Top

European Radiology

Published in:

Open Access 01-03-2018 | Ultrasound

Microflow imaging: New Doppler technology to detect low-grade inflammation in patients with arthritis

Authors: A. K. P. Lim, K. Satchithananda, E. A. Dick, S. Abraham, D. O. Cosgrove

Published in: European Radiology | Issue 3/2018

Abstract

Aim

To assess the efficacy of microvascular imaging in detecting low-grade inflammation in arthritis compared with Power Doppler ultrasound (PDUS).

Method and materials

Patients presenting for ultrasound with arthralgia were assessed with grey-scale, PDUS and Superb Microvascular Imaging (SMI). Videoclips were stored for analysis at a later date. Three musculoskeletal radiologists scored grey-scale changes, signal on PDUS and/or SMI within these joints. If a signal was detected on both PDUS and SMI, the readers graded the conspicuity of vascular signal from the two Doppler techniques using a visual analogue scale.

Results

Eighty-three patients were recruited with 134 small joints assessed. Eighty-nine of these demonstrated vascular flow with both PD and SMI, whilst in five no flow was detected. In 40 joints, vascularity was detected with SMI but not with PDUS (p = 0.007). Out of the 89 joints with vascularity on both SMI and PDUS, 23 were rated as being equal; while SMI scored moderately or markedly better in 45 cases (p <0.001).

Conclusion

SMI is a new Doppler technique that increases conspicuity of Doppler vascularity in symptomatic joints when compared to PDUS. This allows detection of low grade inflammation not visualised with Power Doppler in patients with arthritis.

Key Points

• SMI detects vascularity with improved resolution and sensitivity compared to Power Doppler.

• SMI can detect low-grade inflammation not seen with Power Doppler.

• Earlier detection of active inflammation could have significant impact on treatment paradigms.

Available only for authorised users

Wakefield RJ, Brown AK, O’Connor PJ, Emery P (2003) Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease. Arthritis Rheum 48:285–288CrossRefPubMed

Larche MJ, Seymour M, Lim AK et al (2010) Quantitative power Doppler ultrasonography is a sensitive measure of metacarpophalangeal joint synovial vascularity in rheumatoid arthritis and declines significantly following a 2-week course of oral low-dose corticosteroids. J Rheumatol 37:2493–2501CrossRefPubMed

Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M (2004) Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 50:2103–2112CrossRefPubMed

Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487PubMed

Torp-Pedersen ST, Terslev L (2008) Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis 67:143–149CrossRefPubMed

Demene C, Deffieux T, Pernot M, Osmanski BF, Biran V, Franqui S, et al. (2015) Spatiotemporal clutter filtering of ultrafast ultrasound data highly increases Doppler and Ultrasound sensitivity. IEEE Trans Med Imaging

Lim AK (2014) The Clinical utility of Superb Microvascular Imaging (SMI) for Assessing Musculoskeletal Inflammation. Toshiba Medical Systems, White paper

Hata J (2014) Seeing the unseen. New Techniques in Vascular imaging: Superb Microvascular Imaging. Toshiba Medical Systems, White paper

Xiao XY, Chen X, Guan XF, Wu H, Qin W, Luo BM (2016) Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast-enhanced ultrasonographic microvascular imaging. Br J Radiol 89:20160546CrossRefPubMedPubMedCentral

10.

Park AY, Seo BK, Cha SH, Yeom SK, Lee SW, Chung HH (2016) An Innovative Ultrasound Technique for Evaluation of Tumor Vascularity in Breast Cancers: Superb Micro-Vascular Imaging. J Breast Cancer 19:210–213CrossRefPubMedPubMedCentral

11.

Koski JM, Saarakkala S, Helle M et al (2006) Power Doppler ultrasonography and synovitis: correlating ultrasound imaging with histopathological findings and evaluating the performance of ultrasound equipments. Ann Rheum Dis 65:1590–1595CrossRefPubMedPubMedCentral

12.

Rees JD, Pilcher J, Heron C, Kiely PD (2007) A comparison of clinical vs ultrasound determined synovitis in rheumatoid arthritis utilizing gray-scale, power Doppler and the intravenous microbubble contrast agent ‘SonoVue’. Rheumatology 46:454–459CrossRefPubMed

13.

Porta F, Radunovic G, Vlad V et al (2012) The role of Doppler ultrasound in rheumatic diseases. Rheumatology (Oxford) 51:976–982CrossRef

14.

Naredo E, Collado P, Cruz A et al (2007) Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum 57:116–124CrossRefPubMed

15.

Naredo E, Rodriguez M, Campos C et al (2008) Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum:59515–59522

16.

Scire CA, Montecucco C, Codullo V et al (2009) Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology 48:1092–1097CrossRefPubMed

17.

Brown AK, Conaghan PG, Karim Z et al (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58:2958–2967CrossRefPubMed

18.

Sreerangiah D, Grayer M, Fisher BA, Ho M, Abraham S, Taylor PC (2016) Quantitative power Doppler ultrasound measures of peripheral joint synovitis in poor prognosis early rheumatoid predict radiographic progression. Rheumatology (Oxford) 55(1):89–93

19.

Platzgummer H, Schueller G, Grisar J et al (2009) Quantification of synovitis in rheumatoid arthritis: do we really need quantitative measurement of contrast-enhanced ultrasound? Eur J Radiol 71:237–241CrossRefPubMed

Title: Microflow imaging: New Doppler technology to detect low-grade inflammation in patients with arthritis
Authors: A. K. P. Lim
K. Satchithananda
E. A. Dick
S. Abraham
D. O. Cosgrove
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 3/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5016-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Microflow imaging: New Doppler technology to detect low-grade inflammation in patients with arthritis

Abstract

Aim

Method and materials

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Method and materials

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 3/2018

Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck

Pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia: Correlations between computed tomography findings and cerebral complications

Incidental perifissural nodules on routine chest computed tomography: lung cancer or not?

Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks: Comparison of outcomes in 494 patients with lumbar radiculopathy

Determination of single-kidney glomerular filtration rate (GFR) with CT urography versus renal dynamic imaging Gates method

The value of subtraction MRI in detection of amyloid-related imaging abnormalities with oedema or effusion in Alzheimer’s patients: An interobserver study