Semin Musculoskelet Radiol 2009; 13(1): 066-073
DOI: 10.1055/s-0029-1202246
© Thieme Medical Publishers

Doppler Ultrasonography and Dynamic Magnetic Resonance Imaging for Assessment of Synovitis in the Hand and Wrist of Patients with Rheumatoid Arthritis

Catherine Cyteval1
  • 1University of Montpellier I, Department of Radiology, Lapeyronie Hospital, Montpellier, France
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Publikationsverlauf

Publikationsdatum:
23. Februar 2009 (online)

ABSTRACT

Rheumatoid arthritis (RA) activity is closely correlated with inflammation. The synovial membrane is the principal site of inflammation in which the inflammatory process enhances capillary perfusion and permeability. Doppler ultrasonography (DUS), using the amount of color pixels in the region of interest, and dynamic magnetic resonance imaging (DE-MRI), using the early enhancement rate and relative enhancement of the synovium, are both able to detect this inflammation in the wrist and hand. Although these techniques are both capable of monitoring synovium inflammation modifications after RA treatment, DE-MRI may be better for quantifying inflammation changes. It yields additional information about joint inflammation and complements clinical and biological examination, the current reference standard. DUS could become an essential tool for RA joint monitoring in routine practice in view of its sensitivity in the detection of synovitis, feasibility in outpatient clinics, and low cost, whereas DE-MRI could become a valid imaging gold standard against which other measures should be compared, especially in clinical trials.

