gms | German Medical Science

43. Kongress der Deutschen Gesellschaft für Rheumatologie, 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 25. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

02.-05. September 2015, Bremen

Contrast-enhanced ultrasound (CEUS) in coxitis

Meeting Abstract

  • Christian Löffler - Klinikum Ludwigshafen, Rheumatologie, Ludwigshafen
  • Horst Sattler - Klinikum Ludwigshafen gGmbH, Medizinische Klinik A, Ludwigshafen
  • Michael Uppenkamp - Klinikum Ludwigshafen, Ludwigshafen
  • Raoul Bergner - Klinikum Ludwigshafen gGmbH, Medizinische Klinik A, Ludwigshafen

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 43. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 25. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Bremen, 02.-05.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.07

doi: 10.3205/15dgrh058, urn:nbn:de:0183-15dgrh0587

Published: September 1, 2015

© 2015 Löffler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



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.