Orlandi Davide, Gitto Salvatore, Perugin Bernardi Silvia, Corazza Angelo, De Flaviis Luca, Silvestri Enzo, Cimmino Marco Amedeo, Sconfienza Luca Maria
Servizio di Radiologia, Ospedale Evangelico Internazionale, Genova, Italy.
Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy.
Ultrasound Med Biol. 2017 Sep;43(9):1880-1887. doi: 10.1016/j.ultrasmedbio.2017.05.004. Epub 2017 Jun 17.
We compared the diagnostic performance of an advanced power Doppler technique (superb microvascular imaging [SMI]) with that of power Doppler Imaging (PDI) and B-mode ultrasound (US) in patients with early rheumatoid arthritis (RA) and RA under treatment with rituximab. Thirty patients (21 women aged 45 ± 11 y) affected by RA with remission to moderate disease activity were examined. Both hand joints were evaluated using US, PDI and SMI. Two radiologists reviewed all video clips and evaluated synovial vascularity intensity using a semi-quantitative scoring system. SMI revealed the presence of synovial vascularity in a significantly larger number of patients than PDI (p = 0.02). Inter-observer agreement for US, PDI and SMI was moderate (κ = 0.59), very good (κ = 0.87) and very good (κ = 0.82), respectively. We conclude that SMI detects more vessels than PDI in RA patients. This may allow increased sensitivity for early diagnosis of synovial inflammation, monitoring of its dynamic changes under therapy and evaluation of true imaging remission.
我们比较了一种先进的能量多普勒技术（超微血管成像[SMI]）与能量多普勒成像（PDI）及B型超声（US）在早期类风湿关节炎（RA）患者和接受利妥昔单抗治疗的RA患者中的诊断性能。检查了30例病情缓解至中度活动的RA患者（21名女性，年龄45±11岁）。使用US、PDI和SMI对双手关节进行评估。两名放射科医生查看了所有视频片段，并使用半定量评分系统评估滑膜血管强度。与PDI相比，SMI在显著更多的患者中显示出滑膜血管的存在（p = 0.02）。US、PDI和SMI的观察者间一致性分别为中等（κ = 0.59）、非常好（κ = 0.87）和非常好（κ = 0.82）。我们得出结论，在RA患者中，SMI比PDI能检测到更多血管。这可能会提高对滑膜炎症早期诊断的敏感性、监测其在治疗过程中的动态变化以及评估真正的影像缓解情况。