REFERENCES

  • 1 FitzGerald O, Bresnihan B. Synovial membrane cellularity and vascularity.  Ann Rheum Dis. 1995;  54(6) 511-515
  • 2 Conaghan P, Lassere M, Østergaard M et al.. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 4: an international multicenter longitudinal study using the RA-MRI Score.  J Rheumatol. 2003;  30(6) 1376-1379
  • 3 Grigor C, Capell H, Stirling A et al.. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial.  Lancet. 2004;  364(9430) 263-269
  • 4 Drossaers-Bakker K W, Kroon H M, Zwinderman A H, Breedveld F C, Hazes J M. Radiographic damage of large joints in long-term rheumatoid arthritis and its relation to function.  Rheumatology (Oxford). 2000;  39(9) 998-1003
  • 5 Szkudlarek M, Court-Payen M, Strandberg C et al.. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging.  Arthritis Rheum. 2001;  44(9) 2018-2023
  • 6 Østergaard M, Szkudlarek M. Ultrasonography: a valid method for assessing rheumatoid arthritis?.  Arthritis Rheum. 2005;  52(3) 681-686
  • 7 Stone M, Bergin D, Whelan B et al.. Power Doppler ultrasound assessment of rheumatoid hand synovitis.  J Rheumatol. 2001;  28(9) 1979-1982
  • 8 Weidekamm C, Koller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis.  Arthritis Rheum. 2003;  48(2) 325-333
  • 9 Ellegaard K, Torp-Pedersen S, Lund H et al.. Quantification of colour Doppler activity in the wrist in patients with rheumatoid arthritis—the reliability of different methods for image selection and evaluation.  Ultraschall Med. 2008;  29(4) 393-398
  • 10 Bajaj S, Lopez-Ben R, Oster R, Alarcon G S. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study.  Skeletal Radiol. 2007;  36(2) 123-128
  • 11 Scheel A K, Hermann K G, Kahler E et al.. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis.  Arthritis Rheum. 2005;  52(3) 733-743
  • 12 Wakefield R J, Balint P V, Szkudlarek M et al.. Musculoskeletal ultrasound including definitions for ultrasonographic pathology.  J Rheumatol. 2005;  32(12) 2485-2487
  • 13 Walther M, Harms H, Krenn V et al.. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis.  Arthritis Rheum. 2001;  44(2) 331-338
  • 14 Terslev L, von der Recke P, Torp-Pedersen S, Koenig M J, Bliddal H. Diagnostic sensitivity and specificity of Doppler ultrasound in rheumatoid arthritis.  J Rheumatol. 2008;  35(1) 49-53
  • 15 Szkudlarek M, Narvestad E, Klarlund M et al.. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination.  Arthritis Rheum. 2004;  50(7) 2103-2112
  • 16 Terslev L, Torp-Pedersen S, Savnik A et al.. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study.  Arthritis Rheum. 2003;  48(9) 2434-2441
  • 17 Ribbens C, Andre B, Marcelis S et al.. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study.  Radiology. 2003;  229(2) 562-569
  • 18 Ozgocmen S, Ozdemir H, Kiris A, Bozgeyik Z, Ardicoglu O. Clinical evaluation and power Doppler sonography in rheumatoid arthritis: evidence for ongoing synovial inflammation in clinical remission.  South Med J. 2008;  101(3) 240-245
  • 19 Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O. Power Doppler assessment of overall disease activity in patients with rheumatoid arthritis.  J Clin Ultrasound. 2006;  34(1) 5-11
  • 20 Rooney M, Condell D, Quinlan W et al.. Analysis of the histologic variation of synovitis in rheumatoid arthritis.  Arthritis Rheum. 1988;  31(8) 956-963
  • 21 Qvistgaard E, Rogind H, Torp-Pedersen S et al.. Quantitative ultrasonography in rheumatoid arthritis: evaluation of inflammation by Doppler technique.  Ann Rheum Dis. 2001;  60(7) 690-693
  • 22 Klauser A, Frauscher F, Schirmer M et al.. The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis.  Arthritis Rheum. 2002;  46(3) 647-653
  • 23 Magarelli N, Guglielmi G, Di Matteo L et al.. Diagnostic utility of an echo-contrast agent in patients with synovitis using power Doppler ultrasound: a preliminary study with comparison to contrast-enhanced MRI.  Eur Radiol. 2001;  11(6) 1039-1046
  • 24 Drape J L, Thelen P, Gay-Depassier P, Silbermann O, Benacerraf R. Intraarticular diffusion of Gd-DOTA after intravenous injection in the knee: MR imaging evaluation.  Radiology. 1993;  188(1) 227-234
  • 25 McQueen F M, Benton N, Perry D et al.. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis.  Arthritis Rheum. 2003;  48(7) 1814-1827
  • 26 Hetland M L, Ejbjerg B J, Horslev-Petersen K et al.. MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2 year randomized controlled trial (CIMESTRA).  Ann Rheum Dis. 2008 April 3;  , [Epub ahead of print]
  • 27 Hodgson R J, O'Connor P, Moots R. MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy.  Rheumatology (Oxford). 2008;  47(1) 13-21
  • 28 Hodgson R J, Barnes T, Connolly S et al.. Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis.  Skeletal Radiol. 2008;  37(3) 201-207
  • 29 Cimmino M A, Innocenti S, Livrone F et al.. Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease.  Arthritis Rheum. 2003;  48(5) 1207-1213
  • 30 Hodgson R J, Connolly S, Barnes T et al.. Pharmacokinetic modeling of dynamic contrast-enhanced MRI of the hand and wrist in rheumatoid arthritis and the response to anti-tumor necrosis factor-alpha therapy.  Magn Reson Med. 2007;  58(3) 482-489
  • 31 Boesen M, Boesen L, Jensen K E et al.. Clinical outcome and imaging changes after intraarticular (IA) application of etanercept or methylprednisolone in rheumatoid arthritis: magnetic resonance imaging and ultrasound-Doppler show no effect of IA injections in the wrist after 4 weeks.  J Rheumatol. 2008;  35(4) 584-591
  • 32 Reece R J, Kraan M C, Radjenovic A et al.. Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging.  Arthritis Rheum. 2002;  46(2) 366-372

Catherine CytevalPh.D. 

University of Montpellier I, Department of Radiology, Lapeyronie Hospital, 583 avenue du Doyen Gaston Giraud

34095 Montpellier Cedex 5, France

eMail: c-cyteval@chu-montpellier.fr

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