Diao Xue-Hong, Shen Yan, Chen Lin, Zhan Jia, Fang Liang, Liu Ying-Chun, Chen Yue
Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
Department of Rheumatology, Huadong Hospital, Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2022 May;12(5):2866-2876. doi: 10.21037/qims-21-859.
Detection of synovitis is essential for assessing rheumatoid arthritis (RA) activity and predicting prognosis. This study aimed to compare the diagnostic performance of superb microvascular imaging (SMI) with that of contrast-enhanced ultrasound (CEUS) in patients with RA in clinical remission.
SMI and CEUS were applied to 63 patients with active RA and 48 patients with RA in clinical remission. Differences in positive synovial vascularity (SV) and its semi-quantitative scale were observed, and the correlations of SMI and CEUS results with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were analyzed.
For the 63 joints with active RA, the detection rates of SV as determined by SMI and CEUS were 90.5% (95% CI: 83.0-97.9%) and 93.7% (95% CI: 87.5-99.8%), respectively, with no significant difference observed between the two modalities (t=-1.137; P=0.260). There was good agreement between the two modalities in detecting positive blood flow (Kappa =0.784) and blood flow signal score (Kappa =0.792). For the 48 joints with clinical remission, the detection rates of SV determined by SMI and CEUS were 79.2% (95% CI: 67.2-91.1%) and 83.3% (95% CI: 72.4-94.3%), respectively, with no significant difference found between the two modalities (t=1.000; P=0.322). There was high consistency between the two modalities in detecting positive blood flow (Kappa =0.727) and blood flow signal score (Kappa =0.661). The vascularity scores of SMI and CEUS were positively correlated with CRP, ESR, and RF in the joints with active RA, but not in those with clinical remission.
SMI is as sensitive as CEUS for detecting vessels in the synovium and displaying local SV in patients with RA who achieve clinical remission.
滑膜炎的检测对于评估类风湿关节炎（RA）的活动度及预测预后至关重要。本研究旨在比较在临床缓解期的RA患者中，超微血管成像（SMI）与对比增强超声（CEUS）的诊断性能。
对63例活动期RA患者和48例临床缓解期RA患者应用SMI和CEUS。观察滑膜血管（SV）阳性及其半定量分级的差异，并分析SMI和CEUS结果与C反应蛋白（CRP）、红细胞沉降率（ESR）及类风湿因子（RF）的相关性。
对于63个活动期RA关节，SMI和CEUS检测SV的阳性率分别为90.5%（95%CI：83.0 - 97.9%）和93.7%（95%CI：87.5 - 99.8%），两种方法之间差异无统计学意义（t = -1.137；P = 0.260）。两种方法在检测血流阳性（Kappa = 0.784）和血流信号评分（Kappa = 0.792）方面具有良好一致性。对于48个临床缓解期关节，SMI和CEUS检测SV的阳性率分别为79.2%（95%CI：67.2 - 91.1%）和83.3%（95%CI：72.4 - 94.3%），两种方法之间差异无统计学意义（t = 1.000；P = 0.322）。两种方法在检测血流阳性（Kappa = 0.727）和血流信号评分（Kappa = 0.661）方面具有高度一致性。在活动期RA关节中，SMI和CEUS的血管分级与CRP、ESR及RF呈正相关，但在临床缓解期关节中无相关性。
对于临床缓解的RA患者，SMI在检测滑膜血管及显示局部SV方面与CEUS同样敏感。
