Ultrasound of entheses in ankylosing spondylitis patients: The importance of the calcaneal and quadriceps entheses for differentiating patients from healthy individuals

OBJECTIVES: To compare the ultrasonographic findings of entheses in ankylosing spondylitis (AS) patients with those of healthy control individuals and to assess the ability of ultrasound (US) to identify aspects related to the disease. METHODS: A cross-sectional study involving 50 patients with AS and 30 healthy controls was performed. Clinical assessment included the use of a visual analog scale for pain, assessment of swelling of the enthesis, global assessments for patients and physician, use of a disease activity index, mobility and dysfunctional indices, erythrocyte sedimentation rate and clinical enthesitis index. US was performed for the following entheses by two experienced musculoskeletal radiologists: brachial triceps, distal quadriceps, proximal and distal patellar tendons, calcaneal tendon, and plantar fascia; the total and subitems of the Madrid Sonographic Enthesitis Index were used for evaluations. RESULTS: Comparison between groups showed a statistically significant difference with worse scores in AS patients, with bone erosion of the calcaneal enthesis and bone erosion and thickening of the plantar fascia. The odds ratio for thickening of the plantar fascia in the AS group was 3.47, according to logistic regression analysis. The AS group also had worse scores regarding the presence of calcification in the quadriceps enthesis, with a fivefold increased risk. CONCLUSION: US analysis showed that only entheses of the foot and quadriceps were able to differentiate AS patients from healthy individuals.

Ultrasonographic evaluation of inflammatory swellings of buccal space.

Objectives : The main objective of the study was a) to differentiate cellulitis and abscess in buccal space region, b) to study the ultrasonographic anatomy of cheek region and c) to investigate the use of ultrasound in the diagnosis of inflammatory swellings of cheek region. Patients and Methods : The study consisted of 25 patients with unilateral buccal space inflammatory swellings of odontogenic origin. The contra lateral side was used as control. Toshiba ultrasonographic device with a linear array transducer (5-8 MHz) was used. The areas of interest were scanned under both transverse and longitudinal sections and were interpreted by a single observer. The clinical diagnosis of cellulitis or abscess was confirmed by the absence or presence of pus respectively both sonographically and by aspiration. Also various anatomical structures present in buccal space were studied. Results : Clinically 23(92%) were diagnosed as buccal space abscess and 2 (8%) were cellulitis. Ultrasonographically and therapeutically 24 (96%) were buccal space abscess and 1 (4%) was cellulits. The sensitivity of clinical criteria over ultrasonographic diagnosis was 96% with a specificity of 100%. Also the cheek thickness in males and females varied from 8.2 to 17.1mm with a mean of 11.6mm±2.1 (SD) and 8.2 mm to 14.2 mm with a mean of 11±1.8 (SD). The subcutaneous tissue appeared moderately echogenic, buccinator - highly echogenic, deep adipose tissue - less echogenic and parotid duct was appreciated as a thin hyperechogenic band crossing the buccinator muscle. Buccal space, masticator space and parotid space were appreciated. Conclusion : This study supports the ultrasonographic method of imaging of orofacial inflammatory swellings with high sensitivity and specificity. This imaging modality can also help in aspiration of pus in different spaces. We have described the ultrasonographic anatomy of the above mentioned spaces which can help a beginner in this field.