PDF herunterladen
Ultrasound Int Open 2016; 02(04): E117-E123
DOI: 10.1055/s-0042-115774
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of a Novel Semi-Automated Ultrasound System for the Detection of Synovitis: A Prospective Study involving 45 Patients with Rheumatoid Arthritis

M. Witt
1   Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
,
J. Frielinghausen
1   Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
,
R. Mueller
2   Division of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
,
F. Mueller
1   Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
,
F. Proft
1   Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
,
H. Schulze-Koops
1   Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
,
M. Grunke
1   Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
,
D.-A. Clevert
3   Department of Clinical Radiology, University of Munich, Munich, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 17. April 2016

accepted 04. August 2016

Publikationsdatum:
14. September 2016 (online)

   Lizenzen und Reprints

Abstract

Background: Arthrosonography has proven to be more sensitive and reliable for the detection of synovitis than clinical examination, but a comprehensive examination of small joints is time-consuming. The automated breast volume scanner (ABVS) has been developed to allow automatic and reproducible series of consecutive B-mode pictures of the female breast.

Objectives: To analyze the comparability of ABVS and conventional manual ultrasonography (mUS) for the detection of synovitis in hands and feet of patients with rheumatoid arthritis (RA).

Methods: 45 patients with early and established active rheumatoid arthritis were recruited for this trial. All subjects were assessed clinically and by manual (Esaote MyLab70) and automated ultrasound (ACUSON S2000™ ABVS). The wrists, the metacarpophalangeal and proximal interphalangeal joints of the hands and the metatarsophalangeal joints of the feet were examined.

Results: A total of 2 340 joint aspects were examined with both methods. ABVS detected 291 grade 1, 124 grade 2, 100 grade 3 cases of synovitis (515 in total) compared to 267, 180 and 145 cases of synovitis (592 in total) with mUS. 242 erosions and 52 cases of tenosynovitis were found by ABVS compared to 244 erosions and 99 cases of tenosynovitis found by mUS. Kappa coefficients for the agreement between both methods ranged from 0.51 in PIP joints to 0.71 in MCP joints. The correlations with clinical parameters as well as interrater agreements were comparable for both ultrasound methods.

Conclusion: Based on the results, ABVS seems to be a promising technology for the comprehensive and time-saving assessment of synovitis in RA.

