Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group.

The purpose of this study way to assess the value of contrast enhanced gray-scale ultrasound (CEUS) in detection of vascularity in joints of patients with rheumatoid arthritis (RA) in a multicenter study of the International Arthritis Contrast Ultrasound (IACUS) study group. We assessed 113 joints in 113 patients (44 men, 69 women; mean age 51+/-14 years) with clinical diagnosis of RA. Gray-scale ultrasound (US), power Doppler US (PDUS) and CEUS, using a low mechanical index US technique, was performed. CEUS was done by bolus administration of the contrast agent SonoVue (Bracco, Milan, Italy) with a dosage of 4.8-ml SonoVue flushed with 10 ml saline. Detection of joint vascularity was performed for differentiation of active synovitis from inactive intra-articular thickening (synovitis/effusion). With the use of US and PDUS, active synovitis could be differentiated from inactive intra-articular thickening in 68/113 joints (60.1%), whereas CEUS enabled differentiation in 110/113 (97.3%) joints (p<0.0001). Thickness measurement of active synovitis was significantly improved after contrast administration (p=0.008). In conclusion, CEUS improves the differentiation of active synovitis from inactive intra-articular thickening. Since CEUS has shown an ability to improve assessment of vascularized synovial proliferation in RA affected joints, this technique may have further potential in monitoring therapy.

Does ultrasound contrast agent improve the diagnostic value of colour and power Doppler sonography in superficial lymph node enlargement?

OBJECTIVE: to analyse whether ultrasound contrast agent (UCA) improves the diagnostic accuracy to differentiate between benign and malignant superficial lymph node enlargement by using colour-coded duplex sonography (CCDS) and power Doppler (PD). METHODS: 32 patients with suspected malignant superficial lymph node enlargement prospectively underwent standardised ultrasound examinations using B-mode sonography and native and contrast-enhanced CCDS and PD immediately before biopsy. Solbiati-Index (longitudinal-transverse diameter ratio) and intranodal flow patterns by using different vascularisation types were assessed. Histological and sonographical findings were correlated. RESULTS: 27 malignant and 5 benign lymph nodes were found. Solbiati-Index was lower in malignant lymph nodes than in benign nodes (mean 1.5 vs. 2.4, P<0.045). More intranodal flow patterns could be detected after UCA (53 vs. 43) but the number of correctly identified malignant nodes decreased after UCA (26 vs. 24) and the number of correctly identified benign nodes remained constant compared with native CCDS and PD. In 31% of the colour-mode studies, PD was considered to visualise more clearly intranodal vascular flow patterns than CCDS. CONCLUSION: despite depicting more intranodal vascular patterns, the use of an ultrasound contrast agent seems not to improve the diagnostic value of CCDS and PD compared with native colour-mode studies in superficial lymph node enlargement.