Artikel
Superb microvascular imaging versus conventional power doppler ultrasound in scoring knee synovitis in juvenile idiopathic arthritis
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Autoren
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Daniel Windschall
- St. Josef-Stift Sendenhorst, Paediatric Rheumatology, Sendenhorst; Martin-Luther-University Halle-Wittenberg, Medical Faculty, Halle (Saale)
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Faekah Gohar
- St. Josef-Stift Sendenhorst, Paediatric Rheumatology, Sendenhorst
| Veröffentlicht: | 18. September 2024 |
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Gliederung
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Introduction: Superb Microvascular Imaging (SMI) is a novel ultrasound (US) doppler technology that expands the visible range of low microvascular blood flow improving the sensitivity of US for joint inflammation compared to conventional power Doppler (CPD). Limited studies have been published comparing SMI with CPD in Juvenile idiopathic arthritis (JIA). We aimed to investigate the sensitivity of SMI vs CPD in the US-evaluation of synovial inflammation in patients with JIA.
Methods: JIA patients with clinically determined knee synovitis were investigated using B-Mode (BM), SMI and CPD. US and probe settings were standardised and six standard views analysed per knee joint: suprapatellar longitudinal and transverse, parapatellar medial and lateral and longitudinal medial and lateral. A semi-quantitative grading scale from 0 (no blood flow signal within the synovial membrane) to 3 (blood flow signal in more than one-half of the synovial membrane) as defined by OMERACT was used to grade the SMI and CPD signals in each individual image. BM for each image was also graded 0–3, depending on the extent of synovial effusion or synovial hypertrophy. The highest individual BM, CPD and SMI grade per knee were taken for calculation of the novel Musculoskeletal Ultrasound Sum Score (‘MUSS’, maximum score 6), calculated as the single highest BM grade per knee + the single highest CPD or SMI grade per knee.
Results: 15 knees with clinical synovitis were analysed with US. In total 18 images per patient were reviewed (in total 90 images per BM, CPD and SMI method). The mean BM grade was 1.9, CPD mean was 0.3 and SMI mean 1.1 when analysing all scans (CPD vs SMI, p<0.01). Using the highest score/knee, the mean MUSS using SMI+BM (mean 4.7, range 4–6) was significantly higher than when calculated using CPD (mean 3.3, range 2–5), p<0.01.
Conclusion: SMI was more sensitive than CPD for the detection of synovial hypervascularity in knees with synovitis. SMI could therefore represent a more precise imaging tool for diagnosing and monitoring intrasynovial hypervascularization, which could play a role in treat-to-target.
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