Key words

ultrasound - arthritides - technical aspects - fingers and toes
 

  • References

  • 1 Aletaha D, Neogi T, Silman AJ et al. 2000 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62: 2569-2581
    Google Scholar
  • 2 Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324
    Google Scholar
  • 3 Taylor W, Gladman D, Helliwell P et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54: 2665-2673
    CrossrefPubMedGoogle Scholar
  • 4 van der Heijde DM, van’t Hof M, van Riel PL et al. Validity of single variables and indices to measure disease activity in rheumatoid arthritis. J Rheumatol 1993; 20: 538-541
    PubMedGoogle Scholar
  • 5 Felson DT, Anderson JJ, Boers M et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum 1993; 36: 729-740
    CrossrefPubMedGoogle Scholar
  • 6 Aletaha D, Smolen JS. The simplified disease activity index and clinical disease activity index to monitor patients in standard clinical care. Rheum Dis Clin North Am 2009; 35: 759-772
    CrossrefPubMedGoogle Scholar
  • 7 Smolen JS, Aletaha D, Bijlsma JW et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-637
    CrossrefPubMedGoogle Scholar
  • 8 Keystone EC, Smolen J, van Riel P. Developing an effective treatment algorithm for rheumatoid arthritis. Rheumatology (Oxford) 2012; 51 (Suppl. 05) 48-54
    CrossrefPubMedGoogle Scholar
  • 9 Scott DL, Antoni C, Choy EH et al. Joint counts in routine practice. Rheumatology (Oxford) 2003; 42: 919-923
    CrossrefPubMedGoogle Scholar
  • 10 Grunke M, Witt MN, Ronneberger M et al. Use of the 28-joint count yields significantly higher concordance between different examiners than the 66/68-joint count. J Rheumatol 2012; 39: 1334-1340
    CrossrefPubMedGoogle Scholar
  • 11 Sokka T, Pincus T. Joint counts to assess rheumatoid arthritis for clinical research and usual clinical care: advantages and limitations. Rheum Dis Clin North Am 2009; 35: 713-722
    CrossrefPubMedGoogle Scholar
  • 12 Grunke M, Antoni CE, Kavanaugh A et al. Standardization of joint examination technique leads to a significant decrease in variability among different examiners. J Rheumatol 2010; 37: 860-864
    CrossrefPubMedGoogle Scholar
  • 13 Scott DL, Choy EH, Greeves A et al. Standardising joint assessment in rheumatoid arthritis. Clin Rheumatol 1996; 15: 579-582
    CrossrefPubMedGoogle Scholar
  • 14 Witt M, Mueller F, Nigg A et al. Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum 2013; 65: 1694-1701
    CrossrefPubMedGoogle Scholar
  • 15 Rees JD, Pilcher J, Heron C et al. A comparison of clinical vs. ultrasound determined synovitis in rheumatoid arthritis utilizing gray-scale, power Doppler and the intravenous microbubble contrast agent ‘Sono-Vue’. Rheumatology (Oxford) 2007; 46: 454-459
    CrossrefPubMedGoogle Scholar
  • 16 Naredo E, Bonilla G, Gamero F et al. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005; 64: 375-381
    PubMedGoogle Scholar
  • 17 Baillet A, Gaujoux-Viala C, Mouterde G et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2011; 50: 1137-1147
    CrossrefPubMedGoogle Scholar
  • 18 Rahmani M, Chegini H, Najafizadeh SR et al. Detection of bone erosion in early rheumatoid arthritis: ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging. Clin Rheumatol 2010; 29: 883-891
    CrossrefPubMedGoogle Scholar
  • 19 Hammer HB, Bolton-King P, Bakkeheim V et al. Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis. Ann Rheum Dis 2011; 70: 1995-1998
    CrossrefPubMedGoogle Scholar
  • 20 Naredo E, Moller I, Moragues C et al. Interobserver reliability in musculoskeletal ultrasonography: results from a “Teach the Teachers” rheumatologist course. Ann Rheum Dis 2006; 65: 14-19
    CrossrefPubMedGoogle Scholar
  • 21 Broll M, Albrecht K, Tarner I et al. Sensitivity and specificity of ultrasonography and low-field magnetic resonance imaging for diagnosing arthritis. Clin Exp Rheumatol 2012; 30: 543-547
    PubMedGoogle Scholar
  • 22 Horikoshi M, Suzuki T, Sugihara M et al. Comparison of low-field dedicated extremity magnetic resonance imaging with articular ultrasonography in patients with rheumatoid arthritis. Mod Rheumatol 2010; 20: 556-560
    CrossrefPubMedGoogle Scholar
  • 23 Lassere M, McQueen F, Ostergaard M et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score. J Rheumatol 2003; 30: 1366-1375
    PubMedGoogle Scholar
  • 24 Wohrle NK, Hellerhoff K, Notohamiprodjo M et al. Automated breast volume scanner (ABVS): a new approach for breast imaging. Radiologe 2010; 50: 973-981
    CrossrefPubMedGoogle Scholar
