Ces radiol. 2012, 66(4):394-402

Discrimination of the degenerative changes and incipient rheumatoid arthritis and the assessment of the disease activity with contrast enhanced ultrasoundOriginal article

Andrea Šprláková-Puková¹, Alena Štouračová¹, Miloš Keřkovský¹, Zdeněk Fojtík², Monika Obrovská², Tomáš Pavlík³

¹ Radiologická klinika LF MU a FN, Brno

² Revmatologie, Interní hematoonkologická klinika FN, Brno

³ Institut biostatistiky a analýz MU, Brno

Aim: The aim of this work was to determine whether the contrast enhanced ultrasound examination would be useful in differentiation between inflammatory joint disease (characterized by angiogenesis) and degenerative disease and to determine whether this method could help to distinguish the active phase of chronic rheumatoid arthritis (RA).

Method: All patients were examined on the ultrasound device Philips iu22 using linear probe 12-17 MHz, the applied contrast agent was sulfurhexafluorid (SonoVue®, Bracco) in quantities of 5 ml. The first group (differentiation between RA and degenerative changes) includes 63 patients, a second group (determination of the active phase of RA) includes 55 patients. All the patients underwent also clinical examination performed by rheumatologist and laboratory examination, in patients with RA the DAS28 score was established.

Results: The sensitivity for the differential diagnosis between the degenerative disease and RA was 75%, specificity 83.7%. For the determination of RA active phase the sensitivity was 80.6%, specificity 66.7%. For the correlations we used the cut-off DAS score 5 to identify the active RA patients. We found statistically significant difference in DAS score between RA patients with negative and positive findings on ultrasound (p < 0,001).

Conclusion: We found that contrast enhanced ultrasound provides clinically acceptable sensitivity and specificity for differentiation between RA and degenerative disease, high sensitivity and comparatively lower specificity for the RA active phase identiffication. This method thus may become a valuable part of the diagnostic algorithm in patients with inflammatory joint disease.

Keywords: rheumatoid arthritis, contrast enhanced ultrasound

Grants and funding:

Podpořeno projektem (Ministerstva zdravotnictví ČR) koncepčního rozvoje výzkumné organizace 65269705 (FN Brno).

Accepted: June 1, 2012; Published: December 1, 2012  Show citation