Knee osteoarthritis. Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging

Department of Rheumatology and Clinical Immunology, Charité, Humboldt University of Berlin, Germany.
Annals of the rheumatic diseases (Impact Factor: 10.38). 01/2008; 67(1):19-25. DOI: 10.1136/ard.2007.067462
Source: PubMed


To develop a new method of digital synovial vascularisation quantification by using contrast-enhanced musculoskeletal ultrasonography (MUS) in detecting synovitis in patients with knee osteoarthritis (OA) compared with healthy subjects and MRI.
Evaluation of 41 patients with painful knee OA and 6 healthy subjects. The severity of knee pain was evaluated. All patients and all 6 healthy subjects underwent contrast medium-enhanced (CE)-MUS with SonoVue, and 36 patients additionally underwent CEMRI with Magnevist. Joint effusion, synovial thickening and pain were assessed and compared with B-mode and Power Doppler sonography (PDS) as well as contrast medium enhancement.
Pain evaluated by the visual analogue scale(VAS) hardly correlated with other markers of disease activity measured by ultrasound (US) in B-mode or MRI. US of the superior recess revealed an effusion or synovial thickening in 58%. PDS findings were positive in 63%, and CE-MUS in the superior knee recess was positive in 95%. MRI showed effusion in the superior recess in 61% and showed positive findings in 82% when using contrast medium. The kappa value was 0.48 between US and MRI with regard to the effusion in the superior recess, and 0.53 between PD signal in the superior recess and effusion in the superior recess by US. Using MRI as the reference standard, there was a sensitivity of 72% for assessing effusion in the superior recess and 81% for assessing effusion in the lateral recess.
Assessment of disease activity (synovitis) in knee OA by VAS is not sufficient. US PDS was more sensitive than B-mode, and CE-MUS was more sensitive than PDS and CE-MRI in detecting synovitis in patients with painful knee OA. Also, CE-MRI was more sensitive in detecting inflammatory changes in the superior recess than without contrast medium. Using CE-MUS and performing time/intensity analysis has shown to be a good model for evaluation of an inflammatory process in the setting of knee OA in the superior recess.

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Available from: Kay-Geert A Hermann
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    • "Recent studies have shown that signal changes in Hoffa's fat pad on non-CE MRI were less specific for peripatellar synovitis than CE sequences [133] and that microscopic synovitis is not correlated with non-CE MRI [134]. Additional investigations have shown that CE-MRI detected synovitis correlates with histology [113] [134] and is more sensitive [125] and specific [133] than non-CE MRI. These studies further the belief that Gdbased CE-MRI improves imaging of the synovium. "
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    • "Therefore, PDUS was used as the standard reference method in this study. Song et al. [16] reported on a greater sensitivity of CEUS in the detection of vascularity in comparison to contrast-enhanced MRI in examining patients with knee osteoarthritis. They admitted that the objective quantification (calculated slope values) were not directly comparable. "
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