Ultraschall Med 2005; 26 - OP023
DOI: 10.1055/s-2005-917304

THREE-DIMENSIONAL POWER DOPPLER ULTRASOUND IMPROVES THE DIAGNOSTIC ACCURACY FOR ASSESSING INFLAMMATORY ACTIVITY IN RHEUMATOID ARTHRITIS

K Strube 1, C Rumbaur 1, P Klingenberger 1, U Lange 1, U Müller-Ladner 1, J Strunk 1
  • 1Rheumatologie, Kerckhoff Klinik, Universität Gießen, Bad Nauheim, Germany

Purpose: 2D and 3D Power Doppler ultrasound ist able to reproduce intraarticular synovial blood vessel formation in inflamed joints of patients with rheumatoid arthritis.[1] The goal of this study was to determine whether three-dimensional power Doppler ultrasound improves the evaluation of inflammatory intensity as compared with two-dimensional ultrasound.

Methods and Materials: 48 examinations of inflamed wrists were made by power Doppler sonography with a HDI 5000 ultrasound system (ATL, Philips, Bothell, WA, USA), equipped with a linear array transducer (5–12MHz). In a region with high Doppler signal intensity a sequence of 2D pictures was performed with free hand technique into a three-dimensional vascular tree. Stored images were interpreted by a blinded investigator with no rheumatologic background. Doppler signals were judged by estimating intensity of Doppler flow according to the semiquantitative grading system published by Newman et al. [2].

Results: Hypervascularization was found in all 48 examinations both in 2D and 3D doppler mode. In 67% (32/48) synovial perfusion was estimated at a higher level in 3D mode compared with 2D grading.

Conclusions: Three-dimensional power doppler exertsseveral advantages over 2D PDUS, especially of avaluation of morphological and vascular characteristics of synovial blood vessel formation. Pathologic findings including hypervascularised vascular flow could be identified in both in 2D as well as in 3D imaging. However, quantification of blood flow could be further improved with addition of threedimensional imaging. This approach may further improve the evaluation of inflammatory activity as a diagnostic tool faciliating an appropriate therapeutic approach.

1 Strunk J, Lange U. Three-Dimensional Power Doppler Sonographic Visualization of Synovial Angiogenesis in Rheumatoid Arthritis. J of Rheumatol 2004; 31(5):1004–6.

2 Newman JS, Laing TJ, McCarthy CJ, Adler RS. Power Doppler sonography of synovitis: assessment of therapeutic response-preliminary observations. Radiology 1999; 198: 582–4.