Article
Contrast-enhanced ultrasound (CEUS) in coxitis
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Published: | September 1, 2015 |
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Introduction: Hip involvement is common in rheumatological joint diseases but can be difficult to diagnose, especially without MRI. B-mode ultrasound (US) detects joint capsule distention while distinguishing effusion from proliferative synovia is strenuous since both appear hypoechoic. Power Doppler ultrasound (PDUS) often fails to detect vascularisation in the hip due to technical limitations. We therefore evaluated the use contrast-enhanced ultrasound (CEUS) in the hip joint.
Methods: We investigated 36 hip joints of patients with known rheumatological joint diseases presenting with hip pain, and 5 hips of healthy controls. All patients received B-mode US, PDUS and CEUS. We assessed CEUS hypervascularisation semiquantitatively. In B-mode we measured the distance between femoral neck and joint capsule (DNC) and compared the results to the avascular intraarticular margin (AIM) in CEUS using t-tests and crosstables.
Results: PDUS signals were received in only 2/36 cases (5.6%). B-mode US established the diagnosis of coxitis in 18/36 hip joints. In 4 cases (11%) the diagnosis was revised after CEUS. In patients with definite coxitis 14 hips (73.7%) showed CEUS hypervascularisation °2, five °1 (26.3%) and none °0 (χ2 = 3.277, p<0.001). The difference DNC/AIM was highly significant in patients with hip pain (p<0.001, 95% CI 2.054-4.684) and in those with definite coxitis (p<0.0001, 95% CI 3.268-7.258).
Conclusion: In most cases clinical parameters and B-mode US findings are sufficient to diagnose coxitis. However, CEUS is capable of visualizing and quantifying the degree of hypervascularisation and enables the discrimination between effusion and proliferative synovia in hip joints.