The superb microvascular imaging is more sensitive than conventional power Doppler imaging in detection of active synovitis in patients with rheumatoid arthritis

초록

Objectives: This study evaluated Superb Microvascular Imaging (SMI) technology for detection of active synovitis in patients with rheumatoid arthritis (RA). Methods: Between June 2015 and October 2016, 56 patients with RA (42 females; mean age, 53.2 years) underwent gray-scale ultrasound (US) imaging, power Doppler imaging (PDI), and SMI for synovitis of both wrists and hands (total 22 joints), scored for each joint from grades 0 to 3. The sum of grades for 22 joints was determined for gray-scale (SYN-sum), PDI (PDI-sum), and SMI (SMI-sum) according to clinical parameters. Follow-up US was performed in 17 patients (mean interval, 251.6 days). Results: The SMI-sum (7.27 ± 4.56) was significantly higher than the PDI-sum (4.38 ± 3.09, p < 0.001) and the SYN-sum (4.55 ± 3.72, p < 0.001), and was significantly correlated with the erythrocyte sedimentation rate, C-reactive protein (CRP), and Disease Activity Score-28 (DAS28)-CRP (γ = 0.409, p = 0.002; γ = 0.695, p < 0.001; γ = 0.726, p < 0.001, respectively). Moreover, in 28 patients with clinical remission, the SMI-sum (4.32 ± 2.01) was greater than the PDI-sum (2.61 ± 1.60, p < 0.001). In 17 patients with follow-up US, the SMI-sum (2.35 ± 1.73) was significantly greater than the PDI-sum (1.24 ± 1.20; p < 0.001) and was also significantly correlated with DAS28 (γ = 0.880). Conclusion: SMI may detect active synovitis with greater sensitivity than PDI in RA patients, even with clinical remission, and is well-correlated with inflammatory parameters during follow-up. Key points: • SMI correlated well with PDI and was more sensitive for detection of active synovitis in RA. • The SMI-sum was not only of greater value but also more strongly correlated than the PDI-sum with clinical inflammatory indicators including ESR, CRP, and DAS28 on initial and follow-up US examinations. • The SMI-sum was even significantly increased in patients with clinical remission. © 2019, International League of Associations for Rheumatology (ILAR).

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