  • 25 Wojcinski S, Farrokh A, Hille U et al. The Automated Breast Volume Scanner (ABVS): initial experiences in lesion detection compared with conventional handheld B-mode ultrasound: a pilot study of 50 cases. Int J Womens Health 2011; 3: 337-346
    PubMedGoogle Scholar
  • 26 Lin X, Wang J, Han F et al. Analysis of eighty-one cases with breast lesions using automated breast volume scanner and comparison with handheld ultrasound. Eur J Radiol 2012; 81: 873-878
    CrossrefPubMedGoogle Scholar
  • 27 Wang HY, Jiang YX, Zhu QL et al. Automated breast volume scanning: identifying 3-d coronal plane imaging features may help categorize complex cysts. Ultrasound Med Biol 2016; 42: 689-698
    CrossrefPubMedGoogle Scholar
  • 28 Xiao YM, Chen ZH, Zhou QC et al. The efficacy of automated breast volume scanning over conventional ultrasonography among patients with breast lesions. Int J Gynaecol Obstet 2015; 131: 293-296
    CrossrefPubMedGoogle Scholar
  • 29 Wang ZL, Xu JH, Li JL et al. Comparison of automated breast volume scanning to hand-held ultrasound and mammography. Radiol Med 2012; 117: 1287-1293
    CrossrefPubMedGoogle Scholar
  • 30 Zhang Q, Hu B, Hu B et al. Detection of breast lesions using an automated breast volume scanner system. J Int Med Res 2012; 40: 300-306
    CrossrefPubMedGoogle Scholar
  • 31 Grunke M, Wendler J, Schuch F et al. Automated ultrasound for the detection of joint swelling in arthritic diseases. Ann Rheum Dis 2013; 72 (Suppl. 03) 763
    CrossrefPubMedGoogle Scholar
  • 32 Kawashiri SY, Suzuki T, Nishino A et al. Automated Breast Volume Scanner, a new automated ultrasonic device, is useful to examine joint injuries in patients with rheumatoid arthritis. Mod Rheumatol 2015; 25: 837-841
    CrossrefPubMedGoogle Scholar
  • 33 Backhaus M, Ohrndorf S, Kellner H et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009; 61: 1194-1201
    CrossrefPubMedGoogle Scholar
  • 34 Dougados M, Devauchelle-Pensec V, Ferlet JF et al. The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound. Ann Rheum Dis 2013; 72: 665-671
    CrossrefPubMedGoogle Scholar
  • 35 Naredo E, D’Agostino MA, Wakefield RJ et al. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 2013; 72: 1328-1334
    CrossrefPubMedGoogle Scholar
  • 36 Wakefield RJ, Gibbon WW, Conaghan PG et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000; 43: 2762-2770
    CrossrefPubMedGoogle Scholar
  • 37 Ohrndorf S, Fischer IU, Kellner H et al. Reliability of the novel 7-joint ultrasound score: results from an inter- and intraobserver study performed by rheumatologists. Arthritis Care Res (Hoboken) 2012; 64: 1238-1243
    PubMedGoogle Scholar
  • 38 Chavez-Lopez MA, Hernandez-Diaz C, Moya C et al. Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis. Rheumatol Int 2013; 33: 173-177
    CrossrefPubMedGoogle Scholar
  • 39 Vlad V, Berghea F, Libianu S et al. Ultrasound in rheumatoid arthritis: volar versus dorsal synovitis evaluation and scoring. BMC Musculoskelet Disord 2011; 12: 124
    CrossrefPubMedGoogle Scholar
  • 40 Witt MN, Mueller F, Weinert P et al. Ultrasound of synovitis in rheumatoid arthritis: advantages of the dorsal over the palmar approach to finger joints. J Rheumatol 2014; 41: 422-428
    CrossrefPubMedGoogle Scholar
  • 41 Kawashiri SY, Suzuki T, Nakashima Y et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology (Oxford) 2014; 53: 562-569
    CrossrefPubMedGoogle Scholar
  • 42 Foltz V, Gandjbakhch F, Etchepare F et al. Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum 2012; 64: 67-76
    CrossrefPubMedGoogle Scholar
  • 43 Scire CA, Montecucco C, Codullo V et al. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology (Oxford) 2009; 48: 1092-1097
    CrossrefPubMedGoogle Scholar
  • 44 Dougados M, Jousse-Joulin S, Mistretta F et al. Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis. Ann Rheum Dis 2010; 69: 828-833
    CrossrefPubMedGoogle Scholar
  • 45 Naredo E, Rodriguez M, Campos C et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008; 59: 515-522
    CrossrefPubMedGoogle Scholar
  • 46 Hammer HB, Kvien TK. Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther 2011; 13: R78
    CrossrefPubMedGoogle Scholar
  • 47 Werner SG, Langer HE, Schott P et al. Indocyanine green-enhanced fluorescence optical imaging in patients with early and very early arthritis: a comparative study with magnetic resonance imaging. Arthritis Rheum 2013; 65: 3036-3044
    CrossrefPubMedGoogle Scholar
  • 48 van Onna M, Ten Cate DF, Tsoi KL et al. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2016; 75: 511-518
    CrossrefPubMedGoogle Scholar