Contrast-Enhanced Ultrasonography for the Detection of Joint Vascularity in Arthritis – Subjective Grading Versus Computer-Aided Objective Quantification

 

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Zusammenfassung

Ziel: Vergleich der Bestimmung von Gelenksentzündungen zwischen subjektiver Graduierung in der Power-Dopplersonografie (PDUS) und kontrastmittelverstärkten Ultrasonografie (CEUS) und der computergestützten objektiven CEUS-Quantifizierung. Material und Methoden: 37 Gelenke von 28 Patienten mit Arthritiden unterschiedlicher Ätiologien wurden durch B-Bild-Ultrasonografie, PDUS und CEUS unter Verwendung eines Kontrastmittels der zweiten Generation untersucht. Die synoviale Dicke, das Ausmaß des vaskularisierten Pannus und die Intensität der Vaskularisation wurden in einem 4-Punkt PDUS- und CEUS-Gradierungssystem eingeschlossen. Die subjektiven CEUS- und PDUS-Punkte wurden mit der computergestützten objektiven CEUS-Quantifizierung mittels Qontrast®-Software zur Berechnung der Signalstärke (SI) und der SI-Rate der Kontrastverstärkung verglichen. Ergebnisse: Die Interobserverübereinstimmung für die subjektive Punktevergabe war gut bis hervorragend (κ = 0.8 – 1.0; p < 0,0001). Die computergestützte CEUS-Quantifizierung zeigte eine statistisch signifikante Korrelation mit der subjektiven CEUS- (p < 0,001) und PDUS-Graduierung (p < 0,05). Die Qontrast®-SI-Rate korrelierte sowohl mit der subjektiven CEUS- (p < 0,02) als auch mit der PDUS-Graduierung (p < 0,03). Die klinische Aktivität korrelierte weder mit der Vaskularisation noch mit der synovialen Verdickung (jeweils p = n. s.) und es konnte keine Korrelation zwischen synovialer Verdickung und dem Ausmaß der Vaskularisation festgestellt werden, weder mit PDUS noch mit CEUS (jeweils p = n. s.). Schlussfolgerung: Beides, sowohl die subjektive CEUS-Quantifizierung als auch die objektive CEUS-Quantifizierung erweisen sich wertvoll für die Bestimmung der Gelenksvaskularisation bei Arthritis und die computergestützte CEUS kann eine geeignete objektive Methode in der Therapienachsorge bei Arthritis darstellen.

Abstract

Purpose: To compare joint inflammation assessment using subjective grading of power Doppler ultrasonography (PDUS) and contrast-enhanced ultrasonography (CEUS) versus computer-aided objective CEUS quantification. Materials and Methods: 37 joints of 28 patients with arthritis of different etiologies underwent B-mode ultrasonography, PDUS, and CEUS using a second-generation contrast agent. Synovial thickness, extent of vascularized pannus and intensity of vascularization were included in a 4-point PDUS and CEUS grading system. Subjective CEUS and PDUS scores were compared to computer-aided objective CEUS quantification using Qontrast® software for the calculation of the signal intensity (SI) and the ratio of SI for contrast enhancement. Results: The interobserver agreement for subjective scoring was good to excellent (κ = 0.8 – 1.0; P < 0.0001). Computer-aided objective CEUS quantification correlated statistically significantly with subjective CEUS (P < 0.001) and PDUS grading (P < 0.05). The Qontrast® SI ratio correlated with subjective CEUS (P < 0.02) and PDUS grading (P < 0.03). Clinical activity did not correlate with vascularity or synovial thickening (P = N. S.) and no correlation between synovial thickening and vascularity extent could be found, neither using PDUS nor CEUS (P = N. S.). Conclusion: Both subjective CEUS grading and objective CEUS quantification are valuable for assessing joint vascularity in arthritis and computer-aided CEUS quantification may be a suitable objective tool for therapy follow-up in arthritis.

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Dr. Marius C Wick

Department of Radiology, Innsbruck Medical University

Anichstrasse 35

A-6020 Innsbruck

Phone:  ++ 43/5 12/50 48 00 77

Fax:  ++ 43/5 12/50 42 27 58

Email: marius.wick@i-med.ac.at