Application of contrast-enhanced ultrasonography and ultrasonography scores in rheumatoid arthritis

Objective: To investigate diagnostic value of ultrasonography scores (US) and contrast-enhanced ultrasonography (CEUS) in evaluating rheumatoid arthritis (RA) activity. Methods: 39 patients with RA were included and the metacarpophalangeal, proximal interphalangeal, wrist, elbow and knee joints of them were examined by high frequency ultrasound. The severe joints and the related indexes (synovial thickness, synovial blood flow, joint effusion and bone erosion) were exposed. Then scores (0 similar to 3) were obtained and the sum was calculated. For 12 patients of the 39, 2.4 ml SonoVue was intravenously injected with observation of synovial enhancing. ROIs time-intensity curve (TIC) was obtained and the parameters including area under curve (AUC), peak intensity (PI) and time to peak (TTP) were analyzed. For 39 patients, the relationships among each parameters, ultrasonography scores, DAS28 scores and biochemical examinations (ESR, CRP, RF, anti-CCP) were analyzed. Results: The US were significantly correlated with DAS28 Scores (r = 0.823, P < 0.01=. The correlation between US and CRP was better than that between DAS28 scores and CRP (rUS = 0.692, rDAS28 = 0.526, P < 0.01). The synovial thickness in US were correlated with DAS28 Scores and biochemical examinations (ESR, CRP) (rDAS28 = 0.852, rESR = 0.779, rCRP = 0.587, P < 0.01. The AUC and PI in CEUS were significantly correlated with US (r(AUC) = 0.832, r(PI) = 0.809, P < 0.01=. The correlations among AUC, PI and ESR were better than that between US and ESR (rAUC = 0.907, rPI = 0.851, rUS = 0.836, P < 0.01=. The correlations among AUC, PI and CRP were better than that between US and CRP (rAUC = 0.855, rPI = 0.854, rUS= 0.692, P < 0.01. Conclusions: US was almost identical with DAS28 Scores and biochemical examinations (ESR, CRP) in diagnosis of RA activity, while CEUS was almost identical with DAS28 Scores and biochemical examinations (ESR, CRP). In diagnosis of RA, US may be better than DAS28 Scores, while CEUS better than US. Both of them were useful for evaluation of RA activity.