patients with RA before and after treatment, and to explore the correlation between the two.

METHODS

Forty patients with RA in wrist underwent ultrasound examination to determine wrist synovial thickness, synovial blood flow grade, and synovial artery resistive index (RI) before and after treatment. The serum level of VEGF was detected by enzyme-linked immunosorbent assay. Correlation between synovial ultrasound indices and serum VEGF level was assessed.

RESULTS

Pre-treatment synovial thickness, synovial artery RI, and serum VEGF level were 8.60 ± 2.82 mm, 0.62 ± 0.07, and 419.49 ± 19.27 pg/mL, respectively. The corresponding post-treatment levels were 4.05 ± 1.89 mm, 0.83 ± 0.10, and 199.30 ± 16.18 pg/mL. Pre-treatment distribution of synovial blood flow grades was as follows: grade 0, nil; grade I, 1 case; grade II, 17 cases; grade III, 22 cases. The post-treatment distribution was as follows: grade 0, 6 cases; grade I, 23 cases; grade II, 11 cases; and grade III, nil. There were significant differences between pre- and post-treatment wrist synovial thickness, artery RI, and blood flow grading. Wrist synovial thickness and synovial blood flow grade showed a strong positive correlation with serum VEGF level (P < 0.01). There was strong negative correlation between wrist synovial artery RI and serum VEGF level (P < 0.01).

CONCLUSION

The strong correlation between wrist synovial ultrasound indicators and serum VEGF may be clinically useful for diagnosis and therapy.

Back Propagation Neural Network-Based Ultrasound Image for Diagnosis of Cartilage Lesions in Knee Osteoarthritis

Objective

To explore the application value of ultrasound image based on back propagation (BP) neural network algorithm in knee osteoarthritis (KOA) and evaluate the application effect and value of ultrasound image technology based on the BP neural network in the diagnosis of knee osteoarthritis cartilage lesions, 98 patients who were admitted to our hospital were diagnosed with KOA and had undergone arthroscopic soft tissue examinations were randomly selected. According to whether image processing was performed, the ultrasound images of all patients were divided into two groups. The control group was image before processing, and the experimental group was image after processing optimization. The consistency of the inspection results of the ultrasound images before and after the processing with the arthroscopy results was compared. The results showed that the staging accuracy of the control group was 68.3% and that of the experimental group was 76.9%. The accuracy of staging cartilage degeneration of the experimental group was higher than that of the control group, and the difference was not remarkable (P > 0.05). The kappa coefficient of the experimental group was 0.61, and that of the control group was 0.40. The kappa coefficient of the experimental group was higher than that of the control group, and the difference was significant (P < 0.05).

Conclusion

The inspection effect of the ultrasound image processed by the BP neural network was superior to that of the conventional ultrasound image. It reflected the good adoption prospect of neural networks in image processing.

Edema-like marrow signal intensity: a narrative review with a pictorial essay

The term edema-like marrow signal intensity (ELMSI) represents a general term describing an area of abnormal signal intensity at MRI. Its appearance includes absence of clear margins and the possibility of exceeding well-defined anatomical borders (for example, physeal scars). We can define "ELMSI with unknown cause" an entity where the characteristic MR appearance is associated with the absence of specific signs of an underlying condition. However, it is more often an important finding indicating the presence of an underlying disease, and we describe this case as "ELMSI with known cause." It presents a dynamic behavior and its evolution can largely vary. It initially corresponds to an acute inflammatory response with edema, before being variably replaced by more permanent marrow remodeling changes such as fibrosis or myxomatous connective tissue that can occur over time. It is important to study ELMSI variations over time in order to evaluate the activity state and therapeutic response of an inflammatory chronic joint disease, the resolution of a trauma, and the severity of an osteoarthritis. We propose a narrative review of the literature dealing with various subjects about this challenging topic that is imaging, temporal evolution, etiology, differential diagnoses, and possible organization, together with a pictorial essay.