Role of Ultrasound in the Assessment of Small-Joint Synovitis

• Published in: Canadian Association of Radiologists journal Vol. 60; no. 2; pp. 69 - 70
• Main Authors: Salimi, Cyrus, MD, O'Neill, John, FRCR(UK), Khalidi, Nader, FRCPC, Harish, Srinivasan, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2009; SAGE PUBLICATIONS, INC
• Subjects: Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - diagnostic imaging; Diagnosis, Differential; Female; Hand Joints - diagnostic imaging; Humans; Inflammatory diseases; Joints; Magnetic Resonance Imaging - methods; Middle Aged; Observer Variation; Radiology; Reproducibility of Results; Studies; Synovitis - diagnosis; Synovitis - diagnostic imaging; Ultrasonic imaging; Ultrasonography; Canada
• ISSN: 0846-5371; 1488-2361
• DOI: 10.1016/j.carj.2009.02.008

Szkudlarek et al [1] studied 200 metatarsalphalangeal (MTP) joints of 40 patients with rheumatoid arthritis (RA) and 100 MTP joints of 20 healthy controls by clinical examination B-mode US, conventional radiography, and enhanced magnetic resonance imaging (MRI), with MRI used as the gold standard. Ultrasound was blinded to MRI or clinical results and synovial assessment was semiquantitative on a 0 to 4 scale. There was good correlation between US and contrast-enhanced MRI for detection and semiquantitative grading of synovitis. US had a higher frequency for the detection of synovium, the authors of the study suggested that this related to the ability of US to detect fibrotic synovial tissue that may not enhance on MRI. US was significantly more sensitive than clinical examination (0.87 vs 0.43) when compared with MRI. Koski et al [2] assessed the validity of power Doppler US (PDUS) to identify synovitis of large and small joints with histopathology as the gold standard. They included 4 extraarticular sites, bursae, and tendon sheaths in 44 patients with monoarthritis or polyarthritis. PDUS was assessed semiquantitatively on a scale of 0 to 3. PDUS detected flow in 83% of patients with active histologic inflammation. Sensitivity increased to 93% when all synovial reactions were included (eg, active), as well as reparative fibrosis. Naredo et al [3] evaluated the sensitivity to change in the PDUS assessment of joint inflammation and its predictive value in disease activity and radiologic outcome in patients with early RA. They studied 42 patients with early RA who started therapy with disease-modifying antirheumatic drugs with blinded sequential clinical, laboratory, and ultrasound assessment at baseline, 3 months, 6 months, and 1 year, and radiographic assessment at baseline and 1 year. The presence of synovitis was investigated in 28 joints using B-mode US and PDUS. They found PDUS to be a sensitive and reliable method for longitudinal assessment of inflammatory activity in early RA, and PDUS inflammatory findings seem to have a predictive value in disease activity.