From the Department of Radiology, Centre Hospitalier Universitaire de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, QC, Canada H2L 4M1 (V.F.); and Departments of Radiology B (R.B., R.C., E.P., J.L.D., H.G.) and Rheumatology A (M.E., J.A., Y.A.), Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France.
Radiology. 2013 Dec;269(3):824-30. doi: 10.1148/radiol.13121994. Epub 2013 Oct 28.
To characterize ultrasonographic (US) features in the hand of patients with systemic sclerosis (SSc) and to evaluate the sensitivity of US in the detection of calcinosis and acroosteolysis.
The local ethics committee approved this study, and oral informed consent was obtained. A total of 44 consecutive patients with SSc (34 women; mean age, 56.1 years ± 12.1 [standard deviation]; 10 men; mean age, 45.0 years ± 14.0) and 30 healthy control subjects (20 women; mean age, 46.3 years ± 12.1; 10 men; mean age, 39.6 years ± 10.8) were included between October 2010 and December 2011. Bilateral US, including Doppler assessment of the wrists, hands, and fingers, was performed, and presence of synovitis, tenosynovitis with or without a layered appearance, calcifications, acroosteolysis, and distal vascularization was recorded. Radiography of both hands was performed to assess for acroosteolysis and calcinosis. Frequency of US features, sensitivity of US for calcinosis and acroosteolysis, and respective confidence intervals were calculated.
Synovitis was found in 17 patients (39%). Tenosynovitis was found in 12 patients (27%), and it had a layered pattern in 15 (41%) of 37 cases. Calcinosis was found in 17 patients (39%) with US, with a sensitivity of 89%. Acroosteolysis was found in nine (20%) patients with US and in 10 (23%) patients with radiography, with 90% sensitivity for US. Distal vascularization was detected in 26 patients (59%) and 30 control subjects (100%) and was in contact with the acroosteolysis bed in seven (78%) of nine patients with SSc.
US can be used to assess features of SSc, including synovitis, tenosynovitis, calcinosis, acroosteolysis, and distal vascularization and is sensitive for calcinosis and acroosteolysis detection. A layered pattern (similar to the appearance of an artichoke heart) of tenosynovitis was seen commonly. Online supplemental material is available for this article.
描述系统性硬化症（SSc）患者手部的超声（US）特征，并评估 US 检测钙沉积和肢端骨质溶解的敏感性。
本研究经当地伦理委员会批准，并获得了口头知情同意。共纳入 2010 年 10 月至 2011 年 12 月期间的 44 例连续 SSc 患者（34 名女性；平均年龄 56.1 岁±12.1[标准差]；10 名男性；平均年龄 45.0 岁±14.0）和 30 名健康对照者（20 名女性；平均年龄 46.3 岁±12.1；10 名男性；平均年龄 39.6 岁±10.8）。对双侧腕关节、手部和手指进行 US 检查，包括多普勒评估，并记录滑膜炎、伴有或不伴有分层外观的腱鞘炎、钙化、肢端骨质溶解和远端血管化的存在情况。对双手进行 X 线摄影，以评估肢端骨质溶解和钙沉积。计算 US 特征的频率、US 检测钙沉积和肢端骨质溶解的敏感性及其相应的置信区间。
17 例（39%）患者存在滑膜炎。12 例（27%）患者存在腱鞘炎，37 例（41%）中 15 例呈分层表现。17 例（39%）患者 US 检查发现钙沉积，敏感性为 89%。9 例（20%）患者 US 检查发现肢端骨质溶解，10 例（23%）患者 X 线摄影发现肢端骨质溶解，US 敏感性为 90%。26 例（59%）患者和 30 名对照者（100%）存在远端血管化，9 例 SSc 患者中有 7 例（78%）的远端血管化与肢端骨质溶解床接触。
US 可用于评估 SSc 的特征，包括滑膜炎、腱鞘炎、钙沉积、肢端骨质溶解和远端血管化，对钙沉积和肢端骨质溶解的检测具有较高的敏感性。腱鞘炎常呈分层（类似于朝鲜蓟心脏的外观）表现。本文提供了在线补充材料。
