Song I H, Althoff C E, Hermann K G, Scheel A K, Knetsch T, Burmester G R, Backhaus M
Departments of Rheumatology, Charité University Hospital, Berlin, Germany.
Ann Rheum Dis. 2009 Jan;68(1):75-83. doi: 10.1136/ard.2007.080382. Epub 2008 Mar 28.
To evaluate contrast-enhanced ultrasound (CE-US) as a monitoring tool to assess hypervascularisation of synovial processes in knee osteoarthritis (OA) treated with intra-articular injections of the bradykinin-receptor 2 antagonist icatibant compared to contrast-enhanced magnetic resonance imaging (CE-MRI).
In a randomised, double-blind, placebo-controlled trial, 41 patients with painful knee OA underwent US (12.5 MHz for B-mode and 3-8 MHz for CE-US), and 36 of the patients underwent additional MRI (0.2T) at baseline and after 3 injections of the study drug (after a mean of 22.2 days). A total of 15 patients received placebo (group A), 12 patients 500 microg icatibant (group B) and 14 patients 2000 microg icatibant (group C). Pain and the synovial process (B-mode, power Doppler US (PD-US), CE-US, CE-MRI) were assessed at both time points.
At baseline, the placebo group showed more activity in terms of effusion in the superior and lateral recess in ultrasound as well as in PD-US in the lateral recess. Pain improved significantly in all subgroups. Effect sizes were 0.43 (pain at rest) and 0.52 (pain during activity) in group B vs 0.48 and 1.11 in group C. There was no change of US and MRI parameters. We found moderate to good correlation (r) and kappa values (kappa) for effusion in the superior recess (r = 0.591, k = 0.453), effusion in the lateral recess (r = 0.304, k = 0.440) and contrast enhancement (r = 0.601, k = 0.242) between US and MRI.
Our results show that CE-US and CE-MRI have good agreement in assessing inflammatory changes in knee OA. For the 41 patients with OA, an analgesic effect of icatibant could clearly be shown, especially for pain during activity in the high dose icatibant group. However, we could not find an anti-inflammatory effect of icatibant by CE-US compared to CE-MRI.
评估与对比增强磁共振成像（CE-MRI）相比，超声造影（CE-US）作为一种监测工具，用于评估经关节腔内注射缓激肽受体2拮抗剂依替巴肽治疗的膝关节骨关节炎（OA）滑膜病变的血管增生情况。
在一项随机、双盲、安慰剂对照试验中，41例膝关节OA疼痛患者接受了超声检查（B超模式为12.5MHz，CE-US为3 - 8MHz），其中36例患者在基线时以及注射3次研究药物后（平均22.2天）还接受了额外的MRI（0.2T）检查。总共15例患者接受安慰剂（A组），12例患者接受500μg依替巴肽（B组），14例患者接受2000μg依替巴肽（C组）。在两个时间点均评估疼痛和滑膜病变情况（B超模式、能量多普勒超声（PD-US）、CE-US、CE-MRI）。
在基线时，安慰剂组在超声检查中显示上隐窝和外侧隐窝的积液以及外侧隐窝的PD-US方面有更多活动。所有亚组的疼痛均有显著改善。B组的效应大小在静息痛时为0.43，活动痛时为0.52；C组分别为0.48和1.11。超声和MRI参数无变化。我们发现上隐窝积液（r = 0.591，κ = 0.453）、外侧隐窝积液（r = 0.304，κ = 0.440）以及超声和MRI之间的对比增强（r = 0.601，κ = 0.242）具有中度至良好的相关性（r）和kappa值（κ）。
我们的结果表明，CE-US和CE-MRI在评估膝关节OA的炎症变化方面具有良好的一致性。对于41例OA患者，依替巴肽的镇痛作用可以明显显现，尤其是在高剂量依替巴肽组的活动痛方面。然而，与CE-MRI相比，我们未发现依替巴肽通过CE-US产生抗炎作用。
